Resources for Navigating Adult Disability Services:
Decision-Making Roles and Support
This page focuses on the different decision-making roles for individuals with disabilities.
Overview of Decision-Making Supports:
When a person turns 18 in Tennessee, they are considered a legal adult and gain the right to make decisions about:
- Health care
- Money and benefits
- Housing
- Education and training
- Daily living
- Community activities
Some individuals may need support as they make decisions. Such support could be formal (e.g., conservatorship) or informal (e.g., supported decision-making).
*NOT all individuals need conservatorship. Tennessee emphasizes the least restrictive alternatives so individuals can maintain as much independence and autonomy as possible.
*Other states have guardianship, but in TN the most restrictive form is conservatorship
Examples of formal and informal decision-making supports include:
- Supported decision-making (SDM)
- Power of attorney (POA)
- Joint bank accounts
- Representative payees
- Limited conservatorship
- Full conservatorship (only if necessary)
What is supported decision-making (SDM)?
Supported decision-making is a non-legal, written agreement. An individual chooses trusted supporters, and the individual retains all of their rights. This works well for individuals who just need help understanding or communicating decisions.
What is a power of attorney?
A power of attorney is a legal document in which a person voluntarily grants another person the authority to assist with financial or medical decisions. This can be revoked at any time, and an individual's rights are preserved.
Joint Bank Accounts: Families may use shared accounts, co-signers, and spending limits. These options support financial independence without restricting rights.
Representative payee: Social Security may appoint a representative payee when an individual needs help managing benefits.
- Manages SSI/SSDI payments
- Pays for basic needs
- Keeps records
- Does not impact other legal rights
What is a conservatorship?
- Limited conservatorship: Court assigns a conservator to make decisions in specified areas only (e.g., finances, healthcare). The individual retains rights not removed by the court.
Must be narrowly tailored to the person’s actual needs.
- Full conservatorship: The court removes the person’s ability to make many or all legal decisions. The conservator has authority defined by the court. In Tennessee, this is considered a last resort. It requires significant court documentation AND annual reporting. Full conservatorship impacts decisions about every part of someone’s life, including finances, community living, safety and security, social and spiritual life, daily life and employment, citizenship and advocacy, and healthy Full conservatorship is often put in place due to significant cognitive impairments, severe safety concerns, or an inability to understand decisions, even with support.
*Courts require strong documentation and encourage exploring other supports before choosing full conservatorship - although possible, it is very difficult to terminate or reverse a conservatorship.*
Watch this video to learn more:
A version of this video is available in Spanish here.
ASSIST videos were supported by the National Institute of Mental Health (R01 MH116058, PI: Taylor). ASISTIR videos were supported by the National Institute of Mental Health (R03 MH129757, PI: Burke).
Below, we share some relevant resources in Tennessee. Click a resource title to visit its website. All resource descriptions are derived from the respective organizations.
Resource |
Contact |
Tennessee Center for Decision‑Making Support
The center’s goal is to provide easy-to-understand, accurate information about all decision-making support options for people with disabilities, in one place.
*Best first stop for families deciding between SDM, POA, and conservatorship.*
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(615) 248-5878 Ext: 322
ds@thearctn.org
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The Arc of Tennessee
Learn who to contact or where to get more resources for decision-making support at The Arc of TN.
Read "Debunking the Myths of Supported Decision-Making and Guardianship"
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(615) 248-5878
info@thearctn.org
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Conservatorship Association of Tennessee
Conservatorship Association of Tennessee (CAT) is a membership organization of people who are concerned about the quality of services forTennesseans with disabilities who need assistance in decision-making.Membership is open to conservators, guardians, attorneys, representative payees, advocates, family members, judges, magistrates, physicians, social workers, case managers, and anyone else interested in improving the lives of Tennesseans. |
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National Resource Center for Supported Decision-Making
The National Resource Center for Supported Decision-Making (NRC-SDM) builds on and extends the work of Quality Trust’s Jenny Hatch Justice Project by bringing together vast and varied partners to ensure that input is obtained from all relevant stakeholder groups including older adults, people with intellectual anddevelopmental disabilities (I/DD), family members, advocates, professionals and providers.
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(202) 448-1454
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Tennessee Disability Pathfinder
Use Pathfinder to locate:
- Legal support
- Advocacy agencies
- Case managers
- Mental health supports
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(800) 640-4636
tnpathfinder@vumc.org
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Information last reviewed January 2026
To recommend other helpful resources, please send suggestions to ucedd@vumc.org.
Tips to Help Decide Which Decision-Making Option is Best
- Identify the individual's strengths
- What decisions can they already make independently?
- What supports do they currently use?
- What accommodations help them understand complex information?
- Review their daily living needs and consider:
- Health care
- Money management
- Housing safety
- Personal care
- Employment support
- Begin with the Least Restrictive Supports
- Supported decision-making
- Power of attorney
- Representative payee
- Joint accounts
- Limited conservatorship
- Full conservatorship
- Conservatorship may need to be considered if:
- The person is unable to understand or communicate decisions
- There are major health or safety concerns
- There is a risk of harm
- Speak with Professionals
- Case managers
- Disability Rights Tennessee
- The Arc TN
- Attorneys who specialize in disability law
- School transition staff
- Medical providers
Advocacy and Self-Advocacy Strategies
- Encourage your child to practice making choices
- Use visual supports or simplified language during discussions
- Ask service providers for decision-making accommodations
- Document strengths and independence
- Avoid assuming conservatorship is required
Teach individuals to:
- Explain their preferences
- Share what supports help them understand decisions
- Ask questions like:
- “Can you say that another way?”
- “What are my choices?”
- “Can I have more time to decide?”
Practice decision-making during daily activities such as:
- Budgeting
- Choosing meals
- Talking to doctors
- Planning activities
Common Myths
- Myth: “All individuals with intellectual disabilities need guardianship.”
Truth: Many Tennesseans use supported decision-making or other types of decision-making supports.
- Myth: “Conservatorship takes away all rights.”
Truth: Only full conservatorship removes most rights. Limited conservatorship preserves many rights.
- Myth: “You can’t change a conservatorship.”
Truth: Conservatorships can be modified or terminated if needs change. However, it is often hard to revise a conservatorship.
- Myth: “Once 18, parents automatically keep legal decision-making rights.”
Truth: They do not. In TN, adultsare presumed competent unless a court rules otherwise.
If you are looking for more decision-related services and programs,
search topics of interest on the Tennessee Disability Pathfinder website.
Sometimes, it can be hard to know where to start in Pathfinder. If you are struggling to understand how to find resources related to decision-making, here are some step-by-step directions:
- Start at the main page and click “Guardianship/Alternatives.”
- Click next
- Select the stage of life - Transition/Young Adult
- Click next
- Select the diagnosis that you or the individual identifies with/has
- Click next
- Choose the appropriate payment option that fits your needs
- Click next
- Select the appropriate city or search by your city and/or address
- Take the time to navigate the resulting resources to find what fits your specific