Participant Choice and Control: When Support Workers Should Say No (And When They Shouldn't)

One of the core principles of the NDIS is participant choice and control—you direct your own supports, make your own decisions, and live your life on your own terms. But when you're receiving personal care, domestic assistance, or community access support in Melbourne, you might encounter situations where your support worker says "no" to something you've requested. This can feel like a violation of the choice and control principle, and sometimes it is. But sometimes it's not.

As a support worker navigating these complex situations, I want to explain when support workers should absolutely respect your choices even if they disagree, when they have a professional and ethical duty to say no, how to tell the difference between the two, and how both participants and workers can navigate disagreements respectfully.

The Foundation: Choice and Control in the NDIS

The NDIS was explicitly designed to replace a system where people with disability had little say in their supports. The NDIS Act enshrines choice and control as fundamental principles. You choose your supports, your providers, when and how supports are delivered, and what goals you pursue.

This is a profound shift from the old system where services decided what was "best for you" without much input from you. Choice and control recognize that you are the expert on your own life and have the right to make decisions—including decisions others might disagree with.

But choice and control have never been absolute or unlimited. The NDIS framework includes concepts like "reasonable and necessary" supports, duty of care obligations, and safeguarding requirements that create boundaries around choice. Understanding these boundaries helps clarify when "no" is appropriate and when it's overreach.

When Support Workers SHOULD Respect Your Choices (Even If They Disagree)

There are many situations where support workers should respect your choices even if they personally disagree or would make different choices themselves:

Lifestyle and Personal Preferences

You have the right to make choices about how you live your life, what you eat, how you spend your time, what clothes you wear, how you style your hair, what relationships you pursue, what religion you practice (or don't), and what political views you hold.

If you want to eat ice cream for breakfast, stay up late playing video games, skip social events to read books instead, or make any other lifestyle choice that doesn't create immediate safety risks, your support worker should respect that choice even if they think it's unwise.

Example: You want pizza for dinner three nights in a row. Your support worker personally thinks you should eat more vegetables and balanced meals. Unless you have specific medical needs requiring dietary restrictions (like severe diabetes requiring careful carb management), this is your choice to make. The support worker can express concern or offer information ("Would you like me to add some vegetables to the pizza order?") but ultimately should respect your decision.

Reasonable Risk-Taking

The concept of "dignity of risk" recognizes that taking reasonable risks is part of living a full life. You have the right to take risks that might not work out perfectly, as long as they're informed decisions and the consequences wouldn't be catastrophic.

This might include trying new activities that might be challenging, pursuing relationships even though they might not work out, making financial decisions that might not be optimal, or setting ambitious goals that might not succeed.

Example: You want to use your community access support to attend a concert in a crowded venue. Your support worker is concerned about crowd management, noise levels, and accessibility. Unless there are specific safety risks that cannot be managed (like the venue having no accessible exits), the support worker should work with you to make the activity as safe as possible rather than refusing to support it.

Preferences About Support Delivery

You have significant control over how supports are delivered, what order tasks are done, what products or techniques are used, how much assistance you want versus doing things independently, and when sessions are scheduled.

Example: During personal care support, you prefer to shower in the evening rather than morning, and you want to dress before eating breakfast rather than after. These preferences might differ from what the support worker thinks is more efficient or what other participants prefer, but they're your choices about your own routine.

Communication Style and Boundaries

You decide how much personal information you share with support workers, whether you want chatty, conversational support or quiet, task-focused support, what topics are okay to discuss and what's off-limits, and how formal or casual the relationship should be.

Example: You prefer minimal conversation during personal care because you find it awkward, while your support worker is naturally chatty and thinks conversation helps put people at ease. Your preference for quiet should be respected—it's your comfort that matters during your support session.

Trying Things That Might Not Work

Part of choice and control is the freedom to try approaches that might not succeed. You have the right to experiment with different supports, try new routines even if they might not work better than current ones, pursue goals that are ambitious and might not be fully achieved, and learn from experience rather than just following expert advice.

