Tennessee Supported Decision Making Agreement

Tennessee's SDM Situation

Tennessee has not enacted a standalone supported decision-making statute. Unlike Texas, which passed the first SDM law in 2015, or the 20+ states that have since followed with formal SDM statutes, Tennessee has no prescribed agreement template, no SDM registry, and no statutory language that explicitly defines the rights and obligations of supporters.

This does not mean supported decision-making is unavailable or unrecognized in Tennessee. It means you build it differently.

Tennessee's conservatorship code under T.C.A. § 34-1-101(11) defines "least restrictive alternatives" as techniques and processes that preserve as many decision-making rights as practical. Supported decision-making — where the individual retains full legal authority while receiving structured help — is the least restrictive option on the spectrum. It sits above powers of attorney, above conservatorship, and above any other tool that delegates or removes rights.

The state's Uniform Health-Care Decisions Act specifically recognizes supported decision-making as a factor in evaluating a person's capacity to make healthcare choices. And the federal Department of Health and Human Services issued guidance recognizing SDM as a reasonable modification under Section 504 of the Rehabilitation Act, which gives SDM agreements leverage with any entity that receives federal funding — hospitals, schools, social services agencies.

What an SDM Agreement Actually Does

A supported decision-making agreement is a voluntary, written contract between an adult with a disability (the decision-maker) and one or more trusted individuals (the supporters). It specifies:

• Which areas of life the decision-maker wants help with — healthcare, finances, housing, employment, education, social relationships
• What each supporter does — gathering information, explaining options in accessible formats, attending meetings, communicating the decision-maker's choices to third parties
• What supporters cannot do — make decisions for the person, override the person's choices, sign documents on the person's behalf, access accounts independently

The decision-maker keeps all of their legal rights. A supporter in an SDM arrangement is not an agent, not a fiduciary, and not a legal representative. They are a structured helper — someone the decision-maker has formally identified as a person they trust to help them understand and navigate specific situations.

How to Create an SDM Agreement in Tennessee

Because Tennessee has no statutory form, you create a private agreement using established SDM frameworks. The Tennessee Center for Decision-Making Support — a partnership between The Arc Tennessee, the Tennessee Council on Developmental Disabilities, and Disability Rights Tennessee — provides resources, training, and attorney referrals specifically for this purpose.

Step 1: Assess which areas need support

Sit down with the decision-maker and identify where they feel confident making choices on their own and where they want help. Common domains:

• Medical decisions — understanding diagnoses, evaluating treatment options, communicating with providers
• Financial management — budgeting, understanding bills and statements, managing bank accounts
• Housing — choosing where to live, understanding lease terms, handling landlord issues
• Employment — navigating workplace expectations, understanding benefits, handling job applications
• Education — IEP decisions, college applications, vocational training enrollment

Step 2: Choose supporters

Supporters should be people the decision-maker trusts and who understand their communication style. Many agreements designate different supporters for different domains — a parent for medical decisions, a sibling for social and recreational choices, a teacher or job coach for employment decisions.

Step 3: Draft the agreement

A written agreement should include:

• The decision-maker's name and statement that they are entering into the agreement voluntarily
• Each supporter's name and the specific domains they will assist with
• A clear statement that supporters will help the decision-maker understand information and communicate choices, but will not make decisions for them
• A clause stating the agreement can be revoked by the decision-maker at any time
• Signatures of the decision-maker and each supporter
• Date of execution

Having the agreement notarized isn't legally required in Tennessee (since there's no statute to satisfy), but notarization adds weight when presenting it to hospitals, banks, or other institutions that may question the arrangement.

Step 4: Pair with complementary tools

An SDM agreement alone doesn't give supporters the ability to access medical records or manage bank accounts on the decision-maker's behalf. Because supporters have no legal authority, you should layer the agreement with:

• HIPAA releases — filed with each healthcare provider, authorizing them to share medical information with designated supporters
• FERPA releases — if the decision-maker is enrolled in school, authorizing educational records access
• A "supporter letter" — a document the decision-maker carries (or that's on file at key institutions) explaining that they make their own decisions with the assistance of named supporters, and asking the institution to allow the supporters to participate in discussions

SDM vs. Conservatorship

The comparison is stark:

SDM is the right tool when the person can make decisions with support — when the challenge is accessing and processing information, not the fundamental ability to understand choices and express preferences. Conservatorship is appropriate only when the person genuinely cannot participate in decision-making, even with support, in specific domains.

When Institutions Push Back

The practical challenge with SDM in Tennessee — as in any state without a formal statute — is institutional acceptance. A hospital administrator who's never heard of supported decision-making may refuse to involve a supporter in medical discussions. A bank may say "we need a power of attorney or a court order."

Responses that work:

For healthcare providers: Reference the Uniform Health-Care Decisions Act's recognition of SDM as relevant to capacity evaluation. If the person has a HIPAA release on file authorizing the supporter to receive their health information, the provider can include the supporter in conversations where the patient wants them present.

For financial institutions: If the bank needs someone to have signing authority on the account, SDM alone won't satisfy that — you'll need either a durable financial POA (if the person has capacity to sign one) or a joint account. SDM can coexist with a POA — the SDM agreement governs how decisions are made, and the POA gives the legal authority to execute those decisions.

For schools: The Delegation of Educational Decision-Making form is the proper tool for IEP authority. SDM complements it by ensuring the student remains involved in the decision process even after delegating signing authority.

Getting Help in Tennessee

The Tennessee Center for Decision-Making Support (tndecisionmaking.org) maintains an attorney directory of lawyers who specialize in SDM agreements and least restrictive alternatives. Disability Rights Tennessee provides free systemic advocacy, and TNSTEP (Tennessee's Parent Training and Information Center) offers SDM training workshops for families.

The Tennessee Adult Guardianship & Alternatives Guide includes an SDM agreement framework with sample language, a supporter code of conduct template, and the capacity assessment worksheet that helps you determine whether SDM alone is sufficient or whether additional tools like POA or conservatorship are needed for specific domains.

See more Tennessee guides →