Current Practices in Virginia
Long-Term Care Facilities
Richard J. Bonnie, Law School
Paul Freedman, Department of Politics
Tom Guterbock, Sociology, CSR
Virginia LTC Voting Survey
 Funded by Alzheimer’s and Related Diseases Research
Award Fund (ARDRAF) at VCU
 Survey conducted by the University of Virginia Center for
Survey Research
Virginia LTC Voting Survey
 Pre-tests in Philadelphia 2003 (Karlawish et. al.
2008)
 Pre-test in Albemarle County, VA 2005
 Virginia statewide survey modified question formats
to sharpen the inquiry and generate quantitative
results for each issue.
Survey Features
 Sample randomly chosen from VDH listings

Not all Assisted Living facilities sampled
 Very good response rate: 55%
 246 completed



110 Nursing Homes (nearly half of all in Va.)
112 Assisted Living Facilities
24 hybrids (assigned to NH or AL category by primary
type)
 Margin of sampling error +/- 5.2%
 In-field pretest of survey: Dec 12-15, 2006
 Field Period:

Jan. 31 – March 9, 2007
Survey Features
 Respondent was “the person most knowledgeable






about voting procedures”
CATI (computer-assisted telephone interviewing)
Complex branching and skipping used
Some questions tailored to nursing homes vs.
assisted living facilities.
Experienced interviewers with significant training
Focus on Election Day 2006
Average interview time: 21 minutes
Survey Topics
 facility characteristics
 registration practices
 procedures regarding absentee voting and
voting at polling places
 assessing capacity to vote
Main Findings
 Wide variation across facilities in practices
and policies with respect to registration,
voting, assessment of capacity
 Systematic differences by type of facility
 Facility-level policies and procedures matter
for registration and voting
Type of Facility
Nursing Home
Assisted Living
For-Profit
73.7
68.5
Non-Profit
21.1
27.9
Public/Other
5.2
3.6
Number of Beds Filled on Election Day
Nursing Home
Assisted Living
<=30
2.1
42.9
31-60
22.1
32.2
61-120
51.6
21.9
>120
24.2
2.9
General Voting Policy
Nursing Home
Assisted Living
Written policy on voting?
23.0
7.3
Staffer in charge of voting?
90.3
72.1
Person In Charge/Most Knowledgeable About Voting
Nursing Home
Assisted Living
Administrator
12.6
50.4
Activities Director
52.1
29.6
Recreation Director
4.2
2.6
Social Worker
23.5
4.3
Other
7.6
13.0
Election Activities at Facility
Nursing Home
Assisted Living
73.2
62.0
Arranged political speakers
7.1
13.1
Candidates or parties campaigned
5.4
9.1
Sponsored election-related program
Estimated Voting and Registration Rates
Informants asked to report:
1) number of residents on Election Day 2006
2) number or percentage of residents registered
3) number or percentage voting by absentee ballot or at polling
place.

Rates calculated based on number of residents on Election Day.
1) registration rate
2) turnout (voting as percent of registered)
3) voting percent (reg  turnout)

