Throughout his adult life, Edward Kozlowski, registered Republican, voted in virtually every election.
"In my family, voting was the highest honor of citizenship," his daughter, Judith Kozlowski, said. "You owed it to your country to vote; that was always the message."
He often told his daughter how his father had walked across Siberia to come to the United States. Born in Chicago 99 years ago, Kozlowski grew up on Midwestern farms. He left West Point during World War II to enlist in the Army Air Corps and made four flights over Europe on D-Day. A mechanical engineer, he spent much of his career at NASA and at Texas A&M.
Kozlowski is a resident of an independent living facility in Chevy Chase, Maryland. He didn't want to vote in person this year, wary of exposure to the coronavirus, so his daughter helped him request a mail-in ballot — even though he has developed dementia.
"Some days he's right on the mark; sometimes he's not," she said. Her father can grow disoriented; prone to wandering, he requires round-the-clock caregivers. Yet he watches "The PBS NewsHour" and CNN "religiously," his daughter said, and tuned in for the presidential and vice-presidential debates.
He has macular degeneration, so she read him the ballot during short, kitchen-table sessions over several days. It probably helped that as a former federal prosecutor and elder justice consultant, she knew the rules better than most.
Her father could tell her which candidates he wanted to vote for.
And that is all it takes.
"There are many misperceptions of what 'capacity to vote' is," said Charles Sabatino, director of the American Bar Association Commission on Law and Aging. "Incapacity to follow a recipe and cook dinner doesn't mean incapacity to vote. The inability to remember your grandchildren's names doesn't mean you can't vote."
What is required — as the commission and the Penn Memory Center point out in a new guide — is the ability to express a preference.
"Can you pick among the choices?" said Dr. Jason Karlawish, a geriatrician and co-director of the Penn Memory Center. "That's it."
The U.S. Census Bureau has reported that more than 23 million U.S. adults — close to 10% — have conditions limiting mental functioning, including learning and intellectual disabilities and Alzheimer's disease or other forms of dementia.
Some are young or middle-aged, but most of the nearly 8 million people with dementia are older adults. Many will be effectively disenfranchised.
Voting can become challenging for older citizens who struggle to reach polling places, stand in lines, use computerized voting machines or read ballots printed in small type.
But misunderstandings about cognitive decline present still more obstacles. Workers in nursing homes and assisted living facilities, as well as family members, might refuse to assist impaired voters because they believe that dementia disqualifies them.
It doesn't. A diagnosis of cognitive impairment does not bar someone from voting.
Voters need pass no cognitive tests. They don't have to be able to name the candidates or explain the issues. If they need help reading or physically marking the ballot, they can be assisted, either at the polls or with mail-in ballots. In some states, even people under court-appointed guardianship don't lose their voting rights.
In any case, the proportion of people who have guardians is low. If you are considering helping someone with dementia to participate in an election, and they have registered to vote, in most cases there are only two real guidelines to keep in mind.
One: After reminding the person that Election Day is nearing, ask whether he or she would like to vote. A "no" stops the process, Sabatino said, but "anyone who expresses an interest in voting should be assisted, within the limits of the law."
Two: You can read the voter the ballot choices, if he or she cannot read them, but cannot provide additional information or interpretation, although discussions before voting begins are permitted. "Ask them their choices and see if they answer," Sabatino said. "If they do, they vote."
Voters need not complete the ballot; they can vote for president and ignore everything else. There is no time limit; a relative or paid caregiver can help the voter complete a mail-in ballot over several days. Write-ins are permitted. "If they tell you they want to vote for FDR, you write in FDR," Sabatino said.
"You may find it disturbing to write in someone odd, but we let people do that," Karlawish said. Voters with normal cognition can write in the name of Mickey Mouse, select the first person on the ballot, whoever that might be, and otherwise behave less than rationally. "We can't hold certain people to standards that we don't hold everyone else to, when it's a matter of a fundamental right," Karlawish said.
Earlier this month, a Medicare memorandum warned that nursing homes must ensure that residents can vote and provide assistance when needed.
Most older people with dementia live at home. Could unscrupulous caregivers take advantage of impaired older voters by overriding their choices or discarding their ballots? It's possible but also illegal.
"Anyone who sees undue influence or coercion should report it" to local election boards, Sabatino said.