NDIS Supported Decision-Making: What Providers Must Know and Document

What Is Supported Decision-Making?

Supported decision-making is the process of helping a person with disability to make their own decisions by providing them with the information, assistance, and support they need to understand their options and communicate their choices. The key distinction is that the person retains the final decision-making authority — the supporter assists but does not decide.

Under the NDIS framework, supported decision-making is grounded in several legislative provisions:

• The NDIS Act 2013, section 4(8), which provides that people with disability should be supported to exercise choice and control
• The NDIS Practice Standards, Outcome 1.4 (Independence and Informed Choice), which requires that providers support participants to make their own decisions and exercise their independence
• The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), Article 12, which recognises that persons with disabilities have legal capacity on an equal basis with others and may require support to exercise that capacity

For NDIS providers, supported decision-making is not optional. It is a core practice requirement that auditors assess during every certification audit. Providers must demonstrate that they actively support participants to make their own decisions rather than making decisions for them or defaulting to substitute decision-makers without first attempting supported approaches.

Supported vs Substitute Decision-Making

Understanding the distinction between supported and substitute decision-making is essential for every NDIS provider. The two approaches exist on a spectrum, with supported decision-making being the preferred approach and substitute decision-making being a last resort.

The Hierarchy of Decision-Making Support

The NDIS Commission and Australian guardianship law recognise a hierarchy of support, from least restrictive to most restrictive:

1. No support needed — the participant makes the decision independently
2. Informal support — a trusted person (family member, friend, support worker) helps the participant by providing information, discussing options, or helping them communicate their decision
3. Formal supported decision-making — a formally recognised supporter assists the participant within a structured framework (some states have specific supported decision-making legislation)
4. Co-decision-making — the participant and a formally appointed co-decision-maker must agree on a decision (available in some jurisdictions)
5. Substitute decision-making — a guardian, nominee, or attorney makes the decision on the participant's behalf

Providers should always start at the top of this hierarchy and move down only when less restrictive approaches have been tried and are insufficient for the specific decision at hand.

Legal Framework Across States and Territories

Guardianship and supported decision-making legislation varies across Australian states and territories. While the NDIS Act and Practice Standards are national, the appointment and powers of guardians and other substitute decision-makers are governed by state and territory law.

Victoria's 2019 Act is notable because it was the first Australian jurisdiction to explicitly legislate a preference for supported decision-making over guardianship. It introduced the principle that a guardianship order should only be made if it is the least restrictive means available to achieve the purpose of the order. Other jurisdictions are progressively moving in this direction, and the NDIS Commission's national expectations align with this trend.

Guardianship: When and How It Applies

Guardianship removes a person's autonomy for specified decisions and transfers that authority to a guardian. It is the most restrictive form of substitute decision-making and should only be pursued when less restrictive alternatives have been exhausted.

Types of Guardianship

• Limited guardianship — the guardian has authority for specific decisions only (e.g., accommodation decisions, medical treatment, service arrangements). The participant retains decision-making authority for all other areas of their life.
• Plenary guardianship — the guardian has authority for all personal and lifestyle decisions. This is the most restrictive form and should only be used in exceptional circumstances.

Provider Obligations When a Guardian Is Involved

• Obtain and file the guardianship order — verify the guardian's identity, the scope of their authority, and the expiry date of the order
• Check the scope before each decision — ensure the guardian's authority covers the specific decision being made. A guardian with authority for "accommodation decisions" cannot consent to medical treatment.
• Still involve the participant — even where a guardian has been appointed, the participant must be involved in decision-making to the greatest extent possible. The guardian should make decisions that reflect the participant's known wishes and preferences.
• Document the guardian's involvement — record who made the decision, the basis for the decision, the participant's views (if expressed), and any disagreement between the participant and the guardian
• Monitor the order — guardianship orders have expiry dates. Providers must ensure they are aware of when an order expires and seek updated documentation.

Implementing Supported Decision-Making in Practice

Supported decision-making is a skill that support workers and coordinators must develop through training and practice. Here are practical strategies for implementing supported decision-making in daily service delivery.

Step 1: Identify the Decision

Clearly identify what decision needs to be made. Is it a routine daily decision (what to eat, what to wear), a medium-stakes decision (changing a support arrangement, attending a new activity), or a high-stakes decision (entering a service agreement, moving house, consenting to a medical procedure)? The level of support required will depend on the complexity and consequences of the decision.

Step 2: Provide Information in an Accessible Way

Present the options and relevant information in a format the participant can understand. This might mean using simple language, visual aids, Easy Read documents, real objects (showing actual food options rather than just describing them), pictures, social stories, or interpreter services. The information should cover what the options are, what might happen with each option (benefits and risks), and that the participant has the right to choose.

Step 3: Support Understanding

Check that the participant understands the information. Ask open-ended questions rather than yes/no questions. Give the participant time to process — some participants need significantly more time than others. Revisit the information if needed, using different formats or approaches.

Step 4: Support the Decision

Help the participant weigh the options based on their own values, preferences, and goals. Do not impose your own views or steer the participant toward the decision you think is best. If the participant makes a choice that involves risk, follow the dignity of risk process rather than overriding their decision.

Step 5: Communicate and Implement

Help the participant communicate their decision to anyone who needs to know. Implement the decision and follow up to ensure it is being respected.

Step 6: Document

Record the decision-making process in the participant's file, including what information was provided, how it was communicated, the participant's understanding, and the final decision. This documentation is critical for audit compliance and for demonstrating that supported decision-making was genuinely practised.

