Direction, Delegation and Supervision
in Physical Therapy Services

HOD 06-96-30-42 [Amended HOD 06-95-11-06; HOD 06-93-08-09; HOD 06-85-20-41; Initial HOD 06-78-22,23-61; HOD 06-84-16-72; HOD 06-77-19-37]

Contents:

Start of Document
Definition and Utilization of the Physical Therapist Assistant
Definition and Utilization of the Physical Therapy Aide
Other Support Personnel

Physical therapists have a responsibility to deliver services in ways that protect the public safety and maximize the availability of the services. They do this through direct delivery of services in conjunction with responsible delegation of certain tasks to physical therapist assistants, physical therapy aides, and other supportive personnel.

Direction and supervision are essential in the provision of quality physical therapy services. The degree of direction and supervision necessary for assuring quality physical therapy services is dependent upon many factors, including the education, experience, and responsibilities of the parties involved, as well as the organizational structure in which the physical therapy services are provided. Supervision should be readily available to the individual being supervised.

The director of a physical therapy service is a physical therapist who has demonstrated qualifications based on education and experience in the field of physical therapy and accepted the inherent responsibilities. The director of a physical therapy service must: 1) establish guidelines and procedures that will delineate the functions and responsibilities of all levels of physical therapy personnel in the service and the supervisory relationships inherent to the functions of the service and the organization; 2) assure that the objectives of the service are efficiently and effectively achieved within the framework of the stated purpose of the organization and in accordance with safe physical therapy practice; and 3) interpret administrative policies, act as a liaison between line staff and administration, and foster the professional growth of the staff.

Written standards of practice and performance criteria should be available for all levels of physical therapy personnel in a physical therapy service. Regularly scheduled performance appraisals should be conducted by the supervisor based on these standards of practice and performance criteria.

Delegated responsibilities must be commensurate with the qualifications, including experience, education and training, of the individuals to whom the responsibilities are being assigned. When the physical therapist of record delegates patient care responsibilities to physical therapist assistants or other supportive personnel, that physical therapist holds responsibility for supervision of the physical therapy program. Regardless of the setting in which the service is given, the following responsibilities must be borne solely by the physical therapist:

1. Interpretation of referrals when available.
2. Initial evaluation, problem identification, and diagnosis for physical therapy.
3. Development or modification of a plan of care which is based on the initial evaluation and which includes the physical therapy treatment goals.
4. Determination of which tasks require the expertise and decision making capacity of the physical therapist, and must be personally rendered by the physical therapist, and which tasks may be delegated. Prior to delegating any procedure, the physical therapist should determine that the consequences of the procedure are predictable, the situation is stable, and the basic indicators are not ambiguous and do not require ongoing observation by the physical therapist.
5. Delegation and instruction of the services to be rendered by the physical therapist assistant or other supportive personnel, including, but not limited to, specific treatment program, precautions, special problems, or contraindicated procedures.
6. Timely review of treatment documentation, reevaluation of the patient and the patient's treatment goals, and revision of the plan of care when indicated.
7. Establishment of the discharge plan and documentation of discharge summary/status.

A. Definition and Utilization of the Physical Therapist Assistant

Definition
The physical therapist assistant is a technically educated health care provider who assists the physical therapist in the provision of physical therapy. The physical therapist assistant is a graduate of a physical therapist assistant associate degree program accredited by an agency recognized by the Secretary of the United States Department of Education or the Council on Postsecondary Accreditation.

Utilization
The physical therapist of record is the person who is directly responsible for the actions of the physical therapist assistant. The physical therapist assistant may perform physical therapy procedures and related tasks that have been selected and delegated by the supervising physical therapist. Where permitted by law, the physical therapist assistant may also carry out routine operational functions, including supervision of the physical therapy aide and documentation of treatment progress. The ability of the physical therapist assistant to perform the selected and delegated tasks shall be assessed on an ongoing basis by the supervising physical therapist. The physical therapist assistant may modify a specific treatment procedure in accordance with changes in patient status within the scope of the established treatment plan.

