Overview
Supported Decision-Making (SDM) is the fastest-growing alternative to guardianship in the United States, and for good reason. It is built on a simple, powerful premise: most people with disabilities can make their own decisions when they have the right help. What they need isn’t someone to decide for them, they need someone to help them understand their options, think through the consequences, and communicate their choices.
Washington State formally recognized Supported Decision-Making in law in 2020 (Senate Bill 6287, effective January 1, 2022), making it one of 13 states nationwide to explicitly codify SDM as a legal alternative to guardianship under RCW 11.130.700–11.130.755. Courts in Washington are now required to consider alternatives to guardianship, including SDM, before granting any guardianship petition.
This page goes deeper than the overview on the Guardianship and Alternatives page →. It explains exactly how SDM works, how to set one up, what it covers, and where to get help — so families can evaluate whether it’s the right fit for their family member.
The Core Principle
The disability rights movement has a phrase: “Nothing about us without us.” Supported Decision-Making is the legal expression of that principle.
Historically, guardianship followed an all-or-nothing model: a person was either legally “competent” or legally “incapacitated.” Once declared incapacitated, they lost the ability to make decisions about their finances, medical care, living arrangements, and personal life, often permanently. A guardian stepped in and made those decisions instead.
SDM rejects that binary. It recognizes that capacity is not all-or-nothing, it varies by domain, by context, and by the support available. A person with an intellectual disability may be fully capable of deciding what they eat, who they spend time with, and how they want to live, with some help understanding the implications of a medical procedure or a rental contract. SDM provides that help without removing the person’s rights.
Under an SDM agreement, the person with a disability retains full legal capacity. They make their own decisions. Their supporters help them get to that decision, but the final call is always theirs.
How It Works in Practice
Step 1: The individual chooses their supporters
The person with a disability identifies one or more trusted people they want as supporters. Supporters can be family members, friends, neighbors, service providers, or anyone else the person trusts. There is no limit on the number of supporters, and different supporters can be assigned to different areas of life.
Supporters must be:
- Trusted by the individual
- Willing to help without imposing their own preferences
- Able to keep the person’s best interests, not their own convenience, at the center
Step 2: The agreement is created
The individual and their supporters sign a Supported Decision-Making Agreement (SDMA) that specifies:
- Which areas of life the supporters help with (medical decisions, financial decisions, housing, relationships, education, employment, or any combination)
- Which areas the individual handles independently
- What the supporter’s role is — explaining, researching, accompanying, communicating, or other specific types of help
- Who the supporters are and how to contact them
The agreement is voluntary, customizable, and can cover as many or as few areas as the person chooses. It does not require court approval.
Step 3: The agreement is used
When the individual needs to make a decision in a covered area, their supporter helps them:
- Gather and understand relevant information
- Think through options and potential consequences
- Ask questions and get clarification
- Communicate their decision to doctors, landlords, banks, or other parties
Third parties like medical providers, financial institutions, schools, government agencies are required to recognize the person’s authority to make their own decisions. The supporter can be present in appointments and meetings, can help explain, and can advocate, but the individual’s decision is what counts.
Step 4: The agreement is adjusted as needed
The individual can change their agreement at any time, adding or removing supporters, changing the areas covered, or ending the agreement entirely. No court involvement is required for any of these changes. This flexibility is one of SDM’s greatest strengths.
What SDM Covers — and Doesn’t
SDM can cover any area of life the individual chooses, including:
- Medical decisions: understanding diagnoses, treatment options, and medications; communicating with healthcare providers
- Financial decisions: understanding bills, bank accounts, budgeting, and contracts
- Housing: evaluating living options, understanding lease agreements, communicating with landlords
- Education and employment: IEP decisions, job choices, workplace communication
- Government benefits: understanding SSI, Medicaid, DDA services, and benefit changes
- Personal and social life: relationships, activities, community participation
SDM does not provide legal authority to sign documents on someone’s behalf, access someone’s accounts, or override someone’s decisions. If those tools are needed, a Power of Attorney or other legal instrument may need to work alongside the SDM agreement.
SDM vs. Guardianship — The Critical Differences
This is the comparison that matters most for families weighing their options:
| Supported Decision-Making | Full Guardianship | |
|---|---|---|
| Individual retains legal rights | Yes — completely | No — rights are removed |
| Who decides | The individual (with support) | The guardian |
| Court involvement to create | No | Yes — legal process required |
| Court involvement to change | No — change anytime | Yes — must petition court |
| Cost to establish | Free | $3,000–$10,000+ |
| What happens if it doesn’t work | Adjust or end it — no court needed | Must petition court to modify |
| Reversibility | Immediately — individual’s choice | Requires court proceeding |
| Individual’s voice | Central — they decide | Depends on the guardian |
The single most important difference: under SDM, if a supporter’s advice and the individual’s preference differ, the individual’s decision controls. Under guardianship, the guardian’s decision controls.
Is SDM Right for Every Person with a Disability?
No, and being honest about that matters. SDM is appropriate for individuals who, with support, can:
- Take in and process information (in whatever form works for them)
- Evaluate options, even in a basic way
- Make a decision and communicate it, even non-verbally
- Understand that decisions have consequences
SDM may not be appropriate when an individual’s cognitive or communication limitations are so significant that even with robust support they cannot meaningfully participate in decision-making, and when their safety genuinely requires someone else to have legal decision-making authority. In those cases, limited or full guardianship may be the more honest and protective choice.
