Physical Therapists, PTAs and CNAs in Hospitals and Nursing Homes


The following is an exchange of e-mails between Tracy who is an LPTA in Illinois and one of therubins co-editors Harold Rubin. We would like to express our thanks to Tracy for her e-mail to us on this matter. One of the purposes of this site is that it is a forum wherein our viewers can express their opinions, and thus bring out into the open issues that are of concern to you our viewers. The following is the e-mail we received from Tracy:


Sent: Thursday, January 25, 2001 2:21 AM

Subject: I read your web page.

I read your web page about Nursing Homes. (Editor's Note: Please see Selecting a Nursing Home) I am a LPTA who works in a Nursing Home in the state of IL. It seems you are a little confused about Nursing Homes and Physical Therapist Ass.

First of all PTAs are very qualified and can give pts the same quality of care as a PT. PTAs work very hard and we have increased a lot of patient's functional capabilities.

Both PTs and PTAs have two years of internships, PTAs education focus more on safety, assessments, and hands on treatment. Most PTAs are required to have a state licensed and 2 yrs of College Education.

CNAs have a 9 wk course, high school education, and usually less compassionate. I say that because they are over worked and understaffed. I think some of them may have a hearing disorder, because I have heard call lights on for more then 1/2 an hour.

I am glad to know your CNAs were properly trained for 9 wks. Sorry to hear that the PTAs you have delt with were not properly trained in their 64wk course on pt care. You must not have visited your mother a lot. Do you feel guilty?

P.S. All nursing homes in IL. work with contracted rehabilitaion companies and there is always someone there for consultation


The following is the response that Harold Rubin e-mailed back to Tracy

Dear "Tracy":
Thank you for sending in the information about PTAs. We do believe that these professionals do extraordinary jobs. The same is true for all professionals working with the elderly.

At the same time, there are some professionals in those fields who, despite their training, perform below the level expected of them or who make assumptions that may not be well grounded, because of a variety of reasons
(triage, minimum staffing, incorrect assumptions, etc.). This we believe was the case with our mother. She was recovering from double pneumonia, was on a PEG, with her weight down to 67 pounds and not very communicative. No attempt
was made to assess her functional capacities including her capacity to walk. She was VISUALLY assessed as "not ready for PT." My brother and I, both of us who visited her twice a day for 39 days in a row during her 39 day stay in
the hospital, began our own brand of PT. She was able to walk out of that hospital with our help and then entered a nursing home where she remained for about 4 years, walking without assistance. The care she received from the
staff at this nursing home was terrific, helped by the fact that my brother and I would each visit her once a day for the four years. We believe it is the social support system that enabled our mother to achieve her rehabilitation in spite of the negative assessment.

In the above nursing home and in the number of nursing homes and Assisted Living Residences we have visited, we find the level of care varying with the site and individuals involved, despite the setup of providing rehabilitation services i.e. in-house services, contractual, independent providers etc.

One thing is clear: HCFA has set up a False Claim Act based on facility deficiencies. Physical therapy services have been cited. We believe that this is evidence that problems exist. HCFA imposes monetary penalties for noncompliance with applicable requirements. Is this because they just like to be punitive? We do not believe so.

We are well aware of the training requirements of PTs, PTAs and CNA. You are very proud of your profession and we applaud you for the work you are doing. Our hope is that you will continue to be a sensitive, caring professional who
uses her academic training and professional acumen to help needy individuals achieve a quality of life commensurate with their level of functioning and will not get into the internecine warfare that exists between many professional groups.

We hope that you will continue to read our articles and send us comments. We would also appreciate it if you would recommend our site to your colleagues and friends.

Again, thank you for your comments.

Harold Rubin

January 24,2001