More than 100,000 Pennsylvanians live in long-term care facilities. Advocates worry voting will be a ‘logistical nightmare.’

In the days before nursing homes and long-term care facilities were in a state of perpetual lockdown, Election Day was an event. Older Pennsylvanians, among the state’s most dedicated voters, strolled into the lobby of the facility where they lived or hopped on a shuttle to a polling place. Others voted absentee and slipped their ballots into the mail, little worry about backlogs or delays.

Today, Pennsylvania’s nursing homes, where the coronavirus took thousands of lives and turned the world upside down, are no longer polling places. Many facilities require those who leave the building to quarantine upon return, and some still don’t allow visitors, such as loved ones who could help a resident fill out a ballot or put it in the right envelope.

And so the work of ensuring thousands of older Pennsylvanians vote is left to the operators of the nursing homes and long-term care facilities that remain under immense pressure to keep the virus at bay. Most facilities are pushing mail balloting, which comes with its own logistical challenges.

Advocates for older Pennsylvanians and people with disabilities who are residents of these facilities worry tens of thousands could be disenfranchised because of how drastically voting protocols have changed. That’s especially meaningful in Pennsylvania, the swing state of swing states, where there are 700 nursing facilities and 1,200 personal-care homes.

“We are extremely concerned that more than 100,000 nursing home residents may be disenfranchised and precluded from voting because of the pandemic,” said Karen Buck, executive director of the Philadelphia-based Senior Law Center. “Older people have lost many essential rights during this pandemic. Freedom, security, and their lives. The pandemic should not be also causing them to lose their most essential rights, and that includes voting.”

Representatives for providers say nursing home operators “have stepped up to answer the call,” but acknowledge the challenges are stark.

“Long-term care residents have been uniquely impacted by both of these issues, the COVID-19 pandemic and the new voting guidelines, perhaps more than any other demographic or population,” said Zachary Shamberg, president of the Pennsylvania Health Care Association, which represents 400 providers.

Congregate care centers in Pennsylvania remain under strict regulations after the first wave of coronavirus infections in the state led to outbreaks in hundreds of facilities and more than 5,000 dead. But facilities that receive Medicare and Medicaid dollars — the vast majority of them — still have a responsibility under federal law to “affirm and support the right of residents to vote,” the Centers for Medicare & Medicaid Services said in an October letter. That’s all residents — including those who are physically or cognitively impaired.

Their vote could be crucial this year, as polls show the presidential race tightening among people over age 65, a large and engaged voting bloc. While older Pennsylvanians favored President Donald Trump four years ago, polls show seniors across the state are abandoning him, many citing his administration’s handling of the pandemic.

» READ MORE: Even seniors are abandoning Trump in Pa. Downplaying the pandemic was the last straw.

Biden officials said the campaign has a targeted “Seniors for Biden” operation, part of which includes ensuring voters who live in nursing homes can vote by mail. The Trump campaign didn’t respond to a request for comment.

Shamberg said that prior to this year, voting in nursing homes ran “like clockwork.” This year, with tight restrictions on who comes into the building, that’s impossible.

“That creates a whole logistical nightmare, because there are folks who still want to cast their ballots in person,” said Michael Johnson, ombudsman at the Philadelphia-based Center for Advocacy for the Rights & Interests of the Elderly. That requires facilities to ensure the person is registered at the nearest polling location, arrange transportation, and ensure they have personal protective equipment.

Many facilities require residents self-isolate for 14 days after leaving the facility and returning. But if a resident leaves to vote, Shamberg said, providers need not require a quarantine unless there is “actual exposure.”

When it comes to mail-in ballots, residents have varying needs of assistance, whether it’s due to impaired vision, limited use of their hands, or dementia.

» READ MORE: Ahead of a divisive election, this Penn doctor is working to ensure people with dementia can vote

For example, at Bucks County’s Neshaminy Manor, a 300-resident long-term care facility, staff asked every resident if they were registered and wished to vote. Eighty-seven applied for mail-in ballots, said county spokesperson Larry King.

Once the ballots arrive, staff will distribute them and ensure residents follow the directions. But staff can’t drop completed ballots off at the county elections office or a drop box — state law requires voters return their own mail-in or absentee ballot. The only exception is for voters with a disability who may designate someone in writing to return it for them, but that person must live in the same “household.”

Long-term care staff don’t count, the Pennsylvania Department of State said in a guidance released this month. So Neshaminy Manor will mail back the dozens of ballots, which must be postmarked by Nov. 3 and arrive at the county office by Nov. 6 to be considered on time.

Johnson said the issue for advocates is “there’s no entity in place to oversee what’s happening in nursing homes” regarding voting procedures. Facilities aren’t required to create a plan.

“We have to take these facilities at their word and say, ‘OK, you say you’re helping them, but at the end of the day, I don’t know if you’re taking their ballots or offering to bring them to the polls,’ and there’s no way of us really knowing,” he said.

A handful of advocates for people with disabilities sent a letter last month to state officials, writing “many facilities throughout the state have made little or no effort to assist residents” and urging the state to require facilities submit a plan of action. Paul O’Hanlon, a retired attorney and Pittsburgh-based disability rights advocate who wrote the letter, said state officials assured him long-term care facility residents could apply to vote by mail.

“But they don’t address the hard questions like, well, how? What have they done to assist this process? How many of these facilities have a prayer of doing this on time?” he said. “Everything is so different this election than last. But we’re not doing anything different for them.”

A Department of Health spokesperson said the state was considering the suggestions in the letter and its most recent guidance for long-term care facilities, updated Tuesday, included information about voting.

Buck said state officials should be “much more proactive” in assisting facilities to ensure they receive ballots with enough time to distribute them and get them filled out, and that they are processed in a timely manner.

“Older people have been treated as less than during this pandemic,” she said, “and this is a fundamental right that older people cherish and value, often more than most of us.”