The key is an honest assessment of the individual’s actual abilities, not a diagnosis, not an assumption based on a label. Many individuals with significant intellectual disabilities can and do make meaningful decisions about their lives with the right support.
Common Misconceptions
“My family member has a significant intellectual disability, SDM can’t work for them.”
Disability rights advocates and practitioners consistently find that capacity is more domain-specific and support-dependent than most families expect. An individual may need significant support understanding a medical procedure but have clear, consistent preferences about where they live, what they eat, and who they spend time with. SDM can be tailored to honor both realities.
“If we use SDM and something goes wrong, we’ll have no legal standing.”
SDM does not leave families without recourse. Supporters can be present at every appointment and meeting, can advocate loudly for the individual’s best interests, and can help the individual change decisions that aren’t working. If a situation genuinely requires legal authority, such as a medical emergency where providers won’t recognize the supporter’s role, a healthcare POA can be used alongside an SDM agreement.
“Doctors and banks won’t take it seriously without guardianship papers.”
Washington State law requires third parties to recognize SDM agreements. In practice, familiarity varies, some providers are well-versed in SDM and others are not. Carrying a copy of the agreement, knowing your rights, and being prepared to advocate helps. DRW can assist when third parties refuse to recognize a valid SDM agreement.
“We need guardianship to access DDA services and make sure services happen.”
DDA does not require guardianship to access or manage services. Families can be deeply involved in their family member’s DDA services, attend all meetings, and advocate strongly without guardianship. Many DDA clients live and receive services without any guardianship in place.
How to Create a Supported Decision-Making Agreement in Washington State
Step 1: Download a free template
DRW and Washington LawHelp both provide free SDM agreement templates specifically for Washington State. The National Resource Center for Supported Decision-Making also has downloadable templates.
- Washington LawHelp SDM Guide and Template
- Disability Rights Washington SDM Resources
- National Resource Center — SDM
Step 2: Complete the agreement together
Fill out the agreement with the individual at the center of the conversation, not as an afterthought. The agreement should reflect their actual preferences about who supports them and in what areas.
Step 3: Sign and notarize
While court approval is not required, having the agreement witnessed and notarized adds credibility with third parties. Some families also have it reviewed by a special needs attorney to ensure it’s well-drafted and clearly covers the areas intended.
Step 4: Share it
Provide copies to all supporters, relevant medical providers, financial institutions, and anyone else who may need to recognize the supporter’s role. Keep a copy accessible, in a binder, on a phone, or in a shared digital folder.
Step 5: Review it periodically
SDM agreements should be reviewed at least annually, or any time the individual’s circumstances, supporters, or needs change. Update it as life evolves.
Getting Help
Disability Rights Washington
Washington’s Protection and Advocacy organization, the experts on SDM in Washington State. Free legal information, technical assistance, and advocacy.
(800) 562-2702 | disabilityrightswa.org | Request Services
Washington PAVE
Free guide and support on SDM specifically for families of individuals with disabilities.
(800) 572-7368 | wapave.org
Washington LawHelp
Free plain-language legal guide to SDM in Washington, including what it covers, how to create an agreement, and what to do if third parties don’t recognize it.
washingtonlawhelp.org/en/supported-decision-making
Informing Families
Washington State Developmental Disabilities Council resource on SDM and how it works in Washington.
informingfamilies.org/bulletins/sdm
Northwest Justice Project
For income-eligible families who need legal assistance drafting or reviewing an SDM agreement.
(1-888-201-1014 | nwjustice.org
National Resource Center for Supported Decision-Making
The national hub for SDM resources — state-by-state guides, research, and free tools.
supporteddecisionmaking.org
Guardianship and Alternatives → | Disability Rights Washington → | Northwest Justice Project → | Special Education Rights → | Washington ABLE Savings Plan →
FAQ
Can my family member have both an SDM agreement and a Power of Attorney?
Yes, and this is a common combination. An SDM agreement covers everyday decision-making support across life areas. A Durable Power of Attorney provides legal authority to act on someone’s behalf in specific circumstances (like signing financial documents). The two work well together and don’t conflict.
What if a supporter starts making decisions for the person instead of helping them decide?
This is called “undue influence” and it undermines the purpose of SDM. The individual can remove any supporter from their agreement at any time without court involvement. If a supporter is acting improperly, DRW can provide guidance and advocacy.
Does Washington law require doctors and banks to honor an SDM agreement?
Yes, Washington State law recognizes SDM agreements and requires third parties to honor them. In practice, some providers are unfamiliar with SDM. Carrying a copy of the agreement, citing RCW 11.130.700, and being prepared to advocate helps. Contact DRW if a provider refuses to recognize a valid agreement.
Can a person with an SDM agreement still be exploited financially?
SDM does not protect against financial exploitation on its own. If financial protection is a concern, consider combining an SDM agreement with a Representative Payee for SSI/SSDI income, a Washington ABLE account to protect savings, and involving a trusted financial institution that knows the individual. A special needs attorney can help structure these layers of protection.
What if our family member’s condition changes and they need more support?
The SDM agreement can be updated at any time to involve more supporters or cover more areas. If circumstances change significantly and formal legal authority becomes necessary, guardianship can still be pursued, starting with SDM doesn’t close that door.
