Supervision and Delegation: PT, PTA, and Aide Roles
The supervision hierarchy
The PT holds responsibility for the patient's plan of care. The PTA provides interventions under the direction and supervision of the PT. Aides perform only non-skilled tasks and never provide skilled physical therapy intervention. Supervision levels range from direct (on-site, immediate availability) to general (periodic contact), and the level required depends on patient complexity, setting, and the Board's rules.
Delegation principles
A PT may delegate only tasks that are within the competent scope of the delegate, that are not prohibited by law, and that do not require the PT's unique judgment. The PT must not delegate the initial evaluation, the plan of care, or discharge. Delegation requires that the PT communicate the plan and that the PTA have access to the PT for consultation.
Documentation of supervision
The PT should document supervision contacts and the PTA's contributions consistent with the plan of care. The PT remains accountable for the care delivered by the PTA.
Question traps
- Assuming a PTA can perform an initial evaluation "if the PT is busy."
- Treating supervision as optional when the setting is busy or rural.
- Believing the PT is off the hook once a task is delegated - accountability does not transfer.
- Assuming an aide can perform a skilled modality because a PT demonstrated it once.
Rule of thumb
Ask three questions before delegating: Is it skilled? Is it within the delegate's scope? Does it require the PT's judgment? If the answer to the first or third is yes, the PT must perform it.