For people with disabilities, making financial, healthcare, or everyday life decisions can be complex. Some individuals may need assistance understanding their options, weighing risks and benefits, and communicating their choices — but that doesn’t mean they need someone to reduce their independence and take over decision-making entirely.

Supported Decision-Making (SDM) is a growing alternative to guardianship or conservatorship, allowing individuals to retain control over their own choices while receiving helpful guidance from trusted people in their lives. Instead of a court-appointed guardian making decisions on their behalf, individuals – referred to as “Deciders” – select “Supporters” to help them navigate the important decisions in their lives.

Supporters can be family members, friends, or professionals who assist with gathering information, evaluating options, and ensuring that the Decider’s preferences are clearly communicated in the choices they make. However, a key distinction of SDM is that the Decider remains in control – the role of a Supporter is to assist and offer guidance, not to take over decision-making for them.

The Job of the Supporter

A Supporter’s job is to empower the Decider to make informed decisions, not to override their wishes. Under an SDM agreement, a Supporter can help a Decider:

• Understand available options related to financial planning, healthcare, housing, employment, and education.
• Think through responsibilities and potential consequences before making a choice.
• Gather and organize relevant information from professionals, institutions, or agencies.
• Communicate decisions to appropriate people, such as doctors, banks, landlords, or service providers.

At the same time, Supporters must respect the independence of the individual to make their own choices. For instance:

• They cannot make decisions for the Decider; all choices must come from the Decider themselves.
• They must not pressure, coerce, or unduly influence the Decider.
• They should not have a financial or personal interest in the Decider’s choices, as conflicts of interest could compromise their role.

Many states have enacted laws regulating who can serve as a Supporter, often prohibiting individuals with a history of financial abuse, fraud, or exploitation from acting in this capacity.

Best Practices for the Supporter Role in SDM

1. Establish Clear Expectations

A strong Supported Decision-Making relationship starts with mutual understanding between the Decider and their Supporter:

• Supporters must recognize that they are facilitators, not decision-makers.
• SDM agreements should outline which types of decisions the Decider wants help with, such as managing finances, accessing healthcare, or choosing housing.
• The Supporter should check in regularly with the Decider to see if their needs or preferences have changed.

2. Encourage Independent Decision-Making

While Supporters provide guidance, they shouldn’t override a Decider’s wishes. Instead, they can:

• Present multiple options and let the Decider weigh the choices.
• Help the Decider think through possible outcomes without pushing a specific decision.
• Ensure the Decider has all relevant information, including risks, responsibilities, and alternatives.
• Provide real-world practice by supporting small, everyday decisions before assisting with major financial or healthcare choices.

By fostering independence, Supporters help Deciders build decision-making confidence and can help positively influence their lives.

3. Communicating Effectively as a Supporter 

Effective communication is essential to helping Deciders understand complex topics and make informed decisions. Depending on the Decider’s preferences and needs, Supporters may want to utilize:

• Plain language explanations to avoid jargon and simplify financial, legal, or medical terms.
• Visual aids such as charts, diagrams, or written summaries to illustrate different options.
• Role-playing or scenario-based discussions to help Deciders weigh pros and cons.
• Extra time for discussions to allow the Decider to process and ask questions.
• Assistive technologies or alternative communication methods (e.g., recorded messages, text-to-speech tools) if needed.

By using a communication approach tailored to the Decider’s needs, Supporters can ensure that individuals feel confident and informed in their decision-making.

4. Prevent Undue Influence and Financial Exploitation

One of the biggest risks in SDM is undue influence, where a Supporter intentionally or unintentionally pressures the Decider into a specific choice. Supporters should be on the lookout for red flags that may indicate someone else is attempting to influence the Decider, such as:

• The Decider suddenly changed financial plans without a clear reason.
• A third party is pressuring the Decider to make a decision quickly.
• The Decider appeared confused or hesitant about a decision they previously felt confident about.

If a Supporter suspects undue influence or financial exploitation, they should:

• Discuss concerns with the Decider and ensure they are comfortable with their choice.
• Consult with a trusted professional if needed.
• Report concerns to protective services in cases of suspected abuse or coercion.

5. Maintain Ethical and Confidentiality Standards

It’s important that Supporters respect the Decider’s privacy and only share information with third parties when explicitly authorized.

• Always obtain the Decider’s consent before discussing financial, medical, or legal matters with others.
• Be mindful of privacy laws, such as HIPAA and financial regulations.
• If assisting in legal matters, recognize that attorney-client privilege may not extend to Supporters in some cases.

By upholding these ethical principles, Supporters can maintain trust and integrity in the SDM relationship.

The Impact of Supporters in the Lives of People with Disabilities

Emerging research underscores the significant benefits of SDM when Supporters are well-trained and structured in their approach. Studies conducted by institutions such as the Burton Blatt Institute at Syracuse University and the Kansas University Center on Disabilities have found that individuals with engaged and informed Supporters experience greater confidence in making financial and healthcare decisions. Additionally, SDM has been shown to reduce reliance on full guardianships, allowing Deciders to maintain control while receiving necessary assistance.

The National Resource Center for Supported Decision-Making also reports that structured SDM relationships reduce the risk of financial exploitation, particularly when combined with fiduciary oversight. Furthermore, Deciders in well-structured SDM arrangements participate more actively in financial planning and personal decision-making. These findings highlight the importance of proper training and clear structuring in SDM relationships to promote Decider autonomy while safeguarding against potential risks.

‍

In a Supported Decision-Making agreement, Supporters play a crucial role in helping Deciders navigate complex decisions while preserving their independence and autonomy. By approaching their role with care, transparency, and respect, Supporters can help Deciders make informed choices, build confidence, and lead the self-directed lives that they ultimately deserve.

‍