Planning a new pool and surrounding environment for an aquatic therapy facility presents the challenge and opportunity to create a space custom made to meet the needs of your physical therapy staff and clients. 

Devorah Billauer, PT

I am a physical therapist with a master’s degree in physical therapy, and I have been working in water since 2003. As time has gone by and I have seen the increasing popularity of water-based therapy, I realized that there is not enough written about it. Like with any therapy, we, as a community, need to share our best practices, so I have decided the time has come for me to write about my experience building aquatic therapy facilities.

When I started in physical therapy, I worked both on land and in the water, but as time went on, I became more and more frustrated when it took longer for patients to reach their goals on land than it did in water. So in 2007, I moved over to water-based therapy completely. 

It was at this point that I was hired to build a hydrotherapy department for the Israeli War Veterans Association. I started with a staff of two therapists, some basic equipment, and a single lane in an Olympic-sized swimming pool that, to no one’s surprise, did not fit the requirements for a proper hydrotherapy center. By 2020, I had built a specially designed complex; had a staff of almost 20 and a wide variety of equipment, including a custom-built underwater electric treadmill; and was providing over 2,000 treatments a month.  

So how did I get there, and what are the key factors to keep in mind when building an aquatic therapy facility? 

Initial Planning Phase

Let’s start with the planning phase. In this part of the project you need to take into consideration three main things: your clientele, your staff, and your local rules and regulations.

The first step is to answer a few basic questions about your clientele. Who will this pool be serving? What are their ages? This is important when considering water depth. What disability levels will you be serving? How will these patients access the pool and its surrounding facilities? What are the hours of operation? This will help when choosing a lighting system. Will there be group lessons as well as individual lessons? Knowing this will help when planning the size of the pool. Will the pool be servicing the community? If so, there may be a need to cool down the water for non-therapy hours. Will there be swimming instruction alongside or after therapy treatments? This will determine if there needs to be lane demarcation. Will there be underwater spin classes or Ai-chi classes? This will help determine what type of floor will be needed: sloping or flat/non sloping. 

Equally important to taking the clients into consideration, is to consider the staff. The office staff will need a separate area with its own air conditioning system that will be closed off from the warm temperatures in the pool area while still allowing a clear view of everyone entering and leaving the facility. 

A therapy room is a good idea to allow for privacy during one-on-one sessions with a client and a private area for land-based evaluations. A comfortable staff room is a must to ensure a happy committed staff. After a few hours in the water, the therapists will need a room that offers some privacy to relax, refresh, replenish, and fill in client treatment reports. 

A separate designated equipment storage area is a must for pool maintenance equipment, which tends to consist of big, bulky machines that are an eyesore. It is important to have a closed off area with good ventilation to store this equipment when not in use. This room can also be used as a wet room for staff to hang their “work clothes” (bathing suits, robes, etc) to dry.

Finally, it is important to research and take into account zoning laws as well as the demographics for planning changing rooms, bathrooms, and shower areas.

There are many decisions that need to be made and the options are endless. Answering all these questions and gathering this information will help with planning the specifics of the actual pool and the surrounding facilities that will serve your clientele. 

Aquatic Therapy Facility Structural Plans

If you are lucky enough to have input into the structural plans, then you will be able to influence the most important factors. Because it isn’t what you see that matters, rather what you don’t see. For the complex to be successful you want everyone to be comfortable, and that is accomplished with a good ventilation system. This is where a lot of the money needs to go. 

An efficient system that will constantly maintain the air temperature at 86° F (30° C) while keeping the humidity in check will guarantee the comfort level of the patients as well as those who accompany them to treatment. Many complexes have large blowers designed to help bring in fresh air, but because they are very noisy they often never get used, rendering them useless. It is essential to bring in an air conditioning/air quality company that specializes in warm, humid environments to arrive at an appropriate solution that will get used and benefit the staff and clientele. 

Alongside the ventilation system is the filtration system. Today there are different options available, and all should be considered when planning a complex. Most pool planners stay with the tried-and-true chlorine system using diatomaceous earth or sand, but some have tried and been successful with bromine systems. There are advantages and disadvantages to both. 

Pool Particulars

Once that is planned out, then comes the fun part – the pool itself! It is very important to take into consideration the target population, but you also don’t want to limit yourself should you change gears in the future. There is a very big trend in Europe to build pools with an adjustable floor.  These allow you to change the height of the pool floor with a push of a button. In theory they are a great idea, but in my humble opinion they cause more trouble than good. The more complex and “high-tech” the system the more things can break, which can result in closing down the pool for hours or even days and therefore a loss in revenue. 

Adjustable floors also put a lot of added pressure on the scheduling staff to coordinate patient sessions based on their water depth requirements. It is also very limiting in the specific therapy session. If you want the patient to first do some walking exercises but then to progress to non-weightbearing exercises in the deep section, this can’t easily be done with an adjustable floor. While it is not state of the art, a sloping pool floor allows much more versatility and no need for complex scheduling. 

Deep Water?

In addition to the type of floor, the question that always arises is to deep water or no to deep water? Pool planners often recommend staying away from deep water. There is a general feeling that if there is no deep-water section then you don’t need to hire a lifeguard, and therefore save money. But, if the pool is planned correctly, a lifeguard becomes an asset. When the pool is filled with clients and patients there will be a need for an extra set of hands for transfers, and eyes on the pool for safety, even if it is not required by law. 

Besides the potential costs, deep water allows for much more versatility in treatment plans and is the ideal place for treating acute back pain patients. So, in my opinion, ALWAYS plan for deep water. That then begs the question, how much deep water? This is dependent on many factors like client ages, disability levels, and other uses for the pool, and can be decided on with the help of a pool consultant.

Aquatic Therapy Facility Pool Positioning

Another important factor to consider is whether to build an above-ground, partially, or fully below ground pool for your aquatic therapy facility. These choices are critical in designing a pool that encourages the patient to be as independent as possible. As a strong proponent of patient independence, I am always looking for ways to push patients into independent activities. The best option for a therapy pool is to have at least one side of the pool flush with the floor. This allows more versatility when planning and choosing a chair lift. 

Another great feature that helps promote independence is a wheelchair ramp along one side of the pool with a sliding platform at the end. The platform is level with the average seating height of a wheelchair, allowing a paraplegic patient to place his legs on the platform and slide himself in. In addition, the side supports of the platform stick out into the pool to allow the patient to do a reverse pull up to hoist himself out of the water back into his wheelchair. This ramp also creates a low wall that can serve as a bench allowing an amputee to sit comfortably, remove her prosthetic, and lower herself into the pool. 


All these factors are only the first level when designing a hydrotherapy complex. The goal is always the same: creating an inviting complex that allows the staff to uphold the highest levels of professionalism while ensuring maximum revenue. The list above is only a partial accounting of all that must be considered and has been provided as a guideline for planning a successful hydrotherapy center.  

The options are endless, and the decisions are many, so it is important to use a consultant with a proven track record to help plan the pool. This is true for building a new complex as well as opening a center in a preexisting complex. The planning and building can and will be a stressful time, but if done right, the rewards of helping patients reach their full potential will make it all worth it. 

Devorah Billauer, PT, is a rehabilitation physical therapist with a specialty in hydrotherapy. After 15 years of creating and running a hydrotherapy clinic for Israeli war veterans, she decided to take on the new challenge of opening a hydrotherapy clinic in a recently built rehabilitation hospital. Billauer has a passion for working with patients dealing with acute back pain and flare-ups from chronic pain. For more information, contact [email protected]