Process isn't simple and the rules vary by state
By LISA EISENHAUER
Ensuring that patients hospitalized at Our Lady of the Lake Regional Medical Center can vote is no small task.
Sue Rosenbluth, an advocacy and public policy project specialist for CHRISTUS Health, registers voters at the system's headquarters in Irving, Texas, in January. Registration was open to staff and visitors.
Several days before an election, notices about patients' rights to cast an unplanned absentee ballot are broadcast by television in patient rooms and common areas of the hospital in Baton Rouge, Louisiana. To start the process, patients have to ask the hospital for forms requesting an "emergency ballot" and the hospital's medical director has to submit written statements affirming that the patients can't get to their polling places. Hospital staff must fax that paperwork to elections officials at the parish where the voters are registered by 4 p.m. the night before the election.
Once the officials check the paperwork and send absentee ballots, hospital staff has to deliver those ballots to the patients so they can cast their votes and the staff can fax the completed ballots to the elections offices by the deadline.
In total, Coletta Barrett, the hospital's vice president of mission, estimates that she or other hospital staff members spend 4 to 4 1/2 hours for each vote. In the most recent election, a statewide one, that was 15 votes.
Regardless of the time required, Barrett says the effort fits into Our Lady of the Lake's social justice mission. "We talk, in our mission and our ministry, about justice and so we live out our core values when we do things like this," she says of the medical center's efforts to facilitate voting. The hospital is part of the Franciscan Missionaries of Our Lady Health System.
Across the Catholic health care ministry, just how many institutions make special efforts to accommodate patient voting is unclear. Representatives of several systems say they prepare educational material about elections — such as registration deadlines and rules for voting absentee — and distribute it to executives at member hospitals. The system representatives say they don't know whether or how far those institutions go to facilitate voting for patients.
State elections officials have told Barrett that no other health care institution in Louisiana has a formal process like the one at Our Lady of the Lake to educate hospitalized patients on their right to cast an emergency ballot and to accommodate the process.
A Benedictine Health System associate assists a resident of one of the health system's communities with voter registration. Benedictine says its communities strive to ensure all patients and residents have an opportunity to fulfill their right to vote. Courtesy of Benedictine
In Minnesota, St. Gertrude's Health & Rehabilitation Center in Shakopee makes a similar effort on behalf of patients in its long-term skilled nursing facility. Marcie Donnelly, St. Gertrude's wellness director, says that work gets a big boost from local elections officials as well as from St. Gertrude's staff.
Donnelly says staffers at the care center ask patients as part of the intake process if they want to vote in elections. If they do, she and other staffers will help the patients fill out the necessary forms to register to vote or transfer their registration to their new residence. Within two weeks before an election, elections officials will set up a polling place at the care center. Those officials bring the absentee ballots — even delivering them to the rooms of nonambulatory patients — and collect the completed ballots afterward. In the last election, 18 of St. Gertrude's 40 long-term care residents voted.
Donnelly has been part of the process to help patients vote since the care center, a member of Benedictine, opened about 20 years ago. "It's their right to vote and I want to give them that right and that's just been my philosophy," she says.
Avera Sister James Care Center in Yankton, South Dakota, has similar arrangements with local elections officials to ensure that patients can vote. Those officials even send out sample ballots in advance so patients at the Avera Heath skilled nursing facility know exactly what races and issues they will be helping to decide.
People who have experience setting up voting processes for hospital or nursing home patients say the key to making the processes work smoothly is to be in close contact with elections officials well before elections to make sure that the requirements and deadlines are met.
Those requirements and deadlines vary vastly among states. Dr. Kelly Wong, an emergency medicine resident at Brown University, found that out when she decided to set up a website to help hospitalized patients figure out how they can vote. Her website, patientvoting.com, offers state-by-state information on the laws for emergency voting.
Wong lives in Rhode Island, where she says the laws are friendly to patients. Absentee ballots can be requested by patients up to 4 p.m. on the day before an election. If patients need assistance filling out their absentee ballots, elections officials send someone to deliver the ballots and assist them. In other states, patients are mostly on their own throughout the process.
In some states, just tracking down the laws that cover emergency voting was a challenge. In Texas, Wong says, "it was easier for me to find out how to vote if you were on a space mission than in a hospital."
Get out the vote
Sara Wojcicki Jimenez says that when she started in her post as director of marketing, communication and advocacy for the central Illinois division of Hospital Sisters Health System, the 2018 midterm elections were just weeks away. She made a call early on to Sangamon County elections officials to find out what steps needed to be taken to provide absentee ballots to patients at the four hospitals in her division.
Jimenez, who is a former Illinois state representative, wasn't surprised or intimidated by the complicated process and strict rules and deadlines. She says she understands that elections have to follow explicit procedures to prevent fraud. "It's not exactly an easy process by design, I think," she says.
