Can I Vote if I Live in a Nursing Home, State Hospital, or Developmental Center?

This is a great question, and the answer can vary across states. 

First, it might be helpful to think of why someone is living in a congregate setting. There are many complex reasons, but often a primary reason is that the person has not been able to receive the care and support they need to live in the community. 

Everyone can live in the community with the right support, but there are many barriers to this, including institutional bias in our insurance and health care systems, and the severe shortage of direct care workers who provide home and community-based services. Our mental health system, in particular, has never been fully funded and/or built into our communities. 

Now, let’s answer the “who” part of the question. 

In nursing homes, the population tends to be older adults and people with disabilities over the age of 65 – but younger adults with disabilities and serious mental illness may be living in nursing homes, too. 

According to the National Center for Health Statistics, 16.9 percent of nursing home residents were younger than 65. This number increases to 25.7 percent in long-term care hospital settings. In July 2023, a federal judge ruled that Florida has been unlawfully institutionalizing disabled children rather than providing families with Medicaid-funded home care support, with an estimated 140 children in Florida nursing homes and 1,800 at risk of institutionalization. 

Developmental centers are state-run institutions for adults with developmental disabilities. While length of stay in these facilities is intended to be shorter-term, many people live in these segregated and restrictive settings for many, many years. It’s hard to find accurate data on average length of stay as it can vary so much between people and between states. 

People with intellectual and developmental disabilities also might live in privately-funded and operated residential facilities for people with disabilities, like intermediate care facilities (ICF), nursing homes, or group homes. 

State-operated psychiatric hospitals or mental health centers have diverse populations across states. While there are privately operated facilities, too, we’re just going to focus on state-run facilities for this article, as the length of stay in state facilities tends to be longer. One reason for this is that people in these facilities may have been involuntarily committed through a court order or sentencing. Stays can range from days to months to years.

Simply living in a nursing home, developmental center, or hospital setting has no impact on your right to vote. Only a court can take away your right to vote. 

In some states, if you have a guardian, your right to vote can be taken away. 

Similarly, in some states, if a court has determined you lack “mental capacity,” your right to vote can be taken away.  

In some states, your right to vote might also be removed if you have a felony conviction or are currently serving a felony sentence. 

There are lots of laws that protect the rights of voters in institutional settings. The Americans with Disabilities Act says that voting must be accessible and also says that both private and public facilities must provide reasonable accommodations to voters. 

The Voting Rights Act of 1965 says that people with disabilities can receive help voting from a person of their choice (except for a union representative, employer, and a few other exclusions in specific states; some states restrict nursing home staff from assisting residents). 

The National Voter Registration Act of 1993 and the Help America Vote Act of 2002 both require voting to be accessible and require agencies that serve disabled clients to help them register to vote. 

Lastly, the Center for Medicare & Medicaid Services has a Residents’ Rights document. One of the rights listed is the right to exercise your rights, such as voting.

This is a great question, and one I’m not sure I know where to find the answer to! What we do know is that there is still a 3.6 percentage turnout gap between disabled and nondisabled voters, according to a 2022 survey by Rutgers University and the U.S. Election Assistance Commission (compared to 4.8 in the 2018 elections). 

The same report tells us that voters with disabilities are about three times more likely to have difficulty voting or need assistance voting. 

However, there is no data specific to people living in institutional settings, which contributes to the further erasure of these voters. 

The United States has a history of excluding and discriminating against people with disabilities, and this includes competence assessments when it comes to voting. 

People with mental disabilities, especially those under guardianship, can be asked in court to demonstrate an understanding of elections and politics before being allowed to vote. No nondisabled person is subjected to this and most members of the general public, disabled and nondisabled, do not have in-depth knowledge of electoral systems. Competency assessments are rooted in racism and ableism, and I feel strongly that they are unnecessary and discriminatory. 

Yet, competence assessments still exist in both law and practice in many states. Even in states where voting restrictions are not enforced and most people retain their rights, the harmful stereotypes and assumptions can still exist. 

A huge barrier for people in congregate settings is that many facility staff and administrators, and even family members, incorrectly assume that they cannot vote or do not want to vote. 

Access to information, especially accessible information, is also a huge barrier for voters. People in restrictive settings likely do not have reliable access to the internet, so may not be able to learn about elections or candidates. 

State voting rights laws like photo ID requirements (especially laws that require non-expired IDs), restrictions on who can assist voters, and difficult or confusing rules around mail-in voting can also make it harder for people in these settings to vote.

Lastly, while nursing homes and other institutional settings are legally required to provide voting information and support residents in registering to vote and completing the voting process, this doesn’t always happen. A center may be understaffed, staff may not be properly trained, or residents may not be fully aware of their rights.

People in congregate settings should be able to choose whatever method of voting they prefer, though this freedom of choice does not always happen in reality, and in some cases the conditions of their confinement may limit their choices. However, if a person is allowed to leave their facility and voting in person is their preferred method, they should be provided transportation and support to go to their polling place.

For many people in congregate settings, absentee or mail-in ballots are a good option. In some states, you can request on-site, in-person support from local election officials. A team of poll workers can bring ballots to the facility and assist voters. It’s important to learn the rules in your state around who can help voters and how people in institutional settings can choose to vote. 

I also want to note that people with disabilities have a right to reasonable accommodations in the voting process. This can include having assistance voting, using accessible ballot marking machines, requesting materials in plain language, and in some states disabled voters can return their ballots electronically. 

First, it is important to understand the rules in your state. In many states there are rules about who can assist voters. 

If you are in the role of a supporter, the first thing you can do is make sure that the people in your community know about their rights, and have access to information on election dates, issues, and candidates, and access to information about how they can vote. Make sure you understand the rules in your state so that you can provide the best support.

In-person workshops and training are typically the best and most accessible way to reach voters in congregate settings. State laws that make absentee ballots, early in-person voting, voter registration and voting support easy and accessible will also likely lead to higher voter turnout from congregate settings.

In addition to state protection and advocacy organizations, the long-term care ombudsman are good resources for supporting people in exercising their rights. 

The organization VoteRiders can help you get a photo ID if you need one to vote in your state. 

Organizations like Self Advocates Becoming Empowered can help educate voters on their rights. 

The National Disability Rights Network also has a helpful resource for institutionalized voters. 

And lastly, the American Association of People with Disabilities has a civic engagement program called REV UP, which is working to build the power of the disability vote. We have coalitions and partners around the country. If you need help finding answers or getting connected in your state, you can email me, [email protected]! 

Register, Educate, Vote! Use your Power! You have a right to vote and your vote is powerful. To quote disability and voting rights activist Fannie Lou Hamer, “Nobody’s free until everybody’s free.” I think this applies to using our voices, too. In order to have a strong democracy, we need everyone to participate.