Voting with a Disability

People with Disabilities Engaging in Voting as an Occupation during a Pandemic

The 2020 election cycle is playing out against a backdrop of social unrest, economic uncertainty and a global health crisis caused by the coronavirus (COVID-19). Of great concern is the pandemic’s impact on voting access for adults with disabilities, a process that can be inherently complex under typical circumstances. 

Efforts by states to reduce transmission of the coronavirus include closure of some polling sites and promotion of mail-in voting. Challenges to the election process are manifold for people with disabilities, underscoring the importance of a comprehensive plan to create the least restrictive voting environment. Additionally, election officials, staff, and volunteers must be adequately educated and trained to assist voters with impairments. 

In 2016, approximately 60 million noninstitutionalized adults in the United States reported at least one disability in mobility, cognition, hearing, or vision (Okoro, Hollis, Cyrus, & Griffin-Blake, 2018). According to the American Civil Liberties Union (2020), one in three people with a disability is eligible to vote in this year’s election process. Individuals with disabilities may be especially susceptible to insufficient preparation and planning by state election officials, whose responsibilities include educating the public and ensuring that accessibility resources are available. 

Brief History of Voting Rights for Persons with Disabilities (PWD)

The right to vote, enshrined in the Voting Rights Act of 1965, remains a fundamental and durable civil right in our democracy, allowing individuals to choose the people that will govern as guaranteed by the 14th and 15th amendments (U.S. Department of Justice, 2017). Many people with disabilities (PWD), however, waited for their right to vote until the Voting Accessibility for the Elderly and Handicapped Act (1984) was passed to require poll accessibility for federal elections (U.S. Department of Justice, 2014). 

After the Americans with Disabilities Act was signed into law 30 years ago, additional protection was granted under Title II that guaranteed the rights of PWD to voter registration, physical voting site access, and submission of votes on election day or the provision of alternative options if accessibility could not be provided (U.S. Department of Justice, 2014). The National Voter Registration Act (1993) was signed into law to increase the number of PWD and other minorities by providing additional assistance for registration and voting (U.S. Department of Justice, 2014). 

The built environment in polling places is not accessible in all sites despite passage of these laws, and many poll workers are not trained to address the needs of PWD (Vasilogambros, 2018). 

The Government Accountability Office (GAO), in a non-representative sample for elections in 2016, found roughly 2/3 of 137 polling places had at least one error in accessibility (GAO, 2017, para.1). In addition, the GAO identified difficulty in polling booths considered to be accessible, finding that 65% prevented private, independent voting by a PWD (GAO, 2017, para.2).  Although voting patterns among PWD typically demonstrate low turnout, a study at Rutgers University of voting patterns during the 2018 midterms revealed that the number of individuals identifying as having a disability outnumbered Latinx voters and was close to the number of African-American voters (Rutgers University School of Management and Labor Relations, 2019, para.1).

A new bill, H.R. 1573 Disability Voting Rights Act, sponsored by Rep. Mary Gay Scanlon, was introduced in March 2019 to the House in the 116th Congress. This bill expands the Help America Vote Act (HAVA) of 2002 to allow use of absentee ballots by PWD in Federal elections, electronic registration to vote or registration by mail, designates single state offices to manage disability voter procedures, tracks delivery of ballots, and allows voting at home to enable individuals to use technology they own to facilitate the voting process, as well as improving physical and functional access to polling places (Disability Voting Rights Act, 2019). Unfortunately, the bill is sitting in the Committee on House Administration. 

Voting as an Occupation

Voting is an Instrumental Activity of Daily Living, defined as “home and community [activities] that often require more complex interactions than those used in ADLs” (AOTA, 2014, p. S19). Voting is also linked to Social Participation in the community, is impacted by physical and social environments, and embedded in personal and temporal contexts. 

Voting is an occupation supporting fundamental rights and values. It is comprised of multiple activities including registering to vote, educating oneself about issues of concern and candidate positions, understanding civil voting rights in general and specifically for PWD, managing transportation to the polling site, accessing the polling site, accessibility of the voting machine or use of an absentee voting form, and understanding one’s rights to assistance at the polling site if needed. 

Voting is further supported by the inclusion of Townsend and Wilcock’s concept of Occupational Justice (2004) in the Occupational Therapy Practice Framework, 3rd edition, whereby a PWD may experience the same access to resources for personal and societal needs, engagement, and participation (AOTA, 2014, p.S35). Voting provides opportunities for client empowerment, increased self-efficacy, participation in civic and community life, and equalization of rights.

Case Study: Nikki G.

Nikki arrived at her newly assigned polling place to vote in the Presidential primary escorted by her husband Anthony. Health risk associated with COVID-19 forced the closure of her regular site. Nikki is visually impaired and participates in the election process with assistance from her husband. In past elections, Nikki’s husband entered the voting booth with her, read the names of each candidate and selected the desired candidates at Nikki’s direction. Despite phonetically spelling her name and showing identification, poll workers could not locate Nikki’s name. She was given a provisional ballot. 

While completing the provisional ballot, Anthony noticed a voting booth with a sign indicating a PWD could use the machine. Concerned that Nikki’s provisional ballot might not be accounted for since her name could not be located, Anthony asked that Nikki use the booth instead. To use the machine, voters had to have already registered with the state or needed to show identification that confirmed their status as a PWD. Nikki provided the required documentation. She was also required to sign an affidavit attesting to her eligibility to use the accessible booth. 

