Supported Decision Making Tennessee

Conservatorship Strips Away Civil Rights — Tennessee Has a Less Restrictive Alternative

When families hear that a conservatorship is the only way to protect a parent who's struggling with decisions, they're often not told about the option that lets the parent keep their legal rights while still getting structured help. Supported Decision-Making (SDM) is a framework where a person with cognitive or developmental challenges chooses trusted "supporters" — family members, friends, professionals — who help them gather information, weigh options, and communicate decisions, without transferring any legal authority away from them.

Tennessee incorporated SDM into its legal framework through a 2018 amendment to the conservatorship statutes. Under T.C.A. § 34-1-101(11), "least restrictive alternatives" are defined as techniques and processes that preserve as many decision-making rights as practical. SDM is explicitly recognized as a vital alternative to conservatorship, and Tennessee courts have an affirmative duty under T.C.A. § 34-3-107 to consider least restrictive alternatives before imposing a conservatorship.

How SDM Actually Works in Practice

An SDM agreement is a voluntary document between the individual and their chosen supporters. It outlines:

• Which areas of life the supporters will help with (medical decisions, financial management, housing, employment)
• What kind of help the supporters provide (researching options, explaining medical information, accompanying the person to appointments, helping communicate decisions to third parties)
• The boundaries of the supporter's role — they advise and assist, but the individual makes the final decision

The individual retains all their legal rights. They can vote, sign contracts, make medical decisions, manage money, choose where to live, and marry. The supporters don't have the authority to override them. If the individual makes a decision the supporters disagree with, the individual's choice stands.

This is fundamentally different from a conservatorship, where the court transfers some or all decision-making authority to the conservator, and the ward may lose the right to decide where they live, whether to accept medical treatment, or how their money is spent.

The Tennessee Center for Decision-Making Support

The Tennessee Center for Decision-Making Support (tndecisionmaking.org), supported by the Department of Disability and Aging, is the state's primary resource for SDM education and implementation. The center provides:

• Free training for individuals, families, and professionals on how to set up SDM agreements
• Model SDM agreement templates
• Resources for navigating the transition from conservatorship to SDM
• Advocacy for expanding SDM recognition across state agencies and financial institutions

The DDA actively promotes SDM as part of Tennessee's disability services framework, recognizing that many people who might otherwise face conservatorship petitions can function effectively with structured support instead.

When SDM Works and When It Doesn't

SDM is appropriate when the individual can still express consistent personal preferences and identify people they trust to help them. A parent with early-stage dementia who has clear days, can articulate what they want, and recognizes their supporters may be an excellent candidate. So might an adult with an intellectual disability who needs help processing complex financial or medical information but can make decisions when the information is explained clearly.

SDM does not work when the individual:

• Cannot consistently express preferences or communicate choices
• Cannot identify or trust any supporter
• Is at immediate risk of financial exploitation that they cannot recognize or resist
• Has already lost the capacity to understand the nature and consequences of their decisions

In those situations, a conservatorship may genuinely be the least restrictive option available. But Tennessee courts are required to consider less restrictive alternatives, including whether an SDM arrangement could address the person's needs; demonstrating a functional arrangement may affect the court's conservatorship decision.

The Practical Limitation: Third-Party Acceptance

Tennessee has not passed a standalone statute making formal SDM agreements legally binding on third-party commercial entities. This creates a practical gap: a bank may refuse to let a supporter help the individual manage their account because the supporter has no legal authority. A hospital may refuse to share medical information with a supporter because they aren't named in a health care power of attorney.

The workaround is to combine SDM with targeted legal instruments. The individual can execute a durable financial POA naming a supporter as agent for specific financial tasks, and an Advance Directive naming a supporter as healthcare agent — while still using the SDM framework for day-to-day decisions that don't require formal legal authority.

This hybrid approach preserves the individual's autonomy for most decisions while ensuring the supporters have the legal backing they need for the situations where third parties demand it.

If There's Already a Conservatorship in Place

Tennessee law allows families to petition the court to modify or terminate an existing conservatorship when circumstances change. If a ward's condition improves, or if the family can demonstrate that a less restrictive arrangement (like SDM) would adequately protect the individual, the court can restore some or all of the ward's decision-making rights.

The Tennessee Power of Attorney & Guardianship Kit covers the full spectrum of legal authority options — from SDM agreements through powers of attorney to conservatorship — with a decision flowchart that helps families determine which level of intervention their parent's situation actually requires.

See more Tennessee guides →