{ "source": "Cooked Index — occupational AI risk register", "page": "https://cookedindex.com/jobs/occupational-therapy-aides/", "methodology": "https://cookedindex.com/methodology", "notice": "Verdicts are re-examined as evidence accumulates. Re-fetch before relying on this; the page above always carries the current score.", "scored_at": "2026-08-11", "model": "claude-opus-5", "occupation": { "title": "Occupational Therapy Aides", "soc_code": "31-2012", "category": "Healthcare Support", "us_employment": 4310, "median_annual_wage": 39160 }, "verdict": "EXPOSED", "risk_resistance": 43, "contested": false, "near_boundary": false, "dimensions": { "task_resistance": 11, "embodiment": 17, "liability_shield": 2, "trust_premium": 9, "judgment_accountability": 4 }, "reasoning": { "task_resistance": "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": "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": "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": "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": "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." }, "rationale": "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.", "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.", "what_would_raise_it": { "levers": [ { "dimension": "task_resistance", "change": "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.", "plausibility": "already happening", "would_add": 3 }, { "dimension": "liability_shield", "change": "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.", "plausibility": "plausible", "would_add": 4 }, { "dimension": "trust_premium", "change": "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.", "plausibility": "plausible", "would_add": 2 } ], "ceiling_note": "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." }, "adjudication": null, "employment_history": { "points": [ { "y": 2017, "emp": 7740, "wage": 29200 }, { "y": 2018, "emp": 7700, "wage": 28160 }, { "y": 2019, "emp": 7560, "wage": 29230 }, { "y": 2020, "emp": 5630, "wage": 30180 }, { "y": 2021, "emp": 3370, "wage": 33560 }, { "y": 2022, "emp": 3710, "wage": 37060 }, { "y": 2023, "emp": 4430, "wage": 36970 }, { "y": 2024, "emp": 5000, "wage": 37370 }, { "y": 2025, "emp": 4310, "wage": 39160 } ], "from": 2017, "to": 2025, "change_pct": -44.3, "comparable_from": 2019, "spans_soc_revision": true }, "pivots": [ { "slug": "exercise-trainers-and-group-fitness-instructors", "title": "Exercise Trainers and Group Fitness Instructors", "verdict": "EXPOSED", "risk_resistance": 61, "median_wage": 47160, "overlap": 71, "skills_to_close": [ "Instructing", "Equipment Selection" ] }, { "slug": "psychiatric-technicians", "title": "Psychiatric Technicians", "verdict": "SAFE", "risk_resistance": 67, "median_wage": 45130, "overlap": 70, "skills_to_close": [ "Monitoring", "Management of Personnel Resources", "Reading Comprehension", "Systems Analysis" ] }, { "slug": "occupational-therapy-assistants", "title": "Occupational Therapy Assistants", "verdict": "SAFE", "risk_resistance": 68, "median_wage": 72300, "overlap": 69, "skills_to_close": [ "Systems Analysis", "Systems Evaluation", "Management of Personnel Resources", "Reading Comprehension" ] } ], "license": "https://cookedindex.com/terms" }