Dignity of Risk in Decision-Making

Dignity of risk is the natural companion of supported decision-making. When a participant is supported to make their own decisions, they will sometimes make choices that involve risk. The provider's obligation is to respect these choices while ensuring the participant was informed about the risks.

The Dignity of Risk Assessment form (Document 37 in the SIL Rescue Kit) provides a structured approach to documenting dignity of risk decisions. It should be used whenever a participant makes a decision that involves identified risk and the provider wants to create a formal record of the risk discussion and the participant's informed choice.

Common Dignity of Risk Scenarios in SIL

• A participant choosing to go for walks independently in the neighbourhood despite a history of getting lost
• A participant declining to follow their prescribed diet
• A participant choosing to manage their own medication despite inconsistent adherence in the past
• A participant wanting to invite guests to the SIL house during the night
• A participant choosing not to attend a medical appointment
• A participant wanting to spend their Disability Support Pension on items the support worker considers non-essential

In each case, the provider's role is to inform, document, and respect — not to prohibit, restrict, or override.

Easy Read Materials and Communication Supports

Easy Read materials are one of the most practical tools for supported decision-making. They transform complex information into simple, accessible formats that help participants with intellectual disability, cognitive impairment, or limited literacy to understand their options and make informed choices.

What Makes a Good Easy Read Document?

• Short sentences (one idea per sentence)
• Simple, everyday language (avoid jargon, acronyms, and technical terms)
• Large font (minimum 14-point, preferably 16-point)
• Supportive images or symbols alongside the text
• Plenty of white space
• Left-aligned text (not justified)
• Bold text for key concepts
• One topic per page where possible

Documents That Should Have Easy Read Versions

• Participant rights statement
• How to make a complaint
• Key terms of the service agreement (what supports you get, how to change providers)
• Information about the NDIS Commission (who they are, how to contact them: 1800 035 544)
• Daily routine or activity schedules
• House rules (for shared SIL environments)
• Emergency procedures

Other Communication Supports

Easy Read is not the only tool available. Depending on the participant's communication needs, providers may also use:

• Visual schedules — pictures showing the sequence of activities in a day or process
• Social stories — short narratives that describe a situation, concept, or social skill in concrete terms
• Communication boards or apps — augmentative and alternative communication (AAC) tools
• Interpreter services — for CALD participants (TIS National: 131 450)
• Auslan interpreters — for Deaf participants
• Real objects or demonstrations — showing actual options rather than describing them verbally

Documenting Participant Choices

Documentation is the evidence that supported decision-making occurred. Without documentation, auditors cannot verify that the provider practised supported decision-making — regardless of how well it was done in practice.

What to Document for Every Significant Decision

• What decision was being made
• What information was provided to the participant
• How the information was communicated (verbally, Easy Read, interpreter, visual aids, etc.)
• Evidence that the participant understood the information (what questions they asked, how they demonstrated understanding)
• The participant's decision and their reasons (if shared)
• Whether a support person was involved and who they were
• Any risk mitigation strategies put in place
• The date, time, and who was present

Where to Document

• Progress notes — for routine daily decisions documented as part of shift notes. The Notes Rewriter tool can help structure these entries.
• Dignity of Risk Assessment — for decisions involving identified risk (Document 37 in the SIL Rescue Kit)
• Support plan — for decisions that affect the participant's ongoing support arrangements
• Consent forms — for formal consent decisions (consent to services, consent to share information, etc.)
• Meeting records — for decisions made during support plan reviews or family meetings

Staff Training Requirements

Support workers are on the front line of supported decision-making. They are the people who assist participants with daily choices, explain options, and document decisions. Without adequate training, even the best policies will fail in practice.

Training Topics

• The presumption of capacity — all adults are presumed to have capacity unless demonstrated otherwise
• The difference between supported and substitute decision-making
• How to present information accessibly (using Easy Read, visual aids, simple language)
• How to support a decision without steering it — avoiding leading questions, not imposing personal values
• Dignity of risk — when and how to accept participant decisions that involve risk
• When to escalate — how to identify that a participant may need formal capacity assessment or that a guardianship question may arise
• Documentation — how to record decision-making processes in progress notes

Training should be included in the staff induction process (Document 32 in the SIL Rescue Kit includes supported decision-making items) and refreshed annually. Include scenario-based exercises to help staff practise these skills in realistic situations.

What Auditors Look For

During a certification audit, the NDIS Approved Quality Auditor will assess your compliance with Outcome 1.4 (Independence and Informed Choice) through multiple evidence sources.

Document Review

• Person-Centred Support Policy (or equivalent) that references supported decision-making
• Support plans that reflect participant goals in the participant's own words
• Progress notes that document participant choices and decision-making support
• Dignity of Risk Assessment forms where applicable
• Easy Read versions of key participant-facing documents
• Staff training records showing training on supported decision-making
• Copies of guardianship orders, nominee appointments, or powers of attorney where substitute decision-makers are involved

Staff Interviews

Auditors will ask frontline staff questions such as:

• "How do you help participants make their own decisions?"
• "Can you give me an example of when you supported a participant to make a difficult choice?"
• "What would you do if you disagreed with a participant's decision?"
• "How do you explain information to a participant who has difficulty understanding?"
• "What is the difference between supported decision-making and making a decision for someone?"

Participant Interviews

Auditors will ask participants (with their consent):

• "Do your support workers help you make decisions about your life?"
• "Do you feel you have choices about how you spend your day?"
• "Has anyone ever made a decision for you that you disagreed with?"

Positive participant feedback — combined with documented evidence in files — is the strongest possible indicator of compliance with Outcome 1.4.