CMS Alerts States About SNF Resident Voting ‘Coercion’

In a “Special Alert” to State Survey Agency Directors, the Center for Clinical Standards and Quality under CMS warned about coercion of residents during the voting process. In a separate memo, the agency rescinded a pandemic-era memo on residents’ right to vote.

Called the “Protecting the Voting Rights and Autonomy of Vulnerable Residents in Long-Term Care (LTC) Facilities,” the Special Alert memo focuses on cautioning nursing homes about voting and registering to vote.

In this notice, CMS said it is rescinding in a separate memo the October 2020 and September 2024 Quality, Safety and Oversight (QSO) memoranda titled “Compliance with Residents’ Rights Requirement related to Nursing Home Residents’ Right to Vote” (QSO-21-02-NH and QSO-24-21-NH).

“In this QSSAM, we reiterate nursing homes’ responsibility to preserve residents’ rights to vote and to promote participation in the democratic process. However, this activity should not violate federal or state voting laws, and CMS is reminding facilities and their staff that they cannot engage in inappropriate coercion or other violations of residents’ rights,” the agency said.

Residents in nursing facilities retain all constitutional and statutory rights enjoyed by other citizens, CMS said, including the right to vote and the right to decline participation in elections.

Why CMS Said it Acted

By way of background, CMS said “unfortunately, in recent years, we have become aware of several allegations of instances in which resident rights were unlawfully violated.”

The agency included two examples.

“In Texas, a social worker was charged with 134 felony counts involving election fraud for unlawfully registering residents of the Mexia State Supported Living Center. Texas Attorney General Paxton said, ‘Registering citizens to vote or to obtain mail ballots without their consent is illegal. It is particularly offensive when individuals purport to be champions for disability rights, when in reality they are abusing our most vulnerable citizens in order to gain access to their ballots and amplify their own political voice.’”

And, CMS said in Wisconsin, the police investigated a case in which they alleged that eight men and women whose mental capacities had diminished due to age or disease sent mail-in ballots from Ridgewood Care Center. There was no mention of further adjudication.

Registering Rules

As a result, CMS said it would also like to clarify that nursing homes may not engage in any activity that violates federal or state voting laws.

“This includes actions like registering residents as voters without their knowledge or consent or completing a mail-in ballot on a resident’s behalf without authorization. Additionally, pursuant to 42 C.F.R. § 483.10(g)(14), CMS expects facilities to notify the resident’s authorized representative when a change occurs in the resident’s legal or civil rights related to voting,” the memo said.

“Residents who require assistance to vote should have the option of receiving assistance from the person of their choosing and should be offered the option of receiving assistance from their authorized representative.”

CMS said it also encourages nursing homes to coordinate with state election officials to encourage the use of bipartisan election workers where authorized by state law and to facilitate voting in long-term care facilities without reliance on facility staff, thereby reducing “the risk of undue influence wherever possible.”

Questions or comments? Contact Patrick Connole at pconnole@parkplacelive.com.