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

Alexia Kemerling

Alexia Kemerling

Many states have recently modified laws about who can return ballots on behalf of another person, how many ballots can be returned by designees, and whether there are extra steps involved. Alexia Kemerling is here to assure you that your voice will still be heard if you live in a congregate setting.

Voting When You Are Receiving Long Term Care

Around 1.9 million people currently live in nursing homes, while a quarter million reside in developmental centers or state hospitals across our nation. Active engagement in democratic processes can foster a sense of autonomy, agency, and social inclusion for residents of congregate settings, as well as giving them a voice in shaping policies that affect their lives.

Are you eligible to vote if you live in a facility where you are receiving long term care? Yes, you may be eligible to vote and your voting rights would be protected by federal law.

Meet Alexia Kemerling - She will REV UP the vote for you!

Alexia Kemerling, the REV UP Coalitions Coordinator at the American Association of People with Disabilities, explains how to navigate the voting process in congregate settings. REV UP is a program that is working to build the power of the disability vote. REV UP stands for “Register! Educate! Vote! Use your Power!”

Alexia’s background is in disability grassroots organizing. She also worked for Disability Rights Ohio and has spent time in many different congregate settings educating and registering voters.

In her conversation with U.S. Vote Foundation (US Vote), Alexia discusses inclusive strategies to address accessibility challenges and improve the voting experience for residents of congregate settings.


Alexia, let’s start by differentiating between different types of congregate living situations. Who would reside at a nursing home, developmental center, or state hospital?

Alexia Kemerling

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.


Who decides whether someone living in one of these situations is eligible to vote

Can you identify the federal laws that protect the voting rights of individuals living in congregate settings? 

Alexia Kemerling

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.


How does voter turnout in congregate settings compare to turnout in the general population?

Alexia Kemerling

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. 


In your experience, what are the main barriers that deter individuals in congregate settings from voting? 

What specific challenges do they face in navigating how to vote?

Alexia Kemerling

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.


What are the different voting options available to citizens in congregate settings? 

Are some methods more accessible or convenient than others?

Alexia Kemerling

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. 


If a person in a congregate setting votes with an absentee ballot, there may be different options to return the completed ballot, particularly if the voter has a disability

US Vote stays up to date on each state’s requirements, as new laws have been passed since the 2020 election concerning who can return ballots, how many ballots can be returned on behalf of other voters, and witness, signature and notary requirements

Could you elaborate on the role of family, caregivers, staff, or volunteers in facilitating the voting process for citizens in congregate settings, and on how they contribute to ensuring a smooth and inclusive voting experience?

Alexia Kemerling

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.


What strategies or approaches have proven to be effective in encouraging civic participation in congregate settings?

Alexia Kemerling

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.


What support networks are available to individuals in congregate settings who may need assistance with the voting process beyond the help they can get from their person of choice and from the information provided in US Vote’s Guide for Voters with Disabilities?

Alexia Kemerling

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]


Lastly, what key message or advice would you give to potential voters in congregate settings, their families, and the community as a whole?

Alexia Kemerling

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. 

Voters in congregate settings with Voter Accounts at US Vote are well prepared to cast ballots. Voter Accounts privately store your voting information so that it’s at your fingertips when you need to generate voting forms to register to vote or request an absentee ballot. You can also sign up to get reminders about election dates and deadlines. You'll keep up to date on any laws that change about witness, signature, and notary requirements or if there are new restrictions about who can return your ballot. U.S. Vote Foundation makes voting safe, easy, reliable and quick.