Estimated Registration and Voting Rates
NH
90
AL
81.3
80
69.9
70
60
50
40
39.8
32.3
26.3
30
20
15.0
10
0
% of residents
registered
% of registered voting % of residents voting
Facilitating Registration
 Do policies vary across type of facility?
 Do facility policies and procedures affect registration
rates?
 Do effects vary across type of facility (registration
assistance scores)?
Registration Procedures
Nursing Home
Assisted Living
Registration standard practice?
65.0
31.6
Part of SOP?
53.0
16.7
Registration during intake?
55.6
27.2
Reg. status recorded in care plan?
16.4
15.1
Recorded somewhere else?
54.3
18.9
Registration Procedures:
Notify Board of Election of Change of Address?
Nursing Home
Assisted Living
Automatic procedure
20.7
12.2
Staff helps only if requested
34.5
22.6
Do nothing, family is responsible
22.4
55.7
Other
17.2
5.7
Don’t Know
5.2
3.8
Percent Registered according to Registration Assistance
Score
NH
AL
45
41.4
40
34.0
35
30
28.4
26.6
25
20
20.2
22.9
15
10
5
0
Low
Medium
High
Facilitating Voting
 Do policies vary across type of facility?
 Absentee vs. voting booth differences
 Do facility policies and procedures affect voting rates?
 Do effects vary across type of facility (voting assistance
scores)?
Locus of Voting
NH
AL
90
80
78.5
70
60
58.9
50
39.1
40
30
20.5
20
10
0
%voting absentee
%voting in booth
Voting at Booth
Nursing Home
Assisted Living
Was facility a polling place?
2.7
3.7
Polling equipment brought in for
practice?
1.8
0
Transportation to polling place?
65.7
78.0
Anyone assist in booth?
55.8
62.0
Voting at Booth:
Most Frequent Source of Assistance
Nursing Home
Assisted Living
Family member
12.5
19.4
Friend/caregiver
4.2
3.2
Election worker
25.0
45.2
Facility staff
41.7
22.6
Other
12.5
6.5
Don’t Know
4.2
3.2
Percent Voting according to Voting Booth Assistance
Score
NH
AL
35
29.2
30
25.5
25
20
15
19.6
17.7
13.9
12.6
10
5
0
Low
Medium
High
Voting by Absentee Ballot
Nursing Home
Assisted Living
Staff helps request ballot
80.9
54.3
Staff helps complete ballot
85.3
54.3
Voting by Absentee Ballot
Nursing Home
Assisted Living
Staff helps request ballot
80.9
54.3
Staff helps complete ballot
85.3
54.3
Nursing Home
Assisted Living
Ballot completed individually
83.8
64.7
Ballot completed in group
4.4
5.9
Percent Voting according to Absentee Ballot Assistance
Score
NH
AL
45
41.2
40
35
30
25
23.4
22.6
21.3
20
15
11.5
12.9
10
5
0
Low
Medium
High
Combined Voter Assistance Score
 Registration + voting booth + absentee ballot assistance
Percent Voting According to Combined Voting Assistance
Score
NH
AL
45
38.6
40
35
30
25.8
25
19.5
20
13.5
15
10
21.7
8.7
5
0
Low
Medium
High
Assessment of Capacity to Vote
 Did anyone assess capacity?
 Source of information relied on
 Perceived significance of guardian
 Perceived significance of DPOA
Most Common Reasons Why Registered Voters Did
Not Vote
Nursing Home
Assisted Living
25.0
34.8
Physical Impairment
7.5
4.3
Lack of Interest
47.5
47.8
Other
17.5
4.3
Don’t Know
2.5
8.7
Mental Impairment
Assessing Capacity to Vote
Nursing Home
Assisted Living
53.1
27.5
“previous knowledge”
20.3
36.7
pre-election interview/assessment
3.4
10.0
both
66.1
46.7
don’t know
10.2
6.7
Did anyone assess if residents were
capable of voting?
(If yes) Sources of information
Specific Assessments Used
Nursing Home
Assisted Living
minimum data set
general impressions, daily
interactions
72.1
18.8
93.0
81.2
specific diagnosis
74.4
62.5
standardized cognitive test
34.9
31.2
Assessing Capacity to Vote:
Perceived Meaning of Guardianship
“Suppose resident has a legal guardian . . . What is the significance
for deciding if capable of voting?”
Nursing Home
Assisted Living
resident is not capable of voting
guardian decides if resident is
capable of voting
11.0
4.6
15.6
32.4
is not relevant
23.9
24.1
is one factor to consider
35.8
31.5
don't know
13.8
7.4
Assessing Capacity to Vote:
Perceived Meaning of DPOA
“Suppose resident has a Durable Power of Attorney . . .
What is the significance for deciding if capable of voting?”
Nursing Home
Assisted Living
1.8
6.5
5.5
15.7
is not relevant
45.9
42.6
is one factor to consider
33.9
25.9
don't know
12.8
9.3
resident is not capable of voting
guardian decides if resident is
capable of voting
Legal Challenge to Capacity
Actual challenge in 2006
Aware of any challenge in previous
experience?
Nursing Home
Assisted Living
1.8
1.8
2.8
4.7
Next Steps
 Additional research beyond Virginia
 More data on existing facility-level practices
 Look at individual resident-level data on
registration and voting
 Recommendations for facility-level
procedures and for public policy