Close up image of a caretaker helping older woman walk

As election day draws nearer, the general media have increasingly highlighted quandaries facing nursing home operators, their residents and election judges. Scrutiny has grown particularly high in a handful of swing states that are considered up for grabs in the race for president.

In Ohio, for example, the Akron Beacon Journal highlighted a case of a man concerned over how his parents were wearing “I voted today” stickers. The parents, both 81, have memory and cognitive disabilities so strong they don’t recognize the son.

The nursing home arranged for absentee balloting. Under state law, employees from the board of elections go to nursing homes in pairs — one Democrat and one Republican — to assist with the process. Election officials say family members could impose their voting agenda with elderly relatives so they are discouraged from making voting decisions. If nursing home residents are not responsive, election workers simply mark their ballots as not cast.

It’s a scenario being played out in many areas across the country and raises difficult questions over who gets to decide whether a nursing home resident is responsive or competent enough to vote.

According to one estimate, as many as 20% of all voters taking part in this week’s presidential election may cast ballots before Tuesday.