This is a question I had this fall, as my loved one continues to decline with Alzheimer’s! I did a little research, as all good loved ones do, and found the following excellent points from the American Bar Association Commission on Law and Aging and the Penn Memory Center. I have pulled them together as excerpts for easier reading.
“The right to vote is one of the most sacred privileges in our representative democracy and it is available to all citizens, whether they are cognitively impaired or unimpaired. A medical diagnosis does not disqualify a person from voting. A diagnosis of Alzheimer’s disease, traumatic brain injury, or other cause of cognitive impairment does not disqualify a person from being eligible to vote. In fact, many persons diagnosed with a condition that involves cognitive impairment are able to cast a ballot. This means that chart notes, medical diagnoses, or cognitive test scores do not disqualify a person from voting. Everyone should be approached about voting, and everyone who wants to vote should be given the opportunity.
Capacity to vote is much like the capacity to ride a bicycle, which can be determined accurately only by allowing the individual to mount a bike and start pedaling. If capacity is lacking, the task just won’t be completed. Likewise, an individual simply will not be able to make or communicate a choice on a ballot, even with assistance, if capacity to vote is lacking. The process stops by its own lack of momentum. It may mean that only part of the ballot is completed, but that is perfectly okay. There is no requirement to complete every ballot.
Where do you start in determining capacity to vote? First, ask the person if he or she wants to vote. If he or she answers yes, ask if any assistance is needed with registering, ordering, or completing the ballot. Your opinion of a person’s choice—their vote and rationale—is not relevant. If the individual indicates a choice among available ballot selections, their reasons for such choice are not relevant. The helpers’ opinion of the choice is not relevant. What matters is that the person for whom you provide support is allowed to vote and his or her preferences are respected. People who are otherwise cognitively healthy may base their votes on any reason. Similarly, persons with cognitive impairment may also choose according to their own preferences. If a person can indicate a desire to vote, he or she can also indicate a choice among available ballot selections.
COMMUNICATION CHALLENGES
Voting may require persons with cognitive impairment to communicate with his or her supporter about preferences. Trouble communicating can take different forms:
• Difficulty finding the right words,
• Easily losing one’s train of thought,
• Difficulty organizing words logically,
• Speaking less often, or
• More often relying on gestures instead of speaking.
These communication challenges can be successfully overcome with the following techniques that are consistent with election laws:
1. Hone your listening skills: Listen carefully to what the person is saying. If his or her speech is hard to understand, give the person time to speak and do not finish sentences. Repeat information and questions. If the person does not respond, wait a moment. Then ask again. Get the person’s attention. Catch and hold the attention of the person before you start to communicate. Make sure he or she can see you clearly. Eye contact is critical. This will help the person focus on you.
2. Time your discussion: Persons with cognitive impairments may be more alert and focused at different times of the day. Time discussion about voting and the voting process at times when the person is not fatigued. Find an environment that is free from distractions.
3. Notice body language: All of us read body language. Agitated movements or a tense facial expression can make communication more difficult. Be calm and still while you communicate to prevent distractions.
4. Speak clearly: Ask questions one at a time. Speak clearly and calmly. Do not use “baby talk.” Use your normal tone of voice but do recognize that you may need to talk more slowly and at a lower register so that you are heard. Use simple, short sentences. Processing information may take the person longer than usual. Allow enough time for the conversation to unfold.
5. Show respect: Do not speak down or judgmentally to the person with cognitive impairment. Do not treat them like a child, even if they do not seem to understand. Physically position yourself to be at eye level with the person to show respect.
6. Make sure you understand: If you do not understand what is being said, ask the person to point, gesture, or repeat. People who live in a long-term care facility may not trust volunteers from the outside as much as they do the staff, who they know. Making genuine efforts to understand a person can improve trust.
COMMON QUESTIONS TO ASSISTING A COGNITIVELY IMPAIRED PERSON WITH VOTING:
A PERSON MAY NOT BE ABLE TO READ OR MARK THE BALLOT ON HIS OR HER OWN.
It is permissible to offer support in reading and marking the ballot. You should only mark the ballot according to what the person indicates is his or her choice. If a person cannot communicate a choice, you may not mark that person’s ballot. If a person communicates a choice on some ballot items (e.g., election of a president), but not others (e.g., election of a Senator), you may mark only those ballot items for which a choice was communicated.
THE VOTER ASKS YOU WHO HE OR SHE SHOULD VOTE FOR.
You should not attempt to influence their preferences, even if he or she asks you to tell them who to vote for. A person with impairments is free to vote for whomever they wish. If they do not communicate a choice independently, then they do not vote. If a person with impairment asks you who to vote for, a suggested response is: “The choice is yours, not mine. You are free to choose whomever you wish.”
THE VOTER ASKS YOU QUESTIONS ABOUT A CANDIDATE’S BACKGROUND OR POSITIONS.
You are permitted only to convey the information written on the ballot. You should not communicate additional information to the voter. Communicating additional information that is not contained on the ballot could bias the voting process. The person with impairment should be free to vote for whomever they wish, without biasing their preferences.
A VOTER WANTS TO MARK THE BALLOT FOR SOMEONE WHO IS NOT ON THE BALLOT.
Persons with impairment are free to vote for whomever they wish, whether they appear on the ballot or not. If the person expresses a clear choice for a candidate who does not appear on the ballot, you should write in that choice as allowed by state voting laws.
SOMEONE ELSE, SUCH AS A FRIEND OR FAMILY MEMBER, SAYS THEY KNOW HOW THE PERSON WOULD VOTE AND THAT IS HOW THE BALLOT SHOULD BE MARKED.
When supporting a person with impairment, you are permitted only to mark a ballot with the choice the voter makes at the time. If the voter cannot make a choice at the time of voting, you cannot mark the ballot based on previous knowledge of the voter’s preferences. A suggested response to a friend or family member who is stating previous knowledge of voting preferences is: ‘This ballot belongs to [Mr. X / Ms. X] and it needs to be marked with [his / her] current choice. If [he/she] cannot communicate that choice, then I cannot mark the ballot.’”
