Using physiotherapy assistants in residential care
Employing a physiotherapy assistant (PTA) is a fantastic and cost effective way to implement physiotherapy programmes. Many residential care facilities contract in physiotherapy services at an hourly rate, often for only a few hours per week. Supporting this service by having an employee who can accompany the physio on their visit, and then put the exercise programmes in place supports real outcomes for residents. When I quote for services to residential care facilities I always put a persuasive argument in place for them to appoint a PTA at the same time.
Of concern is that we sometimes visit facilities who have a physiotherapy assistant employed but no contracted physiotherapy hours. Why is this a problem and what are the consequences? The problem lies with the fact that “Physiotherapist” is a legally protected title and to practice in New Zealand you must be registered and hold a practising certificate. If there is any perception that the person is a physiotherapist or is carrying out ‘physiotherapy’ then this is illegal and the fine can be up to $10 000. The key word here is perception. Below are some examples that I have come across where I believe the work was illegal.
– A GP requested a physio assessment of a resident with a sore shoulder. This assessment was carried out by an overseas qualified physio working as a PTA in a facility;
– A PTA doing exercises with a resident and the family said “she is having her physiotherapy session so we will wait”;
– Staff referring to their physiotherapy assistant as the “physiotherapist” in conversations.
Physiotherapy New Zealand has written guidelines for using a physiotherapy assistant (this covers the term rehab assistant also). The guidelines state that a client must have:
– An assessment by a NZ registered Physiotherapist and a treatment plan;
– Ongoing monitoring of the physiotherapy status and needs of the client.
The physiotherapy assistant must have strict boundaries which include being deemed competent by a supervising physiotherapist, not advancing or changing the treatment plan without written and verbal instruction from the physiotherapist, not offering any advice or opinion (other than reiterating the physiotherapist’s advice). They must have a clear written job description and adequate support. The work they carry out is the responsibility of the supervising physiotherapist which means only the physiotherapist can prescribe treatments which they have observed the physiotherapy assistant. Competency must be confirmed in respect of each individual treatment plan. This even includes simple exercises such as a walking programme.
We also recommend to our facilities that they consider getting a uniform that clearly designates the person as a ‘physiotherapy assistant’ and a name badge with this written. This helps greatly with the problem of other peoples ‘perception’ as already mentioned. We also recommend and provide separate documentation forms for PTAs.
Being a physiotherapy assistant is usually a very rewarding job but can be isolating for staff as they are usually the only one in their facility and often also have hours as a carer. It is good practice to support them with ongoing training and regular supervision with a physiotherapist that is not just focussed on their clinical role.
This article kindly contributed by Jessie Snowdon – Physiotherapist, founder and director of On the Go Physio. She graduated from Otago University in 1998 and has worked in Christchurch, Edinburgh and London in a variety of roles