Posted on May 20, 2026

People with disabilities who receive services often face barriers to their decision-making authority. This can impact all facets of their life, from their relationships, to self-expression, finances, independence, employment, and more. While everyone has the right to make their own choices, various groups – with either real or even perceived power over the person – can influence or outright restrict decision-making. 

Staff Insights To Promote Decision-Making Authority

In this Capstone, CQL staff are sharing common obstacles that people with disabilities face in exercising their right to make their own decisions. Then, they share strategies that people receiving services and provider organizations can use for promoting and practicing self-determination.

Addressing Issues Involving Living Arrangements

By Nikki Anderson, CQL Quality Enhancement Specialist

A person receiving services expressed a clear and consistent desire to move into their own apartment to gain independence, privacy, and control over their daily life. Their family strongly opposed this decision, citing concerns about safety, isolation, medication management, and the person’s ability to handle emergencies.

The provider is placed in the middle navigating the person’s right to self-determination, while maintaining relationships with family members who believe they were acting in the person’s best interest.

Effective practice begins by centering the person’s voice, clearly identifying and honoring their goals, preferences, and right to make informed decisions. Rather than defaulting to restrictive options, providers should slow the process down, breaking decisions into manageable steps (e.g., trial periods, skill-building) to build confidence and reduce fear.

A key strategy is to translate concerns into actionable supports. Family fears about safety, health, or stability should be acknowledged and then addressed through individualized planning (e.g., technology, check-ins, skill development), rather than used to limit opportunity. This approach shifts the focus from avoiding risk to managing risk in meaningful ways.

Ultimately, supporting autonomy requires balancing dignity of risk with safety through intentional planning, creative supports, and ongoing dialogue. Quality services are demonstrated not by the absence of risk, but by the presence of informed choice, increased independence, and improved quality of life for the person.

By Nova Kalista, CQL Quality Enhancement Specialist

During a recent accreditation, my colleague Anne Buechner and I heard a story from a Residential Director about how the organization recognized that people should not be sharing bedrooms. She said, “no one wants to have an argument with a housemate and then have to go to bed in the same room/space as them that night.” Sharing a bedroom – and especially being limited to a twin-size bed if that is also the case – can directly impact dignity and relationships. This is not just a “space issue.” It’s a rights, choice, and person-centered planning issue.

With promoting rights and person-centered thinking, we need to recognize that adults deserve to live adult lives. Here are some tips providers can use to address this topic:

• Make it clear that sharing a bedroom is only an exception, allowed after discussion and mutual agreement.
• Document in the ISP if a person is sharing a room, using a twin bed, and/or lacking privacy.
• Document consent while keeping in mind that the person has the educational background and experience to draw upon.
• Treat shared bedrooms, whether by choice or agreement, as temporary and revisit the arrangement regularly in ISP/annual planning.
• Adults should have full size beds at a minimum. You need to consider medical needs, personal preferences, as well as body size and comfort. A twin bed should require justification – not the other way around.

This shifts the narrative from “this is just how it is” to “this is something we are actively working on” and “cost matters, but so does dignity.”

Confronting Resistance To Dating

By Rebecca Kasey, CQL Director of Personal Outcome Measures®

Many people with disabilities are limited in how and who they can date. They face obstacles from their families, guardians/conservators, and service providers when they express their desire to date and meet people to form possible romantic connections. If they are supported to date, many people are only provided options for other people with disabilities or are prevented from using dating apps because of safety concerns from those around them.

These tips can help you support people in making their own decisions involving dating:

• Discover the person’s desires and work on a plan together. Begin the conversation with the person receiving services, focusing on what they want from dating and how they would like to pursue it.
• Make sure that they are educated on different options, have opportunities to experience those options, and have been exposed to what is all out there. 
• Talk through how they might prevent harm and promote their safety while they date. 
• Explore how they would like to approach dating with their team. 
• Discuss the person’s plan with their team and if applicable, guardians/family.
• Respect the person’s desires for how, and if, they want this information shared.
• Discuss their desires and how to plan to safely meet them. This could take several conversations. 
• Support the person to date safely and meaningfully.

Remember, people’s perceptions may take time to change, so you should be patient, and continue to advocate for the person to have similar options as everyone.

By Brittany Brashaw, CQL Quality Enhancement Specialist

I’ve noticed a lot of providers struggle to support people with having meaningful relationships. This goes beyond just stating that someone has a boyfriend or girlfriend, but actually providing opportunities for them to engage in activities that would be typical for dating.

People who are dating shouldn’t just see each other where they receive services. They should be engaging in shared interests and activities outside of these environments. However, oftentimes that is not the case. A limitation in this area is not just stating “they can’t do that,” it is also not providing a way for people to actually engage in the relationship when they do have one.

Education is a huge part of this puzzle and making sure that everyone understands what a relationship would look like for those involved. Having real conversations about how someone chooses to engage in this is incredibly important.

What does this person want from the relationship? How are more difficult topics related to abuse and exploitation occurring? Regardless, no one should limit those involved or keep them from a relationship, out of fear that this would occur.

You should ensure that the circle of support is supporting the person to engage in a meaningful relationship based on the person’s wants and desires, and take steps to ensure this is in place for them. This should also include offering options and suggestions that the person may not have considered to provide more thorough support utilizing the Three E’s: Education, Experience, and Exposure.