Example: You want to try managing some tasks independently that you've been receiving support for, even though your support worker thinks you'll struggle. Unless attempting independence creates serious safety risks, the support worker should support you to try, be available to assist if needed, but let you experience the attempt.

When Support Workers MUST Say No

There are situations where support workers have a professional, ethical, and often legal duty to refuse requests, regardless of your preferences:

Working Outside Scope of Practice

Support workers cannot provide services that exceed their qualifications or legal scope, even if you want them to and even if they're willing to try. This includes cutting toenails for participants with diabetes or circulation issues, administering injections or other clinical nursing tasks, providing therapy or counseling (unless they're qualified therapists), making clinical decisions about medications or treatments, or performing any task requiring qualifications the worker doesn't have.

Example: You ask your support worker to cut your toenails because you can't reach your feet and booking a podiatrist feels like too much hassle. Even if you sign a waiver, even if you insist it's your choice, the support worker must refuse because this is outside their scope of practice. This isn't the worker limiting your choice—it's them refusing to work unsafely outside their professional boundaries.

Activities Creating Serious Safety Risks

Support workers can refuse to participate in activities that create serious, immediate safety risks that cannot be adequately managed. This includes manual handling tasks that exceed safe limits without appropriate equipment, situations where the worker's own safety would be compromised, activities clearly likely to result in serious injury, or situations where emergency response would be impossible or severely delayed.

Example: You want to go swimming in the ocean when there are dangerous surf warnings and you cannot swim independently. Your support worker can say no to this because the risk is too high and they cannot ensure your safety in these conditions. However, they should offer alternatives ("Can we go to the pool instead?" or "Can we reschedule for a day with calmer conditions?").

Illegal Activities

Support workers cannot assist with or participate in illegal activities, even if you argue it's your choice. This includes purchasing or using illegal drugs, engaging in activities that would constitute assault, theft, or fraud, violating court orders or legal restrictions, or any activity that would make the worker complicit in crime.

Example: You want your support worker to drive you to purchase cannabis from an illegal source (even if you have a medical prescription, if the source is illegal, it's still illegal). The support worker must refuse. This isn't about judging your choice to use cannabis—it's about not participating in illegal activity.

Situations Creating Unreasonable Risk to Others

While you have the right to take reasonable risks yourself, your choices cannot create serious risks to others, including the support worker, other members of the public, or other people in your household.

Example: You don't want to use mobility aids at home because you dislike how they look, but you've fallen multiple times and your support worker must catch you during these falls, creating injury risk to both of you. The support worker can insist on using mobility aids or transfer equipment during support sessions, even if you prefer not to use them at other times.

Requests Violating Professional Boundaries

Support workers should refuse requests that violate professional boundaries, even if you frame them as your choice. This includes romantic or sexual relationships with participants, significant loans or financial entanglement, involvement in family disputes or taking sides, becoming excessively involved in personal matters beyond the support role, or dual relationships that create conflicts of interest.

Example: You've developed feelings for your support worker and want to pursue a romantic relationship. Even if you insist this is your choice and you're both adults, the support worker must maintain professional boundaries and refuse. The power imbalance inherent in the support relationship makes truly consensual romantic relationships impossible while the professional relationship continues.

Misuse of NDIS Funding

Support workers should refuse to participate in clear misuse of NDIS funding, such as claiming for services not actually provided, billing for supports that aren't NDIS-fundable, inflating hours or charges, or any fraudulent use of NDIS funds.

Example: You ask your support worker to claim for 4 hours when they only provided 2 hours so you can "save some funding for later." The support worker must refuse because this is fraud, regardless of your rationale.

The Grey Area: Navigating Disagreements

Many situations aren't clearly "respect choice" or "must refuse." They're in the grey area where reasonable people might disagree about whether something is safe, appropriate, or within scope:

The Collaborative Approach

In grey-area situations, good support workers use a collaborative approach: acknowledge your right to make choices, express their concerns clearly and specifically, explore whether concerns can be addressed through modifications or safeguards, and if they still have serious concerns, explain why and offer alternatives.

