The Acceptable Roles and Corresponding Limitations of the Physical Therapy Aide in Adult Day Health Care Setting

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The Practice Issues Committee of the Physical Therapy Board of California reviewed an inquiry regarding skilled rehabilitation services in Adult Day Health Care Centers (ADHCs). One of the difficulties in responding to letters such as these has to do with the labels people use to describe their situation. It is the Committee's hope that the following answers are responsive to your situation.

The Adult Day Health Care Center setting is often for the purpose of maintaining the individual's level of functioning and not for the purpose of providing rehabilitation for a specific dysfunction or disability. Therefore, it is questionable whether physical therapy is necessary in this setting routinely. The physical therapist needs to perform an evaluation for those patients who may need physical therapy services. If it is determined that there is a need for rehabilitation, then the physical therapist must have a diagnosis to proceed with determining the prognosis, identifying the intervention, and establishing a treatment plan for the patient. Exercise that is part of this treatment program, for the purpose of rehabilitation, is considered physical therapy. If the physical therapist feels it is appropriate to assign any part of the intervention to an unlicensed person (physical therapy aide), this must be identified and documented in the patient's record. Only a physical therapist may direct and supervise a physical therapy aide. If it is determined that rehabilitation is not necessary, then the services provided are not part of physical therapy and may be provided by other personnel.

The Physical Therapy Board of California is the body that enforces, administers and interprets the applicable statutes and regulations related to the practice of physical therapy. Physical therapy is defined in the Business and Profession Code Section 2620. The key to this section, which separates maintenance care from restorative care that is physical therapy, is the need for the rehabilitation of a condition. The statutes and regulations administered by the Board are not to be read in isolation. Statutes are to be interpreted and applied in light of the Legislative policies and purposes that led to their enactment. Similarly, regulations of the Board are to be interpreted and applied based upon the policies and purposes of the Board that led to their adoption.

While rehabilitation can be part of a registered nurse's job, the specific areas they may work in and responsibilities they may have should be obtained from their licensing board. It is not the responsibility of the Physical Therapy Board to contact agencies or other boards to answer questions regarding other professional's duties and responsibilities. The Board of Registered Nursing may be reached at 1747 North Market Boulevard, Suite 150, Sacramento, CA 95834, (916) 322-3350.

Please contact the Board if there is a need for further clarification on a specific scope of practice question regarding care provided by a physical therapist.

Note: This document is not a declaratory opinion of the Physical Therapy Board of California.