The Aide Who Wanted to Lead the Group
Rosa is an OT supervising a rehab aide, Ken, at a Juneau skilled nursing facility. Ken has 12 years of experience and is popular with residents. Rosa is double-booked Tuesday and asks Ken to "run the morning ADL group" for six residents, including two with recent falls and one with a new pressure injury. Ken would follow a routine Rosa wrote, demonstrate transfers, and adjust seated positioning. Rosa will be in the building but in another wing doing evaluations. A family member has asked whether Ken is "the therapist." The facility administrator pressures Rosa to keep the group on schedule because the state surveyor arrives Wednesday.
1. May Ken lead the ADL group as described? Identify which tasks are delegable to an aide and which are not.
Read the worked answer
Aides may perform routine, non-skilled supportive tasks under supervision - setup, transport, cueing to a written routine, restocking, and assisting with already-established techniques. They may not make clinical judgments, modify treatment, perform skilled interventions, or independently direct a treatment group for residents with complex needs. Demonstrating transfers and adjusting positioning for a resident with a new pressure injury and fall risk involves clinical decision-making (weight-bearing status, skin integrity, safety) that belongs to the OT or OTA. Ken may assist within the group only under direct, on-site supervision with clear limits, and the two high-risk residents need OT/OTA-level direction. Rosa should not delegate the whole group; she can delegate setup and routine cueing while retaining the skilled components.
2. How should Rosa respond to the family member's question and to the administrator's scheduling pressure?
Read the worked answer
To the family: accurate role disclosure. Ken is a rehabilitation aide, not a therapist; the OT remains responsible for the plan and supervision. Misrepresenting an aide as a therapist is a professional-conduct and potentially deceptive-practice issue. To the administrator: Rosa should explain that the schedule cannot override supervision requirements and resident safety, and document her rationale. She can propose alternatives - reschedule some evaluations, split the group, or have Ken assist rather than lead. Pressure from an employer does not transfer accountability; the supervising OT owns the delegation decision and must be able to defend it.