Having Dementia Doesn’t Imply You Can’t Vote

Edward Kozlowski often told his daughter how his father had walked through Siberia to come to America.

Mr. Kozlowski was born in Chicago 99 years ago and grew up on farms in the Midwest. He left West Point to join the Army Air Corps during World War II and flew four times over Europe on D-Day. As a mechanical engineer, he spent much of his career with NASA and Texas A&M.

And throughout his adult life, Mr. Kozlowski, a registered Republican, voted on virtually every election. "In my family, voting was the highest honor of citizenship," said his daughter Judith Kozlowski. “You owed it to your country to vote. that was always the message. "

It remains important to Mr. Kozlowski, who is now resident in an independent residential facility in Chevy Chase, Md. He didn't want to vote in person this year because he wasn't exposed to the coronavirus and his daughter helped him request an email. in the vote – although he has developed dementia.

"Some days it's just right, sometimes it's not," said Ms. Kozlowski, 68. Her father can become disoriented. He is prone to hiking and needs carers around the clock. Still, he watches "The PBS NewsHour" and CNN "religiously," said his daughter, adjusting to the debates of the President and Vice-President.

He suffers from macular degeneration, so Ms. Kozlowski read him the ballot during short, multi-day kitchen table meetings. It probably helped that, as a former federal prosecutor and senior justice advisor, she knew the rules better than most.

Her father could tell her which candidates he wanted to vote for.

And that's all it takes.

"There are many misconceptions about what 'electoral ability' is," said Charles Sabatino, director of the Law and Aging Commission for the American Bar Association. "Inability to follow a recipe and cook dinner doesn't mean inability to choose. Inability to remember your grandchildren's names doesn't mean you can't choose."

What is required – as the Commission and the Penn Memory Center point out in a new guide – is the ability to express a preference.

"Can you choose among the choices?" said Dr. Jason Karlawish, geriatrician and co-director of the Penn Memory Center. "That's it."

The Census Bureau has reported that more than 23 million American adults – nearly 10 percent – have conditions that impair mental functioning, including learning and intellectual disabilities, as well as Alzheimer's disease and other forms of dementia.

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Some are young or middle-aged, but most of the nearly eight million people with dementia are older adults. Many are effectively disenfranchised.

Voting can be a challenge for many senior citizens who may have difficulty getting to polling stations, standing in line, using computerized voting machines, or reading ballot papers printed in small print.

However, misunderstandings about cognitive decline also pose additional obstacles. Nursing and assisted living workers and family members may refuse to serve disabled voters because they believe dementia will disqualify them.

It is not so. A diagnosis of cognitive impairment does not prevent anyone from voting. Voters do not need to pass cognitive tests. You don't have to be able to name the candidates or explain the problems. If they need help reading or physically marking the ballot, they can be assisted either with voting or with postal ballot papers. In some states, even those under legal guardianship do not lose their voting rights.

In any case, the proportion of people who have legal guardians is low. When considering helping someone with dementia participate in an election who has signed up to vote, in most cases there are only two real guidelines to follow.

First, after reminding the person that election day is approaching, ask if they would like to vote. A "no" will stop the process, said Mr Sabatino, but "anyone who expresses an interest in voting should be supported under the law."

Second, you can read the options aloud to the voter if they cannot read them but cannot provide additional information or interpretation, although discussions are allowed before voting begins. "Ask them what their choice is and see if they answer," said Mr Sabatino. "If you do that, vote."

Voters do not have to fill out the voting slip. You can vote for the president and ignore anything else. There is no time limit; A relative or a paid carer can help the voter run a multi-day mail-in vote. Registrations are allowed. "If they tell you they want to vote for F.D.R., write in F.D.R.," Sabatino said.

"You may find it annoying to write in a strange person, but we let people do that," said Dr. Karlawish. Ordinary voters can write on Mickey Mouse's name, pick the first person on the ballot, whoever that is, and otherwise act less than rational. "We can't hold certain people to standards that we don't everyone else adhere to when it comes to a fundamental right," said Dr. Karlawish.

Given the ongoing health crisis, "this year it will be harder for a lot of people to attend," said Myrna Pérez of the Brennan Center for Justice.

For residents of nursing homes and assisted living facilities, for example, visiting restrictions make it more difficult for relatives to support them with voting.

Elaine and Charlie Fettig, married for 58 years, have only seen each other twice in person since June when 82-year-old Fettig moved to a nursing home in suburban Philadelphia. Two years ago he developed dementia after a stroke.

"We always voted," said Ms. Fettig, 81. She allowed a distant visit earlier this month and filled out a request for a postal vote. A staff member helped her husband to set the required signal.

Now Ms. Fettig is wondering if she can come back in time to help him vote. "If I could go every day I wouldn't have to worry about who's going to help him get an X," she said.

Earlier this month, a Medicare memorandum warned nursing homes must ensure residents can vote and provide assistance when needed.

However, long before the pandemic, such facilities were chronically understaffed. Family caregivers may have to cast ballots and harass administrators for residents to fill out and return. (Ms. Pérez recommends consulting at least two trusted sources about government laws that govern who can assist with and return votes.)

However, most older people with dementia live at home, where wider use of postal ballot papers could actually make voting easier. 22 states and the District of Columbia will be sending ballots or ballot requests to most or all of the active registered voters this year, according to the Brennan Center.

Could unscrupulous carers take advantage of disabled elderly voters by overriding their decisions or discarding their ballot papers? It is possible, but also illegal. "Anyone who sees unreasonable influence or coercion should report this to the local electoral body," said Sabatino.

A country committed to ensuring that all eligible citizens can vote could simplify this process. For example, during the 2008 election, Vermont experimented with mobile polls that sent trained election officers to selected nursing homes.

"Everyone said how much the residents felt about their dignity and sense of worth," said Dr. Karlawish. He was part of a research team that followed the effort.

Although some countries focus on reaching out to older voters, mobile polls are rare, likely because election boards are underfunded.

As is so often the case, the responsibility largely rests with the families. On October 8th, after a detailed discussion, Judith Kozlowski helped her father to make his selection. He allowed her to reveal that after a life as a Republican, this time he had voted for Joseph R. Biden Jr.

She drove him to the Dropbox outside a local community center, where other voters and family members were also returning ballots. They applauded spontaneously when Mr. Kozlowski came closer with a walker and pushed his ballot through the slot.

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