← Risk register SOC 31-2012 · reviewed 2026-08-11

Occupational Therapy Aides

4,310 US workers · median $39,160/yr · Healthcare Support

EXPOSED

Aides spend most of the day physically present — setting up therapy equipment, moving patients between treatment areas, cleaning and stocking, guiding patients through routines the OT designed — and none of that is close to robot-ready. The exposure isn't robotics, it's the clerical half of the job: scheduling, insurance forms, supply orders, and progress-note transcription are already being absorbed by software, which shrinks the hours that justify the position. No licensure and no sign-off authority means there is nothing legally reserved to an aide, so the role can be reassigned to OT assistants or techs whenever budgets tighten.

10-year outlook: The job persists because someone must be in the room with the patient, but headcount stays thin and flat as the clerical share evaporates and clinics prefer licensed OTAs who can bill for treatment.

US employment, 2019–2025-43.0%
7,5604,310 workers

Nearly all of this fall was the 2020 shock. It has been climbing back since.

Median pay $29,230 → $39,160 +7.2% in real terms (nominal +34.0%, less ~25% US inflation over the period)

The job count is not the verdict

This line is counted by the Bureau of Labor Statistics — the one figure on this page that isn't a judgement of ours. Headcount moves on demand, offshoring, demographics and the business cycle, and automation is one term among several, often not the loudest.

So a falling line is not evidence that AI did it, and a rising one is not evidence that it won't. Both happen in this register: some occupations resist automation and shrink anyway, others are highly automatable and keep growing. The marked year is 2020.

BLS projection, 2024–2034

+2.5%

Percentage only. The projection counts a different population from the 4,310 above — it includes self-employed workers, which for this occupation is most of them, so the two headcounts are not comparable.

Exposed, but growing

AI can already do a lot of these tasks, and the BLS still expects +2.5% more of these jobs by 2034. Demand for the output is growing faster than the work is being automated away — the mechanism BLS gives for software developers, and the combination people most often misread as an error.

Different clocks. The score is what current AI could do to this work today. The projection is how many of these jobs will exist in 2034. Everything between the two — how fast employers actually adopt, whether demand grows in the meantime — is why they can point opposite ways without either being wrong.

~600 openings a year on average, including replacing people who leave.

One email if this score changes. Watch as many occupations as you like from the same address — no account, and nothing is sent on a schedule, only when a verdict actually moves.

Also known as — 16 job titles this covers

Titles reported by people doing this work, from the US Department of Labor's O*NET survey. If your job title is here, this page is about your work even though the name doesn't match.

Therapy AideRestorative AideRehabilitation Services AideIndependent Living SpecialistOccupational Rehabilitation AideRehabilitation Aide (Rehab Aide)Direct Service Professional (DSP)Direct Support Professional (DSP)Occupational Therapy Aide (OT Aide)Occupational Therapist Aide (OT Aide)Rehabilitation Therapy Aide (Rehab Therapy Aide)Certified Occupational Rehabilitation Aide (CORA)Rehabilitation Nursing Technician (Rehab Nursing Tech)Rehabilitation Therapy Technician (Rehab Therapy Tech)Rehabilitation Services Technician (Rehab Services Tech)SNF COTA (Skilled Nursing Facility Certified Occupational Therapy Assistant)

Score — 43/100 resistance

Holding it up: embodiment (17/20). Weakest point: liability shield (2/20).

Five dimensions, 0–20 each, summed. Higher means more protected. The arithmetic is shown so you can check it: 11 + 17 + 2 + 9 + 4 = 43. · Scored 2026-08-11, and re-examined when evidence accumulates rather than on a schedule.

Task resistance 11/20

Mixed — a routine tier and a judgment tier Setting up mat tables, transferring a patient into a splint fitting, and cueing a hand-therapy routine keep this above a 10, but the scheduling, insurance authorization forms, supply reorders and typed session notes that fill the rest of an aide's shift are already handled by clinic software, which is why it sits at 11 rather than in the resistant band.

