What to do if a participant refuses support?
Respect the refusal, stay calm and do not force the support. Adults with disability have the right to make their own decisions, including risky ones, under the NDIS Code of Conduct. Your job is to understand why, offer alternatives, make sure the person knows the risks, keep them as safe as you reasonably can, and record and report what happened.
NDIS Code of Conduct, National Disability Insurance Scheme (Code of Conduct) Rules 2018
NDIS Practice Standards, core module: rights and responsibilities for participants
National Disability Insurance Scheme (Restrictive Practices and Behaviour Support) Rules 2018
NDIS Quality and Safeguards Commission, worker guidance on the NDIS Code of Conduct
Choice and dignity of risk
The first element of the NDIS Code of Conduct requires workers to act with respect for a person's right to self determination and decision making. The NDIS Practice Standards core module also requires providers to support independence and informed choice. Together they mean a participant can decline a shower, a meal, medication or an outing. Dignity of risk is the idea that people are entitled to take reasonable risks as part of living their own life. A refusal is not a behaviour to be managed. It is a decision to be respected, unless there is an immediate risk of serious harm.
Where duty of care fits
Duty of care does not override choice, but it does shape how you respond. You must take reasonable steps to prevent foreseeable harm. In practice that means making sure the person understands the consequences of refusing, offering the support again later or in a different way, and checking whether something else is going on, such as pain, fear, a communication barrier or a problem with the worker. If the refusal creates a serious health risk, for example refusing insulin or a critical medication, escalate to your supervisor and follow the participant's health plan. Never restrain, coerce or trick someone into accepting support. Any physical, chemical, mechanical or environmental restraint is a restrictive practice under the NDIS (Restrictive Practices and Behaviour Support) Rules 2018 and needs authorisation.
Supported decision making
If the participant has difficulty understanding the risks, use supported decision making before anyone else steps in. Explain in plain language, use their preferred communication method, allow time, and involve a trusted person if they want. A guardian or nominee can only make decisions within the scope of their appointment, which differs by state and territory, so check the relevant guardianship law and the participant's plan. A support plan or positive behaviour support plan may also set out agreed steps for common refusals, and those steps should be followed and reviewed.
Record, report and review
Write a factual case note: what was offered, what the person said or did, what you tried, and who you told. Report the refusal to your supervisor the same shift if it affects health or safety. Repeated refusals are a signal to review the support with the participant, their family if they wish, and the wider team. Under the NDIS Code of Conduct you must also raise concerns promptly if you believe a refusal is linked to abuse, neglect or another worker's conduct.
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