Dementia Care

heAustralianAged Care

QualityAgency

accreditation standards

require that aged care residents

are able to exercise civic legal

and consumer rights and that

aged care providers are

required to assist them to do

this. TheAustralian Electoral

Commission (2015) states that

the right to vote is fundamental

for all Australian citizens.

However, an informal review

of practice at BlueCross

Community and Residential

Services (BlueCross) in the lead-

up to the 2014 Victorian State

Government election indicated

that staff andmanagement held

a number of incorrect

assumptions about the rights of

aged care residents with regard

to voting in government

elections. Some staff believed

that it was no longer

compulsory for people over the

age of 75 years to vote, many

believed that people living in

residential aged care were

exempt and there was a

strongly held belief that anyone

with a diagnosis of dementia or

cognitive impairment would

not have the capacity to vote.

This article explains the

changes BlueCross has made

since then to support our

residents, including those with

dementia, to take part in the

electoral process. This fits with

the aims of the BlueCross

STARLife dementia practice

model which promotes person-

centered care, participation,

engagement and community

involvement for all residents

including those living with

dementia.

We decided to conduct the

informal review after BlueCross

residential homes were

contacted by the Victorian

Electoral Commission before

the state election and asked to

provide a list of people living in

each place. This revealed that a

significant number of BlueCross

residents were listed on the

electoral register at their pre-

admission addresses. This then

raised questions about where

the responsibility lies for

ensuring that the address is

correctly recorded and for the

processes that should be

followed when a resident does

not seem to have the capacity to

vote.

Reviewing the literature

In response to these questions I

reviewed the literature about

voting and contacted the

Victorian Electoral Commission

to confirm statutory obligations

in relation to voting. The

commission confirmed that all

citizens, regardless of age, are

required to vote in state and

federal elections unless they are

medically exempt. (BlueCross

uses theAustralian Electoral

Commission and Victorian

Electoral Commission websites

as references to ensure our

guidelines around resident

voting are in keeping with

current legislation.)

Research suggests that voting

is highly valued and that people

of all ages consider voting as a

fundamental right (Bonnie

et al

2013; McEldowney

et al

2009;

Karlawish

et al

2008). However,

the literature review revealed

that access to voting can be

challenging in residential aged

care settings. Aneed for

research to support the

development of guidelines for

voting by residents in long-term

care settings is acknowledged.

Nurses, employers and

organisational policymakers

have a significant role in

ensuring that older people can

exercise their right to vote and

policy development is

mentioned as being of

particular importance (Bonnie

2013; Regan

et al

2011;

Karlawish

et al

2008).

Based on a US survey,

Karlawish (2008) suggests that

two-thirds of residential aged

care homes indicated that they

assessed voting capacity prior

to elections. They report that

methods differed andmay have

disenfranchised residents who

were actually competent to

vote.

It is often assumed that

people with a diagnosis of

dementia would not have the

capacity to vote. Investigations

into the capacity to vote in

people living with dementia

and the elderly suggest that the

matter is more complicated than

this. Consideration of four

decision making skills

–

understanding, choice,

reasoning and appreciation

–

finds that the capacity to vote,

although impacted by cognitive

deterioration, is more related to

understanding and

appreciation than to choice and

reasoning. Voting by people

living with dementia raises

questions about assessing their

decision-making capacity. In

one study in which tests were

completed to evaluate decision-

making skills, the subjects

performed poorly on

understanding and reasoning

items but scored well on

making choices (Irastorza

et al

2011; Tiraboschi

et al

2011).

Regan

et al

(2011) question the

reliability of the mental capacity

to vote being assessed by nurses

who are not necessarily aware

of voting rights and do not have

access to organisational

guidelines to equip them to

undertake assessment of

decision-making capacity.

Karlawish

et al

(2008) report

on a court ruling in 2001 in

favour of a mentally ill person

with an appointed guardian.

The ruling reasoned that a

person who understands the

process and consequences of

voting and who can choose the

candidate is capable of voting,

irrespective of their

guardianship status.

Supporting residents to vote

As Sue Nelmes, BlueCross

Quality RiskAdvisor and one

of the BlueCross lifestyle team

leaders, explains: “The

conversations about voting

need to start before a resident is

admitted into residential care.

Families and new residents are

often unaware of the need to

change addresses on the

electoral register or that if a

resident does not have the

capacity to vote that an

assessment is required to

remove them from the electoral

roll”.

At BlueCross it is usually the

resident’s GPwho completes

the assessment if capacity to

vote is in question. Sue is

currently reviewing systems

and policies at BlueCross to

ensure that residents’ rights are

acknowledged, and this

includes the right to vote.

Our pre-admission

paperwork has been amended

from a previous question

asking ‘do you want to vote?’,

which suggested that voting is

optional, to ‘are you listed on

the electoral register?’ ”

If the resident still has the

capacity to vote, they or their

representative are prompted to

change their address.

If the resident does not

appear to be able to vote and is

still on the electoral roll

representatives are prompted to

Australian Journal of Dementia Care

June/July 2016 Vol 5 No 3

Supporting the right to vote

With Australia’s Federal election to be held on July 2 this year,

Bridget Howes

considers how people living with dementia in

residential aged care can be supported to exercise their right to vote

Joan Senior (left) is among the

residents who used the mobile

polling station at Riverlea

during the last Victorian

election. “Every vote makes a

difference” says Riverlea

resident Jean Nunn (right)