95-year-old Frieda Albert, right, casts her vote in the German national parliamentary election on Sept. 27, 1998. She voted in her own room in a home for older people in Bremen, Germany, as a mobile election committee came to her, as to other older people or people with disabilities who were not able to walk to a polling station. Photo by Joerg Sarbach/AP Photo

Jason Karlawish had a simple question: how to get more older people to have their votes counted. The geriatrician knew that older Americans want to vote. In fact, 79 percent of all Americans 55 and older were registered to vote in the 2004 presidential election, the highest percentage of any age group. And more than 70 percent of them cast ballots—also the highest rate.

But Karlawish, 41, an associate professor of medicine and medical ethics at the University of Pennsylvania in Philadelphia and a senior fellow at Penn’s Institute of Aging, also knew that all too many older Americans—especially residents of assisted living facilities and nursing homes—are prevented, for any number of reasons, from casting their ballots. Sometimes, transportation is not provided. Sometimes, polling places are not accessible to people with disabilities. Sometimes, ballots and voting equipment are vexingly difficult to use. And sometimes, caregivers simply decide that older people aren’t competent to vote.

Karlawish’s own research drives home the point. After Philadelphia’s 2003 mayoral election, he and some of his colleagues surveyed nursing homes and assisted living facilities in the city, asking about voting access. At nearly a third of the 51 sites that responded, residents who wanted to vote were unable to do so. Among the reasons cited: logistical problems or, as determined by the facility’s staff, a perceived lack of interest among residents. Research in Virginia found similar disparities.

Karlawish’s solution? Mobile polling.

Here’s how it could work: Teams of local election workers or trained, nonpartisan volunteers would visit assisted living facilities, nursing homes and other such settings to help residents register to vote. Before Election Day, the teams would return and help residents cast their ballots, which would be handled under a strict chain of custody and returned to election headquarters to be counted as any other votes.

Karlawish’s primary focus has been the 10 percent of older Americans who are residents of long-term care facilities. Currently, federal regulations oblige nursing homes to respect residents’ voting rights, but they do not provide any guidance on how a facility can satisfy that obligation. Twenty-nine states have no standards for accommodating residents of long-term care facilities who want to cast ballots. The remaining states operate under a patchwork of guidelines, many of them vague and voluntary.

Residents of long-term care facilities can be the victims of a double whammy, Karlawish says. Not only do others often decide whether they can exercise their right to vote, but in the worst cases people steal their votes by falsifying absentee ballots. For that reason, absentee balloting—the most common alternative offered to those who can’t make it to the polls—is not the solution, he says.

The Biggest Challenge

A few countries, including Australia and Canada, have experimented with mobile polling, but the concept—as simple as it is—hasn’t caught on in the United States. Karlawish is hopeful that could soon change.

Over the past few years, he has rallied other doctors and medical professionals, legal experts, election officials and even Capitol Hill lawmakers to the cause. But the biggest obstacle to their efforts is reaching people who are cognitively impaired.

“There has been tremendous progress in recent years in improving access to voting by the disabled, but not among the cognitively impaired,” says Karlawish, who works with Alzheimer’s patients.

About 4.5 million Americans live with some form of cognitive impairment. Nearly two-thirds of all residents of long-term care facilities have some level of dementia. This November, many of them will not be able to vote because an administrator or other employee of the facility they’re in—a social worker, for example—has unilaterally decided that they’re not competent to make a choice.

“In effect, we are deciding what is right for these people,” Karlawish says. “We need to consider the ‘personhood’ of someone with cognitive impairment.”

A little over a year ago, Karlawish assembled a group of 50 nationally recognized experts on law and aging, disability, medicine, long-term care, voting technology, and election administration to come up with recommendations on how to serve the voting needs of the cognitively impaired. The American Bar Association also has taken an active role in crafting the recommendations.

Among the key issues is how best to assess a person’s “capacity to vote” and what kind of assistance is appropriate to help that person cast a ballot. Karlawish believes it makes sense to assume that anyone who fills out a voter registration form is, in fact, competent to vote. And his Dementia Voting Project at Penn’s Alzheimer’s Disease Center has been developing a simple “competency assessment tool for voting” that can be used in cases where questions are raised—by a political party’s poll watchers, for example—about a person’s capacity to vote.

In 2004, Republican Party officials in Ohio enlisted and trained $100-a-day recruits to, among other things, formally challenge older voters assisted at the polls by anyone other than their legal guardians, according to a report in the New York Times. Part of the GOP strategy reportedly focused on older residents of group homes arriving at the polls by bus.

Karlawish brands as “deeply problematic” the practice of challenging, usually for partisan reasons, a person’s vote simply because he or she is assisted in the balloting process. By federal law voters can request assistance from anyone they wish except for their employer or a union official; even voters under guardianship are not limited to assistance from their guardians. Many older voters, he says, need assistance simply because of impaired vision or motor skills.

Karlawish is troubled, too, by the spate of relatively new state laws that require citizens to show government-issued photo identification before they can cast ballots. In June the U.S. Supreme Court upheld Indiana’s tough voter ID law. Such requirements discriminate against older people who may not have driver’s licenses or other government-issued photo IDs, Karlawish says. Nearly one in five citizens 65 and older don’t, according to a recent nationwide survey. Under his plan, the mobile polling teams would help not only with voting but also with all registration requirements—including working with long-term care facilities to obtain government-issued photo IDs for any residents who want to vote.

Change on the Horizon?

Mobile polling is showing signs of making progress. In West Virginia, Secretary of State Betty Ireland recently urged the legislature to study Karlawish’s research and the option of mobile polling. On Capitol Hill earlier this year, Democrats Herb Kohl of Wisconsin, who chairs the Senate Special Committee on Aging, and Dianne Feinstein of California, who chairs the Senate Rules Committee, asked the U.S. Election Assistance Commission to develop voluntary guidelines for the states to implement voting in long-term care facilities. Those are expected sometime in August. The U.S. Government Accountability Office is also studying polling accessibility.

But in this fall’s elections, Karlawish’s idea will get its first real tryout when Vermont tests a mobile polling program with some residential care facilities. After the election, state officials will analyze whether mobile polling boosted voter participation by comparing the percentage of older residents who cast ballots in facilities with the program compared to those without the program.

“Our goal is to find out if this is effective and what the issues are,” says Vermont Secretary of State Deborah L. Markowitz. “There are many people who have some form of dementia who very much want to participate. This project is really focusing on whether we can train election workers to assist people so that those who have cognitive impairment but are capable of voting have an opportunity to do so.”

Vermont will send trained election workers to care facilities. They will work from a script, prepared with the help of Karlawish and other experts, that is designed to elicit from residents with cognitive impairments an interest in the election and voting. Residents who cannot vote on their own will be offered help from bipartisan teams specially trained to work with all older voters, including those with some dementia.

Markowitz is optimistic that the system will work and hopeful that it may eventually serve as a national model. “The fact is that on a good day many people with cognitive impairment know very clearly whom they want to vote for,” she says.

As Markowitz sees it, older Americans shouldn’t have to surrender their interest in civic life as they age. “We shouldn’t be holding elders and those with disabilities to a higher standard than we hold others,” she says.

Susan Q. Stranahan is a freelance journalist who lives on Chebeague Island, Maine. She often writes about public policy and environmental issues.