Example: You want to attend a protest march as part of community participation. Your support worker has concerns about crowd density, potential for conflict, and difficulty providing assistance in chaotic environments. Rather than flatly refusing or reluctantly agreeing while anxious, the support worker discusses specific concerns with you, explores mitigations (staying at the edges, having an exit plan, choosing a smaller rally), and if they still think risks are too high, helps you find alternative ways to engage with the cause you care about.

Informed Choice vs. Uninformed Choice

Sometimes what appears to be limiting choice is actually ensuring choice is informed. Support workers can provide information about risks without making decisions for you.

The difference is: "You can't do that" (making the decision for you) versus "Here are the risks I see with this plan. Knowing those risks, what would you like to do?" (informing your choice).

Example: You want to skip your regular physiotherapy appointments because they're uncomfortable and you're not seeing immediate results. Your support worker can explain the longer-term consequences of missing physiotherapy (increased pain, reduced mobility, faster deterioration) without saying "you have to go." They've informed your choice; the decision remains yours.

Temporary No vs. Permanent No

Sometimes "no" doesn't mean "never"—it means "not right now" or "not this way." Support workers can refuse a specific approach while working toward a way to honor the underlying goal.

Example: You want to cook a complex meal independently, but you're recovering from a stroke and your coordination isn't quite there yet. Your support worker says no to full independence right now but offers to work on cooking skills progressively, starting with safer tasks and building toward the complex meal over time.

When "No" Becomes Paternalism

Sometimes support workers say "no" when they shouldn't—when they're being overprotective, risk-averse, or controlling rather than responding to genuine safety or ethical concerns:

Risk Aversion Masquerading as Duty of Care

Some support workers are so afraid of anything going wrong that they restrict choices far beyond what's necessary for safety. This might look like refusing any activity with even minor risk, insisting on more assistance than you need, preventing you from trying things independently, or making decisions based on worst-case scenarios rather than realistic risk assessment.

This isn't appropriate duty of care—it's excessive risk aversion that limits your independence and autonomy.

Example: Your support worker refuses to support you to use public transport because "something might go wrong," even though you've used public transport successfully in the past and have navigation apps and emergency contacts. This is overreach—the worker's discomfort with uncertainty is limiting your choice without justification.

Personal Values Imposed as Professional Requirements

Support workers shouldn't impose their personal values, preferences, or judgments on you under the guise of professional standards. This might include insisting you eat what they consider healthy food, pressuring you to be more social if you're introverted, judging your spending choices, or disapproving of your relationships or lifestyle.

Unless your choices create genuine safety risks or ethical concerns, the support worker's personal disagreement isn't grounds to say no.

Example: You want to spend your Saturday watching movies at home. Your support worker thinks you should be more active and social and keeps suggesting outings and activities. They might genuinely believe social interaction would be good for you, but this is imposing their values on your perfectly valid choice to have quiet time.

Convenience Disguised as Impossibility

Sometimes "we can't do that" actually means "that would be inconvenient or require extra effort I don't want to make." Support workers who prioritize their own convenience over your choices are limiting your autonomy inappropriately.

Example: You want to visit a friend across town during your community access session. Your support worker says it's "not possible" because traffic makes it inconvenient and parking might be hard to find. Unless there are genuine time or safety constraints, this is the worker prioritizing their convenience over your choice.

How Participants Can Advocate for Choice

If you feel your support worker is limiting your choices inappropriately, here's how to advocate effectively:

Ask for Specific Reasoning

Don't accept vague "I don't think that's a good idea" or "we can't do that." Ask specifically: "What are the specific safety concerns?" "What scope of practice issue prevents this?" "What exactly makes this impossible?"

This forces the worker to articulate their reasoning, which helps you assess whether it's legitimate concern or overreach.

