HLTH 4373 Module 1 Workforce Planning Analysis Example

Fifteen Therapy Hours per Patient per Week: A Workforce Plan for the Therapy Department of a 60-Bed Inpatient Rehabilitation Hospital

Student Name

American College of Education

HLTH4373: Human Resources for Healthcare Administrators

Module 1 Assignment

Instructor Name

October 5, 2026

Why Therapy Staffing Is the Constraint

I work as a human resources generalist at a composite 60-bed freestanding inpatient rehabilitation hospital whose patients arrive after strokes, brain and spinal cord injuries, amputations and major joint or fracture surgery. In most hospitals, nursing is the largest staffing challenge. In ours, the binding constraint is therapy. Medicare's coverage criteria for inpatient rehabilitation facilities generally require that a patient need and be able to participate in an intensive rehabilitation therapy program, which in practice usually means a minimum of three hours of therapy on each of five or more days per week (Medicare Coverage Criteria for Inpatient Rehabilitation Facility Services, 2024). If the hospital cannot deliver that therapy, it cannot admit or keep the patient.

Over the past year, the hospital held beds empty on 41 days because it lacked the therapists to provide required minutes, and it paid agency physical therapists at nearly twice the cost of employed staff to cover gaps. Leadership asked human resources for a workforce plan for the therapy department covering physical therapy, occupational therapy and speech-language pathology for the next three years.

Forecasting Demand

Workforce planning starts with demand: the staff needed to deliver the organization's services at its expected volume. At an average census of 54 patients, each needing roughly fifteen hours of therapy spread across the week, the hospital must deliver roughly 810 therapist hours of direct treatment each week, divided by clinical need among the three disciplines. Patients with stroke and brain injury need substantial speech-language therapy for swallowing, speech and cognition; orthopedic patients need mostly physical therapy; and nearly all need occupational therapy for daily living skills. Over the past year, the mix averaged about 42% physical therapy, 38% occupational therapy and 20% speech-language pathology.

Direct treatment is not all of a therapist's time. Documentation, team conferences, family training and evaluations take roughly 30% of a working week, so each full-time therapist delivers about 28 hours of direct treatment. On that basis, the hospital needs about 12.2 full-time equivalent physical therapists, 11.0 occupational therapists and 5.8 speech-language pathologists at its current census, plus weekend coverage. Leadership plans to raise the average census to 57 within two years, which would increase each figure by about 6%.

Assessing Supply

The hospital currently employs 10.0 full-time equivalent physical therapists, 9.5 occupational therapists and 4.0 speech-language pathologists, supported by therapy assistants. The gap is about 2.2 physical therapist, 1.5 occupational therapist and 1.8 speech-language pathologist positions, filled with agency staff and overtime. Four therapists are eligible to retire within three years, and turnover last year was 18% in physical therapy, higher than in the other disciplines, with most departures going to outpatient clinics and home health agencies that offer weekday hours and no weekend rotation.

The external labor market will not make recruiting easier. Federal projections for 2025 to 2035 show employment growing 12% for physical therapists (U.S. Bureau of Labor Statistics [BLS], 2026b), 15% for occupational therapists (BLS, 2026a) and 17% for speech-language pathologists (BLS, 2026c), in each case well above the pace expected across occupations generally. Rapid growth means competition from other employers for the same graduates, and the hospital's weekend requirement puts it at a disadvantage against settings that do not ask for it.

Weekend and Leave Coverage

The weekday calculation understates the real need because patients also receive therapy on weekends to meet the weekly requirement and to avoid losing progress, and because therapists take vacation, sick leave and continuing education days. Over the past year, the department delivered about 15% of its therapy hours on Saturdays and Sundays, and each therapist averaged about 22 days of paid leave. Covering weekends with the current rotation, in which every therapist works every other weekend, costs about 0.8 full-time equivalents in each large discipline, and leave coverage adds roughly 9% to the weekday requirement.

When these factors are included, the department's true need rises to about 14.1 full-time equivalent physical therapists, 12.6 occupational therapists and 6.4 speech-language pathologists at the current census. Measured against these adjusted figures, the shortfall grows from 5.5 positions on a weekday basis to about 9.6, and a plan built on the smaller number would look adequate on paper and fail on the first holiday weekend. The adjustment also shows why the weekend rotation matters so much: it is not only a staffing cost but, as the exit interviews show, one of the main reasons therapists leave.

The Gap and Its Causes

Set against demand, the supply picture shows a gap of about 9.6 full-time equivalents today once weekends and leave are counted, and about 11 within two years if the census grows and turnover continues at last year's rate. Retirement could widen it further. The causes are clear from exit interviews and market data: the hospital competes for therapists with outpatient and home health employers that offer more predictable schedules; its pay is near the market median but its weekend rotation makes the job less attractive; and it has no relationship with the three therapy programs within 100 miles, so it rarely hosts students who might later become employees. The hospital is not short of therapists because therapists are scarce; it is short because it asks more of them than competitors do and offers nothing in return for the difference.

Strategy to Close the Gap

The plan uses four strategies, each aimed at a cause. First, grow the pipeline: sign clinical education agreements with the three regional therapy programs and host at least eight students a year, since students who complete placements are a proven source of hires, and offer a loan repayment benefit of $5,000 a year for up to three years to new graduates who join. Second, redesign the weekend: create two weekend-only positions at a pay differential, which reduces the rotation for everyone else from every other weekend to one in four. Third, use therapy assistants where regulations and clinical judgment allow, adding two physical therapist assistants and one certified occupational therapy assistant, which extends each therapist's capacity. Fourth, reduce turnover through the retention measures described later in the course, beginning with a structured orientation and mentoring program for new therapists.

The plan also sets a target for agency use: no more than 5% of therapy hours by the end of year two, down from 14% last year, with the savings used to fund the weekend differential and loan repayment.

Risks and Assumptions

The plan rests on assumptions that should be monitored. Census growth may not occur, in which case hiring should pause before the second year's additional positions. Therapy assistant use is limited by clinical need and by the level of skilled therapy some patients require, so the added assistant positions must be reviewed with the therapy managers. Medicare's rules for inpatient rehabilitation facilities could change, altering demand. And loan repayment will attract applicants only if the hospital's reputation among students is good, which depends on the quality of their placements. The plan will be reviewed every six months against these assumptions.

Measures

Five measures will track progress: vacancy rate by discipline, turnover rate by discipline, time to fill therapist positions, the share of therapy hours covered by agency staff, and the number of days beds are held because of therapy staffing. The last measure connects human resources to the hospital's mission and finances most directly, since each held bed is a patient who could not be admitted. Results will be reported quarterly to the chief executive and the therapy director, with a target of fewer than 10 held-bed days in the second year, down from 41.

References

Medicare Coverage Criteria for Inpatient Rehabilitation Facility Services, 42 C.F.R. § 412.622 (2024).

U.S. Bureau of Labor Statistics. (2026a). Occupational therapists. In Occupational outlook handbook. U.S. Department of Labor. https://www.bls.gov/ooh/healthcare/occupational-therapists.htm

U.S. Bureau of Labor Statistics. (2026b). Physical therapists. In Occupational outlook handbook. U.S. Department of Labor. https://www.bls.gov/ooh/healthcare/physical-therapists.htm

U.S. Bureau of Labor Statistics. (2026c). Speech-language pathologists. In Occupational outlook handbook. U.S. Department of Labor. https://www.bls.gov/ooh/healthcare/speech-language-pathologists.htm