Date of Award

Winter 2006

Project Type


Program or Major

Occupational Therapy

Degree Name

Master of Science

First Advisor

Lou Ann Griswold


Insurance reimbursement guidelines have changed the way allied health services are delivered. The onset of the Prospective Payment System (PPS) reorganized financing for therapy services. Instead of basing reimbursement on each individual case, finances are based on diagnostic and case mix groupings and regulate expected service needs. This has forced both occupational and physical therapy to vie for the same reimbursement monies.

Cross training occupational and physical therapists was suggested as a means of cost containment. Downsizing rehabilitation departments was actually performed to minimize costs. These drastic responses to reimbursement changes in the health care field were also coupled with a documented lack of consumer knowledge regarding the respective roles of occupational and physical therapy. These concepts together illustrated the need for occupational therapy to clearly stake claim to their domain in the future of health care.

This study, qualitative and phenomenological in nature addressed the roles of occupational and physical therapy in a skilled nursing facility. Through the use of a case study, semi-structured interviews regarding clinical reasoning were conducted with three occupational and three physical therapists working in five different skilled nursing facilities. The aim was to truly understand the therapists' perceptions of their own and each others' roles. Using the constant comparative method from grounded theory, the data was analyzed and categorized and themes were identified for each profession, which were then compared and contrasted.

The results showed unique histories, philosophies, types of clinical reasoning, and foci of intervention for each profession. These themes uncovered clearly outlined differences between the two professions. Professional boundaries separating the two professions were consistently identified with each interviewee.

The results of this research could aid in the future understanding of the role of occupational therapy. It could aid in solidifying occupational therapy's claim to their intervention domain. It could also clarify, to the potential consumer and the potential reimbursing insurance company, the role of occupational therapy in a client's recovery from disability.