Propose Mitigations

If the worker raises valid concerns, propose ways to address them: "What if we brought extra safety equipment?" "What if we had a backup plan?" "What if we started with a smaller version and built up?"

This shows you're taking concerns seriously while still asserting your right to make informed choices.

Know Your Rights

Familiarize yourself with NDIS participant rights, including the right to make choices about your supports and services, the right to take reasonable risks, and the right to independence and dignity. The NDIS Code of Conduct requires workers to respect your independence and choice.

Document Patterns

If a support worker consistently limits your choices inappropriately, document specific examples with dates and details. This is useful if you need to raise concerns with their supervisor (if agency-employed) or if you're considering changing workers.

Consider Whether It's the Right Match

Sometimes a support worker's approach to risk and autonomy simply doesn't match your preferences. If you prefer lots of independence and taking reasonable risks while your support worker is very cautious and protective, this might not be a good long-term match. For plan-managed or self-managed participants, you have flexibility to find workers whose approach aligns better with your values.

How Support Workers Should Handle Disagreements

When I encounter situations where I disagree with a participant's choice or feel I need to say no, here's my approach:

Start with Understanding

Before expressing concerns, I ask questions to understand the participant's reasoning, goals, and what's important to them about this choice. Often understanding the "why" helps identify solutions that honor their goals while addressing safety or ethical concerns.

Express Concerns Specifically

Rather than vague opposition, I articulate specific concerns: "My concern is that without the transfer belt, I can't provide secure support during this transfer, which creates fall risk for both of us" is more useful than "I don't feel comfortable with that."

Explore Options Collaboratively

I present the concern as a problem to solve together rather than a unilateral decision: "You want to do X, and I have concerns about Y. How can we honor your goal while addressing that concern?"

Be Clear About Non-Negotiables

When something genuinely is outside my scope or creates unacceptable risk, I'm clear about that: "I understand you'd prefer I cut your toenails, but that's outside my scope of practice and I cannot do it regardless of your preference. What I can do is help you arrange a podiatrist appointment."

Focus on Alternatives, Not Just Refusals

When I say no to something, I try to offer alternatives that honor the underlying goal: "I can't support you to swim in the ocean today because of the dangerous surf warning, but I can support you to go to the pool, or we can reschedule ocean swimming for a calmer day."

The Role of Support Coordinators

If you and your support worker have ongoing disagreements about choice and control, your support coordinator can help mediate and clarify whether the worker's boundaries are appropriate or overreach.

Support coordinators can assess whether concerns are reasonable given your specific situation and needs, help you find workers whose approach to risk and autonomy better matches your preferences, or advocate for your right to make informed choices when workers are being overly restrictive.

The Bottom Line on Choice and "No"

Participant choice and control are fundamental NDIS principles, but they're not absolute. You have the right to make choices about your life, take reasonable risks, and direct your supports—even when others disagree. But support workers have duties to work within their scope, refuse activities creating serious safety risks, maintain professional boundaries, and decline participation in illegal or fraudulent activities.

The best support relationships navigate this tension through clear communication, mutual respect, collaborative problem-solving, and focus on honoring goals while managing legitimate concerns.

When I provide support services in Melbourne's inner south, I'm committed to respecting your autonomy and supporting your choices while being honest about boundaries I cannot cross. If I say no to something, I'll explain specifically why and work with you to find alternatives that honor your goals. And if you feel I'm being unnecessarily restrictive, I want you to advocate for your choices so we can discuss it openly.

Your NDIS supports should empower your independence, not limit it. But empowerment sometimes means saying no to approaches that would create harm, while saying yes to the underlying goals in safer or more appropriate ways.

Related Resources

• NDIS Code of Conduct including respect for rights and dignity
• NDIS Act principles including choice and control
• NDIS Commission - Participant Rights and Safeguards
• The psychology of accepting support and maintaining autonomy
• Support services that respect your independence and choices
• Contact me to discuss how I approach choice and control in practice