1. Current Practices in Virginia Long-Term Care Facilities Richard J. Bonnie, Law School Paul Freedman, Department of Politics Tom Guterbock, Sociology, CSR

2. 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

3. 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.

4. 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

5. 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

6. Survey Topics facility characteristics registration practices procedures regarding absentee voting and voting at polling places assessing capacity to vote

7. 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

8. Type of Facility Nursing HomeAssisted Living For-Profit73.768.5 Non-Profit21.127.9 Public/Other5.23.6

9. Number of Beds Filled on Election Day Nursing HomeAssisted Living <=302.142.9 31-6022.132.2 61-12051.621.9 >12024.22.9

10. General Voting Policy Nursing HomeAssisted Living Written policy on voting?23.07.3 Staffer in charge of voting?90.372.1

11. Person In Charge/Most Knowledgeable About Voting Nursing HomeAssisted Living Administrator12.650.4 Activities Director52.129.6 Recreation Director4.22.6 Social Worker23.54.3 Other7.613.0

12. Election Activities at Facility Nursing HomeAssisted Living Sponsored election-related program73.262.0 Arranged political speakers7.113.1 Candidates or parties campaigned5.49.1

13. 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)

15. 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)?

16. Registration Procedures Nursing HomeAssisted Living Registration standard practice?65.031.6 Part of SOP?53.016.7 Registration during intake?55.627.2 Reg. status recorded in care plan?16.415.1 Recorded somewhere else?54.318.9

17. Registration Procedures: Notify Board of Election of Change of Address? Nursing HomeAssisted Living Automatic procedure20.712.2 Staff helps only if requested34.522.6 Do nothing, family is responsible22.455.7 Other17.25.7 Don’t Know5.23.8

19. 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)?

21. Voting at Booth Nursing HomeAssisted Living Was facility a polling place?2.73.7 Polling equipment brought in for practice?1.80 Transportation to polling place?65.778.0 Anyone assist in booth?55.862.0

22. Voting at Booth: Most Frequent Source of Assistance Nursing HomeAssisted Living Family member12.519.4 Friend/caregiver4.23.2 Election worker25.045.2 Facility staff41.722.6 Other12.56.5 Don’t Know4.23.2

24. Voting by Absentee Ballot Nursing HomeAssisted Living Staff helps request ballot80.954.3 Staff helps complete ballot85.354.3

25. Voting by Absentee Ballot Nursing HomeAssisted Living Staff helps request ballot80.954.3 Staff helps complete ballot85.354.3 Nursing HomeAssisted Living Ballot completed individually83.864.7 Ballot completed in group4.45.9

27. Combined Voter Assistance Score Registration + voting booth + absentee ballot assistance

29. Assessment of Capacity to Vote Did anyone assess capacity? Source of information relied on Perceived significance of guardian Perceived significance of DPOA

30. Most Common Reasons Why Registered Voters Did Not Vote Nursing HomeAssisted Living Mental Impairment25.034.8 Physical Impairment7.54.3 Lack of Interest47.547.8 Other17.54.3 Don’t Know2.58.7

31. Assessing Capacity to Vote Nursing HomeAssisted Living Did anyone assess if residents were capable of voting?53.127.5 (If yes) Sources of information “previous knowledge”20.336.7 pre-election interview/assessment3.410.0 both66.146.7 don’t know10.26.7

32. Specific Assessments Used Nursing HomeAssisted Living minimum data set72.118.8 general impressions, daily interactions93.081.2 specific diagnosis74.462.5 standardized cognitive test34.931.2

33. Assessing Capacity to Vote: Perceived Meaning of Guardianship Nursing HomeAssisted Living resident is not capable of voting11.04.6 guardian decides if resident is capable of voting15.632.4 is not relevant23.924.1 is one factor to consider35.831.5 don't know13.87.4 “Suppose resident has a legal guardian... What is the significance for deciding if capable of voting?”

34. Assessing Capacity to Vote: Perceived Meaning of DPOA Nursing HomeAssisted Living resident is not capable of voting1.86.5 guardian decides if resident is capable of voting5.515.7 is not relevant45.942.6 is one factor to consider33.925.9 don't know12.89.3 “Suppose resident has a Durable Power of Attorney... What is the significance for deciding if capable of voting?”

35. Legal Challenge to Capacity Nursing HomeAssisted Living Actual challenge in 20061.8 Aware of any challenge in previous experience?2.84.7

36. 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