Embracing Intimate Relationships

By Susan Carr, CQL Quality Enhancement Specialist

A woman receiving services wants to live with her boyfriend, who also receives services. The woman’s mother feels this would be too much involvement based on her daughter’s physical condition.

One suggestion would be for the mother, daughter, agency, and boyfriend to discuss possible scenarios where support may be needed and areas of concern for the mother, as well as the emotional benefits for the couple. The daughter and her boyfriend could then decide how they can be appropriately supported. There may be an opportunity to discuss how financial benefits may be impacted should the couple decide to live together. When a couple receiving SSDI or SSI live together, their combined income and living arrangements may affect the amount of SSI benefits they receive, as SSI is based on financial need. SSDI benefits are generally based on each person’s individual work history and are less likely to change due to living together, although marriage or shared household expenses can impact eligibility for certain supports and Medicaid services. More detailed information can be found by reviewing the ‘Treatment of Married Couples in the SSI Program’ issue paper.

Supporting Self-Expression

By Tina Lowry, CQL Quality Enhancement Specialist

A person living in a residential setting notices someone with a really cool tattoo and gets excited about the idea of getting something similar. When they bring it up, staff quickly shut it down, telling them tattoos are too expensive and that they should be spending their money on more important things. Staff also talk about how painful a tattoo is and discourage the person from wanting one. The conversation ends there. The person is left feeling dismissed and a little embarrassed for even asking.

The Three E’s: Education, Experience, and Exposure can create a more supportive, person-centered approach:

• Education: Have an open, honest conversation about tattoos – what they cost, how to stay safe, what hygiene looks like, and how to care for them afterward. The goal is to share information, not to steer the person away or make them feel judged.
• Experience: Talk through what getting a tattoo is actually like. What does the process feel like? How long does it take? How might it affect them physically or financially? This helps the person picture the full experience and think it through in a real way.
• Exposure: Give the person a chance to explore – look at designs together, visit a licensed tattoo studio, or talk to people who have tattoos. This can build confidence and understanding.

At the end of the day, it’s about making sure the person has the information and support they need, to make their own choice.

Advancing Employment Outcomes

By Rebecca Kasey, CQL Director of Personal Outcome Measures®

A person may have expressed to you a desire to work but their guardian says they are not capable of working and their benefits will be at risk if they do work. If they have not had prior work experiences, teams may often say that a person receiving services is “unemployable” or incapable of working without conducting any assessments, discovery, trials, or training.

Organizations can take a number of steps when it comes to helping people achieve their employment goals:

• Research the options available to the person to find employment. These could be through Vocational Rehabilitation Services, work-placement programs, skill development or job training programs, or beginning with volunteer opportunities. 
• Research ways for the person to understand how their income may affect other benefits they receive, which could include a benefits review from a Benefits Counselor. 
• Talk to the person about their desires for work and what skills and support needs they may have. Talk about how they want to discuss this with their guardian and team to prepare a plan.
• Assist the person in presenting this information to their guardian and team. Remember, this can sometimes take several conversations and creative approaches to be successful. 
• Support the person in accessing needed services so they can successfully find their chosen employment.

Remember, work and career are often an important part of every person’s self-worth, and sometimes, identity.

Making ‘Cents’ Of Money Management

By Susan Carr, CQL Quality Enhancement Specialist

A person receiving services has to pre-pay (give money to the staff) when going to visit places in the community such as an aquarium. The person has their own debit card and uses the card when not with the agency staff.

The agency could help reinforce effective use of the debit card, including the pin number, by encouraging the person to use the debit card as needed. This would also open up the opportunity to use apps such as Google wallet to store things like tickets.

By Anne Buechner, CQL Quality Enhancement Specialist

There are many legacy practices in existence with little to no adequate due process on money control and financial literacy supports. Once people enter into more residential-type services, it’s either a written expectation, informal practice, or continuation of previously assigned rep payee status, that people who receive services sign over rep payee authority to the organization. People are afforded limited to no opportunities involving current, modern financial institution supports available to all citizens.

People are regularly held to a higher standard for demonstrating change-making skills, balancing budgets, writing out hard copy checks, etc. There is often very limited to no consideration of automatic bill paying or other financial services provided by community banking institutions.

Providers and the people they support should build relationships with local banking institutions, or possibly credit unions, which may have more significant roots to a person’s community.

There should be full on strengths-based supports when evaluating people’s financial literacy. For example, with the proper banking support, this could include how the person learns to access monthly statements, review automatic bill payments, and potentially set up savings, based on what personal aspirations people may have.

Organizations should explore how to navigate learning about and supporting consideration of ABLE accounts and other asset-based resources for people who receive services.

Many people who receive services live at or under the poverty line. Considerations might need to be given to supporting how people can creatively and concurrently develop financial security/literacy without risking the loss of third party benefits.

Promoting Decision-Making In Your Work

While barriers to people exercising their decision-making authority may stem from ‘good intentions’ related to issues of safety, health, risk aversion, or general well-being, they limit people from experiencing full and meaningful lives. Hopefully, this Capstone can spark some ideas you can use in your daily work, to ensure that people receiving services can exercise their rights, make their own choices, and be afforded the dignity of having control over areas that impact them.

Thank you to the following CQL staff who facilitated this edition of Capstone:

• Jasmine Black, CQL Quality Enhancement Specialist
• Susan Carr, CQL Quality Enhancement Specialist
• Katherine Dunbar, CQL Vice President of Services and Systems Excellence
• Kendra Julius CQL Quality Enhancement Specialist