Embodiment 17/20

Hands-on in uncontrolled environments Every hour is spent in a clinic on your feet — hauling weighted equipment, wiping down mats between patients, walking someone with poor balance from waiting room to ADL kitchen, adapting mid-transfer when a patient's knee buckles — and only the fact that it happens in a controlled, familiar treatment space rather than out in homes and job sites holds it at 17 instead of 20.

Liability shield 2/20

No licence, no signature requirement Aides need no state licence in any state, typically only a high-school diploma plus CPR, and nothing an aide does is legally reserved to the title — the OT and the licensed OTA carry the documentation and treatment liability, so the 2 reflects on-the-job training rather than any credential that would slow a substitution.

Trust premium 9/20

Some relationship component Patients in a long rehab course learn which aide sets the splint bath at the right temperature and remembers their grandkids' names, and that familiarity is real, but the plan of care, the reassessments and the discharge conversation all belong to the OT — so the relationship is a comfort layer on someone else's clinical bond, not the product, which is a 9.

Judgment & accountability 4/20

Executes defined procedures on defined inputs The OT writes the plan and the aide executes it — no evaluations, no treatment modifications, no goal-setting under most state practice acts — and the discretion that does exist is limited to noticing a patient is in pain or a transfer looks unsafe and calling the therapist, which is escalation, not a call you own, hence 4.

Confidence: medium · reviewed 2026-08-11 · how scoring works

What this job involves — and which parts are yours

The verdict above describes this occupation as a whole. Almost nobody does the typical version of a job — tick what's actually in your week and see how your own mix sits.

AI already does these at usable quality

These still need a person

Active moats on the surviving side: embodiment, physical-presence

How to future-proof this job

Training paths for your skill gaps: Coursera — teaching and instructional design, audit free free to audit · Coursera — engineering and procurement courses, auditable without paying free to audit · edX — performance measurement and evaluation free to audit · Coursera — people management and team leadership specialisations free to audit · Khan Academy — reading and vocabulary, all levels, free free · MIT OpenCourseWare — systems analysis and engineering free · edX — systems thinking and evaluation methods free to audit

All 35 skills ranked by how many jobs they open →

Where this experience transfers — occupations you could move toward

Computed from U.S. Dept. of Labor O*NET skill and knowledge profiles: high overlap with what you already do, a materially higher resistance score, no large jump in required training, and no licence you would have to start a new pipeline to get. Targets that pay meaningfully less, that are themselves COOKED, or whose own headcount is falling are excluded — a move into a shrinking trade is not an escape.

Exercise Trainers and Group Fitness Instructors EXPOSED · 61/100 · you already have ~71% of the skill profile

Skills to close: Instructing, Equipment Selection

Psychiatric Technicians SAFE · 67/100 · you already have ~70% of the skill profile

Skills to close: Monitoring, Management of Personnel Resources, Reading Comprehension, Systems Analysis

Occupational Therapy Assistants SAFE · 68/100 · you already have ~69% of the skill profile

Skills to close: Systems Analysis, Systems Evaluation, Management of Personnel Resources, Reading Comprehension

What would move this back up — beyond any one person

The moves above are yours to make. This is the other half: what would have to change in the world for the occupation itself to score higher. None of it is in any one person's gift, but it is where the floor actually comes from. Scores here are not a one-way ratchet. Only two of the five dimensions — task resistance and embodiment — track what machines can do. The other three track law, what buyers will pay for, and who is answerable, and those move in both directions, often in response to the same pressure AI creates. If every lever below landed, this occupation would score around 52/100, still EXPOSED.

3 specific changes that would raise this score
  • already happening task resistance +3

    Task-mix shift: if scheduling, authorization forms, supply reordering and note transcription are fully absorbed by clinic software, the surviving aide hours are almost entirely hands-on setup, transfers, patient guarding and equipment sanitation — the residual job is more resistant than today's blend, even though total hours fall. Watch for job postings that drop 'clerical/front-desk duties' from aide descriptions.