The physical therapist assistant must work under the direction and supervision of the physical therapist in all practice settings. When the physical therapist and the physical therapist assistant are not within the same physical setting, the performance of the delegated functions by the physical therapist assistant must be consistent with safe and legal physical therapy practice and shall be predicated on the following factors: complexity and acuity of the patient's needs; proximity and accessibility to the physical therapist; supervision available in the event of emergencies or critical events; and type of setting in which the service is provided. When the physical therapist and the physical therapist assistant are not continuously within the same physical setting, greater emphasis in directing the physical therapist assistant must be placed upon oral and written reporting.

When supervising the physical therapist assistant in any off site setting, the following requirements must be observed:
1. A qualified physical therapist must be accessible by telecommunications to the physical therapist assistant at all times while the physical therapist assistant is treating patients.
2. The initial visit must be made by a qualified physical therapist for evaluation of the patient and establishment of a plan of care.
3. There must be regularly scheduled and documented conferences with the physical therapist assistant regarding patients, the frequency of which is determined by the needs of the patient and the needs of the physical therapist assistant.
4. In those situations in which a physical therapist assistant is involved in the care of a patient, a supervisory visit by the physical therapist will be made:
a. Upon the physical therapist assistant's request for a reevaluation, when a change in treatment plan of care is needed, prior to any planned discharge, and in response to a change in the patient's medical status.
b. At least once a month, or at a higher frequency when established by the physical therapist, in accordance with the needs of the patient.
c. A supervisory visit should include: 1) An on-site re-assessment of the patient; 2) On-site review of the plan of care with appropriate revision or termination; 3) Assessment and recommendation for utilization of outside resources.

B. Definition and Utilization of the Physical Therapy Aide

Definition

The physical therapy aide is a non-licensed worker who is specifically trained under the direction of a physical therapist. The physical therapy aide performs designated routine tasks related to the operation of a physical therapy service delegated by the physical therapist or, in accordance with the law, by a physical therapist assistant.

Utilization

The physical therapist of record is the person who is directly responsible for the actions of the physical therapy aide. The physical therapy aide provides supportive services in the physical therapy service, which may include patient related or non-patient related duties. When providing direct physical therapy services to patients, the physical therapy aide may function only with the continuous on-site supervision of the physical therapist or, where allowable by law and/or regulation, the physical therapist assistant. Continuous on-site supervision requires the presence of the physical therapist or physical therapist assistant in the immediate area, and the involvement of the physical therapist or physical therapist assistant in appropriate aspects of each treatment session in which a component of treatment is delegated to a physical therapy aide.

The physical therapy aide may assist patients in preparation for treatment and, as necessary, during treatment and at the conclusion of treatment, and may assemble and disassemble equipment and accessories, in accordance with the training of the physical therapy aide. The extent to which the physical therapy aide participates in operational activities, including maintenance and transportation and in patient-related activities, will be dependent upon the discretion of the physical therapist and the applicable state and federal regulations.

Students who are enrolled in physical therapist professional education programs or physical therapist assistant education programs and who are employed in a physical therapy clinical setting where such employment is not a part of the formal educational curriculum will be classified as physical therapy aides. Where their employment is part of the formal educational curriculum this policy will not apply. The physical therapist student who is a graduate of an approved physical therapist assistant program is exempt from this restriction and may be classified as a physical therapist assistant.

C. Other Support Personnel

When other personnel (e.g., exercise physiologists, athletic trainers, massage therapists), work within the setting of a physical therapy service they should be employed under their appropriate title. Any involvement in patient care activities should be within the limits of their education, in accord with applicable laws and regulations, and at the discretion of the physical therapist. However, if they function as an extension of the physical therapist's license, their title and all provided services must be in accordance with state and federal laws and regulations. In all situations when the physical therapist delegates activities to other support personnel, the physical therapist must recognize the legal responsibility and liability for such delegation.

Return to the Top of the document.