The Liberty Daily 
(The Daily Signal)—As the Trump administration seeks to crack down on potential voter fraud in nursing homes, an election watchdog group is providing additional information to long-term care facilities, citing several past criminal cases involving political operatives and staff who took advantage of vulnerable elderly residents.
A Centers for Medicare and Medicaid Services memo from late July cited two major cases in recent years, one out of Texas and another out of Wisconsin, involving elderly people being exploited in long-term care facilities for collecting votes.
The memo says facilities have a “responsibility to preserve residents’ rights to vote and to promote participation in the democratic process.” But says, “this activity should not violate federal or state voting laws.” And that staff “cannot engage in inappropriate coercion or other violations of residents’ rights.”
“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,” the CMS memo says.
The Election Integrity Network released a toolkit for instructing senior facilities on how to comply with the CMS guidance.
Among other things, the toolkit suggests facilities or caregivers avoid assumptions and ensure a resident expresses interest in voting; refer that interest promptly to a designated voting coordinator; and protect the resident’s choice and ensure there is no pressure to vote for or against a candidate.
Magan McCreary previously worked at nursing homes and other long-term care facilities in Texas, Connecticut, and Rhode Island before becoming an executive assistant at the Election Integrity Network. She was surprised at what she saw.
“I’ve seen coercion from state volunteers saying ‘this is how I would vote.’ I didn’t stay at a facility after I saw social workers filling out ballots,” McCreary told the Daily Signal. “There is a lack of education about the vulnerability, and too many see it as less of a civic duty and more of something to cross off the activity box. There is a breakdown in the training.”
Concerns about election integrity, voter intimidation or undue influence in nursing homes long predate the Trump administration.
A Government Accountability Office report in 2009 noted that seniors in long-term care facilities are “vulnerable to fraud and undue influence from relatives, long-term care facility staff, campaign workers, or candidate supporters.”
The GAO report further notes, “according to researchers, requiring local election officials to deliver absentee ballots in person to facilities or conduct on-site absentee balloting at facilities, which some states require or allow, can decrease the likelihood of fraud and inappropriate influence by eliminating the need for assistance from influential third parties.”
Activist groups have been known to collect ballots from facilities with no assurance that the ballots won’t be tampered with, according to the Center for Vulnerable Voters. The center, a project of the American Constitutional Rights Union, educates nursing home staff and election officials about the potential dangers of ballot trafficking in nursing homes with cognitively impaired residents.
“We heard recurring stories about this over the years about nursing home staff filling out ballots for nonverbal residents, or activist groups filling out ballots without giving residents a free choice,” Lori Roman, CEO of the ACRU, told the Daily Signal. “This is not partisan. In most cases, the nursing homes just haven’t given this much thought.”
In 2020, Texas state officials charged a social worker with 134 felony counts of election fraud for registering residents of the Mexia State Supported Living Center allegedly without their consent. The social worker eventually pleaded guilty to lesser charges, and no improper votes occurred.
In a separate case in Wisconsin, Racine County Sheriff Christopher Schmaling investigated a case in 2021 alleging that eight people whose mental capacities had diminished due to age or disease had cast mail-in ballots from Ridgewood Care Center. However, the local prosecutor said “my hands are tied” by a jurisdiction issue and would not bring a case.
An industry group, the American Health Care Assocaition/National Center for Assisted Living, notes the CMS memo was not a new process, but a reminder of existing guidelines.
“AHCA/NCAL and our members are committed to ensuring that residents retain their statutory and constitutional right to vote, while taking appropriate steps to maintain the integrity of the voting process,” Holly Harmon, senior vice president of quality, regulatory and clinical services for the industry group, told the Daily Signal in a statement.
Beyond the cases mentioned in the CMS memo, last year, a Mississippi woman was convicted of violating the state’s ballot-harvesting law when she visited senior citizens’ homes to collect ballots for the 2023 Democratic primary. She was fined more than $2,000 and given a suspended six-month sentence, which she reportedly appealed.
In 2022, a nursing home employee in Macomb County, Michigan, pleaded guilty to three misdemeanor charges after being charged with forging signatures on absentee-ballot applications. She received two years of probation.
Also in Texas, a constable candidate in Waxahachie, Texas, was charged with going through nursing homes and filling out mail-in ballot applications for multiple residents. He was convicted in 2017. Some residents said they did not know what they had been asked to sign.
Last month, 13 Democratic senators led by Sens. Elizabeth Warren, D-Mass., and Alex Padilla, D-Calif., wrote CMS Administrator Dr. Mehmet Oz, asserting the guidance was an “attempt to intimidate nursing home staff from assisting residents in the voting process.”
The Democratic senators noted that neither of the cases cited in the memo resulted in false votes being cast.
“Ultimately, we are concerned that the changes to CMS’s guidance will result in the disenfranchisement of nursing home residents,” the Democrat senators said in the letter. It later added, “In order to protect nursing home residents’ voting rights, we request that you immediately rescind the July 2026 memo and reinstate the 2020 and 2024 guidance.”
Taking advantage of seniors has been a substantial problem, particularly in states where ballot harvesting is easier, said Ken Cuccinelli, chairman of the Heritage Foundation’s Election Transparency Initiative.
“People of the right mind can vote, but people who are incapable are rarely declared incapable; they are just cared for, and that’s when too often a liberal social worker might take advantage of them,” Cuccinelli, a former Virginia attorney general, told The Daily Signal.
