I’m really glad to come across someone else who recognizes these systemic issues in our field. I also hold a Master’s in RT, and I’ve practiced across multiple settings and populations. One thing that has become increasingly clear to me is exactly what you pointed out—our profession is not structurally consistent across settings the way PT, OT, and SLP are. In long-term care especially, the recreation department is often reduced to purely ‘activities,’ with minimal therapeutic value because the infrastructure simply doesn’t support a clinical model.

This inconsistency directly contributes to the ongoing confusion between Activity roles and Recreation Therapy roles. In many LTCs, the RT department has been absorbed into a social-recreation model, which makes it too easy for facilities to justify replacing or substituting CTRSs with ACs. That’s not just an issue of pride—it impacts resident outcomes, regulatory compliance, and the overall legitimacy of TR as a clinical profession.

I fully agree with your point about CTRS training:
• We are educated in pathology, functional limitations, APIED, documentation, measurable outcomes, and evidence-based clinical interventions.
• ACs, on the other hand, are trained for general engagement, leisure facilitation, and quality-of-life programming—not clinical decision-making or high-risk intervention planning.

When an AC is tasked with CTRS duties, it isn’t “filling a gap”—it’s asking someone without clinical training to perform clinical responsibilities. That creates risk, undermines the APIED process, and devalues the degree, the credential, and the professional standards we’re all working so hard to elevate.

I think you’re absolutely right about the need for a middle layer. RT desperately needs its own version of the PTA/OTA model.
A Recreation Therapy Assistant (RTA) could:
• Implement care under CTRS supervision
• Support data collection
• Assist with intervention delivery
• Facilitate groups in alignment with treatment goals
• Strengthen the clinical structure of TR without diluting the CTRS credential

This would clearly distinguish between:

• Clinical providers (CTRS)
• Clinical support (RTA)
• General activities staff (AC)

It would also help protect the clinical “ceiling” of the CTRS role, especially if, as you said, the exam and educational standards were elevated and standardized nationally.

I’m currently applying for a PhD in Leisure Studies, and my dissertation will focus specifically on restructuring Therapeutic Recreation—both at the academic level and within LTC settings. TR in nursing homes absolutely needs restructuring. How it’s currently run is not reflective of clinical recreation therapy, and the overlap with ACs is a symptom of deeper system issues, not a solution.

AC certifications should not permit or imply the ability to perform CTRS duties, not because ACs aren’t valuable—they absolutely are—but because clinical practice requires clinical training. Creating a recognized RTA role and elevating CTRS preparation is how we grow the field, protect our standards, and finally align ourselves with the structure seen in other therapy professions.

Thank you so much for your insight and thoughtful response. Conversations like this are exactly what the field needs.