The patient experience staff at the four hospitals help distribute the necessary paperwork to interested patients and return the forms to elections officials. That staff plans to do the same again for this year's elections. "Some of the feedback that I received from the last time is that people were very grateful" to be able to cast their vote, Jimenez says.
Linda Townsend is vice president of advocacy and government affairs for CHRISTUS Health, which has hospitals and care centers in Texas, Louisiana, New Mexico and Arkansas. She says that a get-out-the-vote effort is one of her staff's big projects. Those efforts, however, are largely focused on the system's associates.
"We create material that we can then distribute to our regional ministries for them to use," Townsend says. "It is tailored by state because all of our states have different information on their primaries and rules on early voting and things of that nature."
Hospital directors often use the information to send out emails to staff and to post or broadcast messages to encourage voting. "We have to be diligent as do other Catholic health care systems and nonprofit organizations to ensure any get-out-and-vote efforts are done in a nonpartisan way," Townsend says. "So, we really focus on raising awareness, providing information, and encouraging people to register and vote."
The system goes so far as to set up voter registration tables. At one in the main lobby of its headquarters in Irving, Texas, in January about 80 people registered to vote. The table was staffed by a CHRISTUS employee who had been deputized by elections officials. Registration was open to both CHRISTUS staff and visitors.
Michael Richards, vice president of government affairs and public policy at St. Louis-based SSM Health, says his office provides information on how registered voters can cast emergency ballots at its hospitals in Missouri, Illinois, Wisconsin and Oklahoma.
"We're providing resources so that if somebody is in the hospital and does want to vote, (hospital staff) know how to make those accommodations for those patients and visitors," Richards says. SSM Health encourages the ministry leaders at all its facilities to do whatever is needed to accommodate voters, he said.
In Baton Rouge, Barrett says her staff's efforts to secure emergency ballots have been repaid in gratitude from patients eager to exercise their constitutional rights. She recalls one patient who was on a ventilator but still wanted to vote. In that case, after hospital staff secured an absentee ballot and delivered it to the patient's room, the patient's husband read the ballot to her and she squeezed his hand to indicate who she wanted to vote for.
Officials at other Louisiana hospitals have contacted Barrett to express interest in copying the "standard operating procedure" for emergency voting used by Our Lady of the Lake. "It is our hope and desire that in the future we won't be the only one doing this," she says.
Some doctors work to simplify voting process for hospitalized patients
Dr. Kelly Wong
Dr. Kelly Wong says she was surprised when patients told her during the run-up to the 2016 presidential election how concerned they were about missing the opportunity to vote because they were hospitalized.
"I didn't really think about it again until the midterm elections in 2018," says Wong, who is an emergency medicine resident at the Alpert Medical School at Brown University in Providence, Rhode Island. "Just before that I decided I was going to try and see what process was in place for hospitalized patients to vote" in Rhode Island.
Wong says her research "blew up from there" because the hospital where she was working had patients from other states and she quickly found out that each state's laws on emergency absentee voting vary. She ended up creating a website called patientvoting.com. By clicking on the outline of a state in a map of the U.S., users can get details on applicable voting laws.
"I wanted the website to be a central access point with information for all of the states in a very simple format that's easy for hospital patients to read while they're in their hospital bed dealing with their health conditions," Wong says.
In addition to creating the website, Wong helped educate care providers and patients at the hospitals affiliated with the Alpert Medical School on emergency voting laws. This year, Wong hopes to expand that part of her initiative and recruit representatives at hospitals across the nation to run patient voting programs.
Dr. Jennifer Okwerekwu, a fourth-year resident in the adult psychiatry resident training program at the Cambridge Health Alliance, was part of a similar effort at the health system based in Cambridge, Massachusetts.
Okwerekwu was one of the founders of the alliance's social justice coalition. The coalition focused on patient voting in 2016. Its members studied the emergency provisions for voting in Massachusetts, distributed educational material to care providers and patients at Cambridge Hospital, helped patients get the necessary paperwork to secure absentee ballots and even delivered some of those ballots to elections officials.
"When you think about the people who are most likely to be hospitalized, they often represent an intersection of many marginalized communities and so the fact that they are unable to vote just further compounds that disenfranchisement and it just further compounds the injustice," Okwerekwu says.
The voting laws were so complicated and the process so rarely used that Okwerekwu says she and other members of the alliance sometimes had to educate local elections officials on what the voting rules were.
Undertaking the voting promotion was a learning process, Okwerekwu says, and even resulted in academic papers. One of those papers focused mainly on how voting can be particularly challenging for psychiatric patients, whose mental capacity can raise barriers. In the end, she says the big takeaway from that paper is that any institution that gets federal funding has a duty to accommodate patient voting.
"Hospitals really do have an obligation to be able to help people exercise their constitutional rights," she says.
— LISA EISENHAUER
Copyright © 2020 by the Catholic Health Association
of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3490.