Current Practices in Virginia Long-Term Care Facilities

Richard J. Bonnie, Law SchoolPaul 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 usedSome questions tailored to nursing homes

vs. assisted living facilities. Experienced interviewers with significant

trainingFocus on Election Day 2006Average interview time: 21 minutes

Survey Topics

facility characteristicsregistration practicesprocedures regarding absentee voting

and voting at polling placesassessing 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

Sponsored election-related program 73.2 62.0Arranged political speakers 7.1 13.1Candidates or parties campaigned 5.4 9.1

Estimated Voting and Registration Rates

Informants asked to report: 1) number of residents on Election Day 20062) 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.

registration rate turnout (voting as percent of registered) 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? 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 HomeAssisted 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

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? 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 HomeAssisted 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

Voting by Absentee Ballot

Nursing HomeAssisted Living

Staff helps request ballot 80.9 54.3

Staff helps complete ballot 85.3 54.3

Voting by Absentee Ballot

Nursing HomeAssisted Living

Staff helps request ballot 80.9 54.3

Staff helps complete ballot 85.3 54.3

Nursing HomeAssisted Living

Ballot completed individually 83.8 64.7

Ballot completed in group 4.4 5.9

Combined Voter Assistance Score

Registration + voting booth + absentee ballot assistance

Assessment of Capacity to Vote

Did anyone assess capacity?Source of information relied onPerceived significance of guardianPerceived significance of DPOA

Most Common Reasons Why Registered Voters Did Not Vote

Nursing Home

Assisted Living

Mental Impairment 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

Assessing Capacity to Vote

Nursing Home

Assisted Living

Did anyone assess if residents were capable of voting? 53.1 27.5

(If yes) Sources of information

“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

Specific Assessments Used

Nursing Home

Assisted Living

minimum data set 72.1 18.8general impressions, daily interactions 93.0 81.2specific diagnosis 74.4 62.5standardized cognitive test 34.9 31.2

Assessing Capacity to Vote:Perceived Meaning of Guardianship

Nursing Home

Assisted Living

resident is not capable of voting 11.0 4.6guardian decides if resident is capable of voting 15.6 32.4is not relevant 23.9 24.1is one factor to consider 35.8 31.5don't know 13.8 7.4

“Suppose resident has a legal guardian . . . What is the significancefor deciding if capable of voting?”

Assessing Capacity to Vote:Perceived Meaning of DPOA

Nursing Home

Assisted Living

resident is not capable of voting 1.8 6.5guardian decides if resident is capable of voting 5.5 15.7is not relevant 45.9 42.6is one factor to consider 33.9 25.9don't know 12.8 9.3

“Suppose resident has a Durable Power of Attorney . . . What is the significance for deciding if capable of voting?”

Legal Challenge to Capacity

Nursing Home

Assisted Living

Actual challenge in 2006 1.8 1.8Aware of any challenge in previous experience? 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