{
  "source": "Cooked Index — occupational AI risk register",
  "page": "https://cookedindex.com/jobs/occupational-therapy-assistants/",
  "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 Assistants",
    "soc_code": "31-2011",
    "category": "Healthcare Support",
    "us_employment": 51290,
    "median_annual_wage": 72300
  },
  "verdict": "SAFE",
  "risk_resistance": 68,
  "contested": false,
  "near_boundary": false,
  "dimensions": {
    "task_resistance": 14,
    "embodiment": 18,
    "liability_shield": 12,
    "trust_premium": 15,
    "judgment_accountability": 9
  },
  "reasoning": {
    "task_resistance": "Hand-over-hand cueing during a sit-to-stand, splint fabrication and heat-moldable thermoplastic fitting, grading resistance mid-exercise when a patient's tone spikes — these are the billable minutes, and none of them survive being turned into a screen prompt; the 14 rather than 18 reflects that a real slice of your shift is SOAP notes, CPT unit math, and home-program handouts that software will write for you.",
    "embodiment": "You work on the floor of a SNF room, in a patient's own cluttered bathroom, and in a hand clinic — transferring a hemiplegic patient with a gait belt, guarding during tub transfers, positioning a contracted wrist — uncontrolled spaces with unpredictable bodies, which is why this sits at 18 and not lower.",
    "liability_shield": "Nearly every state licenses or certifies OTAs (NBCOT COTA credential, state license with supervision requirements written into the practice act), and you can be disciplined for practicing beyond the plan of care — but the 12 rather than 17 is because the supervising OT signs the evaluation, the plan, and the discharge, so the ultimate professional exposure is not yours.",
    "trust_premium": "Patients see you three to five times a week for weeks while the OT sees them at eval and recert, so the rapport that makes someone attempt a transfer they're afraid of is yours specifically; capped at 15 because referral flow comes from the facility and physician, not from patients choosing you by name.",
    "judgment_accountability": "You decide in the moment whether to downgrade an activity, stop for pain, or hold treatment and call the nurse — genuine clinical discretion — but the frequency, duration, goals, and modalities are set by the OT's plan of care, and changing them is outside your scope, which is exactly what holds this to 9."
  },
  "rationale": "The core of this job is physically guiding patients through therapeutic exercises, transfers, ADL retraining, and adaptive-equipment fitting in homes, SNFs, and clinics — work robotics cannot touch and language models cannot substitute for. AI will absorb the documentation layer: progress notes, billing codes, exercise handouts, and productivity tracking. Judgment is capped because the OT owns the plan of care and the evaluation; the assistant executes and reports back, which is why this scores solid-safe rather than top-tier.",
  "outlook": "Demand keeps rising with the aging population and the job stays hands-on; expect documentation load to shrink and caseload-per-day expectations to rise as a result.",
  "what_would_raise_it": {
    "levers": [
      {
        "dimension": "liability_shield",
        "change": "CMS therapy supervision rules and state OT practice acts already require an OTA to hold a state license/certification and work under an OT plan of care; a tightening — e.g. CMS restoring direct (rather than general) supervision for Part B therapy assistants in SNFs, or state boards requiring the treating OTA to personally sign each treatment note and attest to the modality delivered — would make the licensed human signature non-substitutable at the point of care rather than only at evaluation. Also watch the CMS assistant payment differential (85% of fee schedule under the CQ/CO modifier): if it were repealed, employer incentive to substitute shifts back toward licensed staff.",
        "plausibility": "plausible",
        "would_add": 4
      },
      {
        "dimension": "judgment_accountability",
        "change": "Scope expansion by state practice act allowing OTAs to make within-session modifications and progress-toward-goal determinations without OT re-authorization, or AOTA/NBCOT advanced-practice credentialing (e.g. hand therapy, low-vision, driving rehab specialty certification for OTAs) that makes the assistant the accountable clinician for a defined modality. Some states already permit OTAs broad treatment discretion under general supervision; codified specialty roles would raise the ceiling set by 'OT owns the plan of care'.",
        "plausibility": "plausible",
        "would_add": 4
      },
      {
        "dimension": "task_resistance",
        "change": "Task-mix shift: this role genuinely has two tiers. If AI absorbs documentation, billing modifiers, HEP handout generation and productivity tracking (already happening in SNF EMRs like PointClickCare and Casamba), the residual day is transfers, manual facilitation, adaptive-equipment fitting and family training — the tier no model or robot performs. The score rises because the denominator shrinks, not because capability stalls.",
        "plausibility": "already happening",
        "would_add": 3
      },
      {
        "dimension": "trust_premium",
        "change": "Narrow route only: home-health and private-pay pediatric/hand-therapy clients selecting a named, consistent therapist over agency-rotated staff, and payer/parent resistance to app-delivered HEP substitution. This is a preference for a specific human, not a premium paid to avoid AI, so the headroom is small.",
        "plausibility": "plausible",
        "would_add": 2
      }
    ],
    "ceiling_note": "Structurally capped: the OT owns evaluation and plan of care, so judgment_accountability cannot approach the top tier without a statutory scope change in many states at once. Embodiment is already near maximum and cannot rise. The real downside risk is not automation but payment — the 15% assistant differential and any move toward group/concurrent therapy or app-delivered HEP shifts volume, not capability."
  },
  "adjudication": null,
  "employment_history": {
    "points": [
      {
        "y": 2017,
        "emp": 41650,
        "wage": 59310
      },
      {
        "y": 2018,
        "emp": 42660,
        "wage": 60220
      },
      {
        "y": 2019,
        "emp": 44990,
        "wage": 61510
      },
      {
        "y": 2020,
        "emp": 42750,
        "wage": 62940
      },
      {
        "y": 2021,
        "emp": 41980,
        "wage": 61730
      },
      {
        "y": 2022,
        "emp": 43810,
        "wage": 64250
      },
      {
        "y": 2023,
        "emp": 46090,
        "wage": 67010
      },
      {
        "y": 2024,
        "emp": 47910,
        "wage": 68340
      },
      {
        "y": 2025,
        "emp": 51290,
        "wage": 72300
      }
    ],
    "from": 2017,
    "to": 2025,
    "change_pct": 23.1,
    "comparable_from": 2019,
    "spans_soc_revision": true
  },
  "pivots": [],
  "license": "https://cookedindex.com/terms"
}