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 HomeAssisted Living For-Profit Non-Profit Public/Other5.23.6

Number of Beds Filled on Election Day Nursing HomeAssisted Living <= >

General Voting Policy Nursing HomeAssisted Living Written policy on voting? Staffer in charge of voting?

Person In Charge/Most Knowledgeable About Voting Nursing HomeAssisted Living Administrator Activities Director Recreation Director Social Worker Other

Election Activities at Facility Nursing HomeAssisted Living Sponsored election-related program Arranged political speakers Candidates or parties campaigned5.49.1

Estimated Voting and Registration Rates Informants asked to report: 1) number of residents on Election Day ) 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)

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 HomeAssisted Living Registration standard practice? Part of SOP? Registration during intake? Reg. status recorded in care plan? Recorded somewhere else?

Registration Procedures: Notify Board of Election of Change of Address? Nursing HomeAssisted Living Automatic procedure Staff helps only if requested Do nothing, family is responsible Other Don’t Know5.23.8

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)?

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

Voting at Booth: Most Frequent Source of Assistance Nursing HomeAssisted Living Family member Friend/caregiver Election worker Facility staff Other Don’t Know4.23.2

Voting by Absentee Ballot Nursing HomeAssisted Living Staff helps request ballot Staff helps complete ballot

Voting by Absentee Ballot Nursing HomeAssisted Living Staff helps request ballot Staff helps complete ballot Nursing HomeAssisted Living Ballot completed individually Ballot completed in group4.45.9

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

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 HomeAssisted Living Mental Impairment Physical Impairment Lack of Interest Other Don’t Know2.58.7

Assessing Capacity to Vote Nursing HomeAssisted Living Did anyone assess if residents were capable of voting? (If yes) Sources of information “previous knowledge” pre-election interview/assessment both don’t know

Specific Assessments Used Nursing HomeAssisted Living minimum data set general impressions, daily interactions specific diagnosis standardized cognitive test

Assessing Capacity to Vote: Perceived Meaning of Guardianship Nursing HomeAssisted Living resident is not capable of voting guardian decides if resident is capable of voting is not relevant is one factor to consider don't know “Suppose resident has a legal guardian... What is the significance for deciding if capable of voting?”

Assessing Capacity to Vote: Perceived Meaning of DPOA Nursing HomeAssisted Living resident is not capable of voting guardian decides if resident is capable of voting is not relevant is one factor to consider don't know “Suppose resident has a Durable Power of Attorney... What is the significance for deciding if capable of voting?”

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

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