Before You Take that Dip: Renting a Community Pool for Aquatic Therapy

Byline: Andrea Salzman, MS, PT

Classify it under gross, but true. A private practice PT rents space at the local hotel pool. She is very pleased with the casual arrangement. The pool is warm; it has the right depths. It is rarely used. They only charge her $5 to use the pool for aquatic therapy sessions. She is quite lucky.

Over the summer months, she notices the water quality trending south: call it cloudy with a side-order of debris. No longer able to see the pool bottom, she approaches the front desk staff with her concerns.

Together, the day manager and she discover that the maintenance man who "cleaned the pool on the side" had quit almost three weeks before and no one else had been assigned to the pool. There wasn't a drop of chlorine in the entire building. Fast forward to queasy therapist spending her weekend buying antimicrobial body wash.

Many hospitals, SNFs and private practices want to offer aquatic therapy, but they do not have an on-site option. They look around and covet their neighbor's pool. "Why, just look at all that unused water," they say.

Let's assume for a minute that they-or you-have found the perfect pool at the community center, Holiday Inn or YMCA. They'll still need to consider some hypothetical scenarios before diving into a rental relationship.

Liability Concerns

Mrs. Trendelenberg has just come off home health and is attending outpatient PT for her newly minted hip. She has glaucoma, relies on a four-wheeled walker with casters a shopping cart would mock, and tends toward occasional-though spectacular--acts of unpredictability.

You schedule Mrs. T for her first session at 8 a.m. on Jan. 12 at the pool you rent at the Holiday Inn. It's winter. The lot is dark. The walk is long, but she makes it. only to collapse into the cushy, faux leather chair in the lobby.

Stop and ask yourself who is ultimately responsible for the pool's premises liability-you? If a patient slips and falls, gets cut or takes a header in the 3-feet section of the pool, whose insurance will cover that situation?

Keep in mind that these patients are not naturally occurring customers of the Holiday Inn. They are on the premises because you invited them there. Is it necessary to name the rental facility on your general liability policy to protect the facility from lawsuits? Do they need to name you?

What if the damaged party is the therapist? Doubt it will ever come up? Harken back to the introductory example. What if this therapist comes down with an infection or shingella? Who pays for her condition: her worker's compensation or the facility's liability coverage?

Access Concerns

Assuming your patients actually make it in from the parking lot, what arrangements exist to get them past the front desk staff? Will they need pool passes, permission slips, stealthy diversion tactics-or should they just palm the bearded gentleman a fiver as they cross into the inner sanctum?

You certainly don't want to create a situation where you are required to serve as "escort." This would wreak havoc on your day (and perhaps, your reputation). And what about access into the pool? If you are renting a condo or hotel pool, odds are there are no ADA-compliant means into the water.

Equipment Concerns

You are the creative type. You're willing to work under less-than-ideal conditions, but even you have your limits. Four detergent bottles and three dollar-store noodles won't cut it as therapy equipment. So, you buy some posh gear: A few state-of-the-art bells, some boots, gloves, a water walker, even aqua-socks for your diabetic patient. You store your supplies on a PVC cart in the corner with a nice sign stating "For Therapy Patients Only. THANK YOU FOR YOUR COOPERATION!"

But who really owns the equipment that you use? Is it yours to hoard? What if you throw out the pool's existing equipment and buy replacements-is the new stuff yours to take with you? What if the pool site buys it, but you wreck it? It is possible for any damage to be considered "natural wear-and-tear" under your lease.

Water and Air Quality Concerns

You show up at the community center, primed for four hours (eight patients) of water-time. You undress, don your aquatic unitard and prance off, poolside. Left foot in. What? The water is arctic. There's a polar bear in the hot tub. You can't believe how cold your big toe is. There's no way your people are going to pay to get into 62-degree water. Heck, you'll pay them to cancel, so you don't have to.

Who determines if the pool's water temperature is unsatisfactory? Worse, what happens if it vacillates from day to day? Maybe the certified pool operator's mother never taught him that cleanliness is next to godliness. And what if your therapist doesn't think the water (or air) quality is up to par, but can't get any satisfaction from the pool operator?

Cut to the converse situation: What happens if your patient suffers a continence accident? Are you supposed to clean it up? Who is responsible for the loss of revenue that occurs-for both parties?

Privacy Concerns

You've chosen to treat your patients in the middle of a public pool setting. Let's face it; there's a huge potential for other people to overhear or observe private treatment moments.

The Centers for Medicare and Medicaid Services (CMS) state that providers must rent exclusive use of the entire pool-or a designated portion of the pool-in order to diminish such privacy concerns. This regulation now applies to private practice therapists, outpatient hospitals, SNFs and other providers. Rehabilitation agencies and CORFs have to meet an even higher threshold. In order to use a community pool, these providers must undergo an inspection of the entire pool by the state agency.

Communication Concerns

How will you notify your patients of the pool shutdown? Will you be allowed use the facility phones or will you have to use T-Mobile? If you have negotiated permission to use the facility phones, does that mean it's OK to make a quick three-minute call or will they provide a place to sit down and hammer out calls for 30 minutes? For that matter, do you even have a place to work-other than the pool deck-when you aren't in the water?

Now, let's assume it's your patient who decides to cancel. She is going to need to reach you. If she calls the pool, whose job is it to take the message? And how angry are you going to be when you don't get it?

Loyalty Concerns

You decide to rent space at the YMCA for a year or two to see if aquatic therapy is just a fad or if there are truly enough aquaphiles to make it worthwhile. You put in the time, build up a massive following, fall in love with aquatics and decide to put in your own prefab pool at your Riverside office.

So, who keeps the patients you currently see in the pool? Are they yours, to take with you when you decide to leave, or are they the pool's, to keep by contracting with another therapist to take over your schedule? What if the Y helped you promote your aquatic services? What if the patients are all members? Assuming you are allowed to take your patients with you, will they even want to go? What if your new pool is farther away?

Final Thoughts

OK. You've made it through this article without giving up on the idea. You are ready to rent exclusive use of the first two lap lanes at the pool on Mondays and Wednesdays. You like the maintenance personnel and they promise you bath-worthy water temperatures. They even gave you your own desk. Great.

Just get it in writing. Memories fail and people leave. Never trust a verbal contract when your livelihood is at stake. A final word of advice? Don't enter into any rental situation without a clear exit strategy. Work out the details so your people will make the jump with you. It would be tragic to build up a faithful following. only to lose them in transition.