After a few minutes of two poll workers reading instructions, plugging in cords, pushing buttons that did not respond to touch, and waiting for lights that never came on, it became evident they were not properly trained to operate the voting booth. Eventually, Nikki was asked to return later that afternoon to allow time for the booth to be repaired. Nikki requested that her husband enter the booth with her as he had done for every other election. Poll workers told Anthony that he was not permitted to assist Nikki because of the risk that he might ‘sway her vote’ in violation of Section 208 of the Voting Rights Act, permitting all voters the right to bring someone to assist the voting process if there is disability or difficulty with literacy (U.S. Department of Justice, 2020). Nikki and Anthony decided to return to the polling site later. 

When Nikki returned, Anthony realized the poll workers had searched the registration book labeled J through Z. Nikki and Anthony’s last name begins with the letter G. After checking the correct book, Nikki’s name was located, and she proceeded to the voting booth. The voting machine on site was an audio booth that required the voter to follow verbal instructions to move through the election process. Over-ear headphones in substandard condition were provided, leaving the exposed metal ear-frames resting directly on Nikki’s ears. No disposable headphones were available. Considering the pandemic, Nikki and Anthony were concerned about the cleanliness of the headset. 

With the headphones held an inch away from her ears, Nikki struggled to listen to the instructions. A couple of prompts required that she press a button when that button changed color. Due to the nature of Nikki’s visual impairment, she could not discern those colors. She was also going to need help locating buttons on the voting panel but could not use accommodations from prior years to cast her ballot. Reluctantly, Nikki decided to complete a provisional ballot and left.

Implications for Practice

The Intentional Relationship Model (Taylor, 2020) provides a conceptual model of practice to allow therapists to build and sustain an interpersonal reasoning model supporting therapeutic use of self and client-centered practice. Taylor identifies interpersonal style and communication patterns to support client engagement; one of the modes is advocacy. 

Advocacy on the part of the occupational therapist may involve direct provision of education or information to support engagement in desired roles and occupations or may be used to help the client build the skills and behaviors to self-advocate. Taylor includes “awareness of laws or rights, consciousness raising, and normalization of experience” (2020, p. 85). 

Nikki, even with some assistance from Anthony, confronted multiple barriers to voting participation despite asking the right questions and understanding her voting rights. Her experience is not unique. There is an opportunity for occupational therapists to help clients build the skills and behaviors to empower them to participate in their constitutional right to vote.  Vote-by-mail or the use of provisional ballots are not a panacea to increase access to voting but might result in access for some segments of the population, especially during the pandemic. 

Individuals with compromised immune systems, with disabilities or concerns about traveling on public transportation may feel unsafe voting in person. The voting block of PWD is variable, like other minority groups, and very diverse in the accessibility options required to register and submit votes. Despite the critical nature of voting, there is little documentation in the occupational therapy literature discussing this IADL. 

SabeUSA, whose motto “Self-Advocates Become Empowered”, is a non-profit that offers free PowerPoints, videos, and print materials to support civic engagement and the development of voting skills. Occupational therapists enthusiastically participate in AOTA’s annual Capitol Hill Day to support key legislation for client populations and the profession, as well as bring awareness of the profession to legislators. However, there is less information on how occupational therapists are training clients in the civic literacy and self-advocacy skills they require to engage in and participate in voting behaviors. We hope that in this critical election year, therapists will embrace the occupation of voting and support interested clients to exercise  this critical civil right.


American Civil Liberties Union National Disability Rights Network (2020). Let people with disabilities vote.    
American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl.1), S1–S48.

Disability Voting Rights Act, H.R. 1573, 116th Congress (2019).

Government Accountability Office GAO Highlights (2017, October). Voters with disabilities: Observations on polling place accessibility and related federal guidance. GAO-18-4. Retrieved 8/17/10, from

Okoro, C.A., Hollis, N.D., Cyrus, A.C., & Griffin-Blake, S. (2018, August 17). Prevalence of disabilities and health care access by disability status and type among adults – United States, 2016. Centers for Disease Control and Prevention: Morbidity and Mortality Weekly Report. 67, 882-887.

Rutgers University School of Management and Labor Relations. (2019, July 10). Voter turnout surges among people with disabilities. Retrieved 8/17/20, from

SabeUSA GoVoter Project (2019). Voter education toolkit. Retrieved from

Schur, L., & Kruse, D. (2019, July). Fact sheet: Disability and voter turnout in the 2018 elections. Rutgers University School of Management and Labor Relations.

Taylor, R.R. (2020). The intentional relationship: Occupational therapy and use of self (2nd ed.). F.A. Davis.

U.S. Department of Justice Civil Rights Division, Disability Rights Section. (2014, September). The Americans with Disabilities Act and other federal laws protecting the rights of voters with disabilities. Retrieved 8/19/20, from

United States Department of Justice. (2020, March 11). Statutes enforced by the voting section. Retrieved 8/19/20, from

United States Department of Justice. (2017, July 28). History of federal voting rights laws. Retrieved 8/19/20, from

Vasilogambros, M. (2018, February 1). PEW Stateline: How voters with disabilities are blocked from the ballot box. Retrieved 8/19/20, from

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