  • plausible liability shield +4

    A state occupational therapy practice act amendment creating a registered or certified 'OT aide' credential with a state registry and mandatory training hours — the model CNA/nurse-aide registry under OBRA '87, which several states have discussed extending to rehab aides. Also relevant: state ratio rules capping aides per supervising OT (e.g., limits already written into some state OT board rules) and CMS Part B 'line-of-sight supervision' language for therapy aides in outpatient settings. A tightened, enforced supervision-plus-registry regime makes the aide a named, non-substitutable role rather than an interchangeable tech.

  • plausible trust premium +2

    Narrow route only: private-pay pediatric, hand-therapy and post-op home-based practices where the family pays for a consistent named person to do the physical setup and coaching between OT visits. If home-health and cash-pay pediatric caseloads keep growing and clinics market continuity of the same aide, this rises modestly. There is no broad hospital-side route — institutional buyers do not pay a premium for a specific aide.

The limit. The binding constraint is headcount economics, not machine capability. Embodiment is already near ceiling at 17 and cannot carry the score. Because aides are barred by every state practice act from evaluation, treatment planning or discharge decisions, judgment_accountability has no plausible upward route — raising it would require redefining the occupation as an OT assistant, which is a different SOC. Even with a registry credential the role stays reassignable to OTAs and multi-skilled techs whenever a facility consolidates support staff.

These are conditions, not forecasts — what would have to happen, not what will. Specific rules, cases and bills are named so you can go and check whether they exist and where they stand; verify before relying on any of them. Nothing here is legal or financial advice.

Where this work is, and what it pays there

BLS metro figures for 19 areas. The verdict above does not change by city — the rubric judges what the work involves, not where it happens — but pay and headcount do, and the national median hides a very wide range.

Most of these jobs

New York-Newark-Jersey City, NY-NJ 200 $46,260 +18%
Pittsburgh, PA 150 $37,100 -5%
Atlanta-Sandy Springs-Roswell, GA 130 $38,090 -3%
Seattle-Tacoma-Bellevue, WA 130 $38,550 -2%
Dallas-Fort Worth-Arlington, TX 110 $42,790 +9%
Washington-Arlington-Alexandria, DC-VA-MD-WV 100 $45,840 +17%
Houston-Pasadena-The Woodlands, TX 70 $41,400 +6%
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 70 $40,200 +3%

Best paid

Riverside-San Bernardino-Ontario, CA 30 $68,550 +75%
Hartford-West Hartford-East Hartford, CT 40 $46,320 +18%
New York-Newark-Jersey City, NY-NJ 200 $46,260 +18%

Percentages are against this occupation's national median of $39,160. Counts are jobs in that metro, not vacancies. Metros where the BLS suppressed the cell are absent rather than shown as zero.

Who is actually doing this — nobody, on the record

We have no reported case of a named organisation automating this occupation. Not one deployment, not one announcement.

That is worth saying out loud next to a score of 43. The verdict above is about what the work exposes — what current AI could do to these tasks. It is not a claim that anyone has done it. For this occupation those two things have come apart completely: the capability argument is on this page, and the evidence column is empty.

Read that as a gap in the reporting we can see, not proof of absence — the dispatch runs on English-language feeds and misses plenty. If you know of a case, tell us, or add a field report from inside the job.

Quick take — do you do this job?

Has AI actually changed your work? One tap, anonymous, and the running tally is public. Nothing else is asked of you.

Self-reported and unverified — a sentiment signal, not a survey. One response per person per occupation; you can change your answer.

Field reports — what people say has changed

No field reports yet. A written account takes a paragraph rather than a tap, goes to an editor before it appears, and is the one thing on this page the rubric cannot produce on its own.

File a field report

Concrete beats general: a tool that arrived, a task that moved, a headcount decision you watched happen. Don't include anything that identifies you or your employer if that would put you at risk.

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