ATU Resources · Pool Planning

Building a Therapy Pool

When a pool makes sense, with free checklists to decide between building and renting, plan the design, cost it out and get your team ready.

Published by ATU Educational Services, LLCLast reviewed October 23, 2026A 6–8 minute read, plus the checklists

When a pool makes sense
Build or rent checklist
Design checklist
Cost worksheet
Staffing check
Launch plan
Questions
Ask us

When does a pool make sense?

A therapy pool is a long-term commitment of space, money and staff. It usually makes sense when three things are true.

Patients are waiting

Expert opinion

Your referral sources can name patients they have nowhere to send. Their answers are your first demand estimate.

The evidence fits your patients

Recent reviews often find aquatic exercise comparable to land exercise, and better for some outcomes, such as musculoskeletal pain¹ and exercise capacity in chronic obstructive pulmonary disease.² Not every review favors water, for example in knee osteoarthritis.³

Comparable still matters: hip and knee joint forces were 36% to 55% lower in chest-high water than on land,⁴ so water may let a patient start sooner.

The hours will fill

Expert opinion

A pool costs money every open hour, used or not. Plan therapy blocks, fill quieter hours with community programs and estimate weekly hours of use.

Build or rent: a decision checklist

Sections marked Expert opinion are practical guidance from ATU Educational Services, LLC. They are not rated as evidence.

Build or rent decision checklist

Expert opinion

Check each statement that is true for you. There is no score: if most of your checks are in the first group, rent first and revisit later. If most are in the second, building may be worth a closer look.

Signs that renting fits now
We have not yet measured demand from our referral sources.
A pool our patients can reach has hours we could book.
We cannot yet fund both building a pool and running it every year.
We want to test which programs fill before we commit space and money.
A pool owner is willing to put our hours and our part of the pool in writing.
Signs that building may fit
Our referral sources name more patients than rented hours could serve.
No pool nearby meets our patients’ needs for water temperature, depth or access.
We have local written estimates for building the pool and for running it each open hour.
Community programs or partners could use the pool in the hours therapy does not.
The people who decide have approved a written case with measures for year one.
We have, or can hire, staff trained in aquatic therapy and in pool operations.

Your checks and notes stay on this device only. Nothing is sent to us.

Plan the program before the pool

As Sue Nelson, who has advised aquatic facilities on programming and design, put it, “programming precedes design.”¹¹ Decide who you will serve, which programs you will run and how many hours the water will be used. The program then sets the depth, temperature, access and staffing.

Depth

Deeper water supports more of the body,⁵ but fast movements and resistive fins can raise joint forces again.⁴

Water and air temperature

Water temperature, air temperature and humidity belong in each pool user’s screen, according to guidance from the Aquatic Therapy Association of Chartered Physiotherapists (ATACP), a professional network in the United Kingdom.⁶

Expert opinion

Therapy usually needs warmer water than lap swimming, which raises energy and air-handling costs. Set targets with current professional guidance and your local code.

Access and entry

Under the 2010 Americans with Disabilities Act (ADA) Standards, new and altered public pools need accessible entry: one lift or sloped entry for smaller pools, and two means of entry for pools with more than 300 linear feet of wall.⁷ Many therapy programs plan for more than the minimum.

Air quality

Indoor pool air can carry chloramines that irritate eyes and airways, so air handling must bring in enough fresh air, according to the Centers for Disease Control and Prevention (CDC).⁸

Codes and plan review

The CDC’s Model Aquatic Health Code is guidance that states and localities use to write pool codes; your own state or local code is what applies.⁹

Expert opinion

Expect plan review before construction. Bring in a licensed aquatic designer or engineer with therapy-pool experience early.

Pool design checklist

Expert opinion

Use this with your design team. Each unchecked item is a question to settle before drawings are final.

Program
We have written down who we will serve, which programs we will run and how many hours a week the water will be used.
Water temperature
We set water temperature targets with current professional guidance and our local code, for each program we plan.
The heating and air handling can hold those temperatures steady, and we know what that costs.
Air temperature and humidity are part of the design, not only the water.
Depth
The depths fit our programs: shallow water for standing and gait work, and deeper water if we need it.
We have weighed a range of depths, or an adjustable floor, against our budget.
Entry and ADA access
Pool entry meets the 2010 Americans with Disabilities Act (ADA) Standards for our pool size.
We plan more entry options than the minimum, such as stairs with rails, a ramp or a lift, for the patients we expect.
The route from parking to changing room to deck is accessible.
Changing rooms are private and accessible, with space for a wheelchair and a helper.
Air quality, codes and review
The air handling brings in enough fresh air for an indoor pool.
We know which state or local pool code applies, and we have asked the health department about plan review.
A licensed aquatic designer or engineer with therapy-pool experience is involved early.
Staffing
We know who will treat, who will supervise and who is rescue-trained for every open hour.
A trained pool operator will test and run the water.
Scheduling
We have a draft weekly schedule with therapy blocks and time between sessions for transfers and changing.
Community programs or partners can fill the quieter hours.
There is storage for equipment, and transfer space on deck.

Your checks and notes stay on this device only. Nothing is sent to us.

Cost and return worksheet

Answer these in writing before you ask anyone to approve a pool. Costs vary widely by region, pool size and building, so use local written estimates, not national averages.

Cost questions worksheet

Expert opinion

Write your answer under each question, and check it off when you have a written source for it.

What does one open hour cost: staff, chemicals, energy for water and air, dehumidification, maintenance, insurance, permits and inspections?
How many hours a week must be filled to cover that cost?
Which payers cover aquatic therapy for our patients, and under what conditions?
Which community programs or partners could use, share or fund the pool when therapy does not?
What one-time costs have qualified professionals quoted in writing?
What would it cost to rent pool time for the same hours instead?
What will we measure in year one, and what would make us change course?

Your checks and notes stay on this device only. Nothing is sent to us.

Is your team ready?

Guidance from the Aquatic Therapy Association of Chartered Physiotherapists (ATACP), a professional network in the United Kingdom, says every therapy pool needs an emergency evacuation procedure, practiced at least once a year and with new staff, and recommends that besides the treating clinician at least one other person trained in the evacuation procedure and basic life support is available to respond.⁶

Staffing and training readiness check

Expert opinion

Check each statement that is true for your team today. Each unchecked item is a gap to close before the first patient.

Each clinician who will treat in the water has aquatic therapy training, not only land-based training.
Supervision of assistants in the pool follows our state practice act and our payers’ rules.
Besides the treating clinician, at least one other person trained in the evacuation procedure and basic life support can respond during every session.
We have a written emergency and evacuation plan, and staff have practiced it, including new staff.
Every patient is screened before entering the water, including water and air temperature and any precautions or contraindications.
Our documentation shows why each patient needs skilled care in the water.
We know who keeps the water safe: a trained pool operator for our own pool, or the owner’s operator for a rented pool.
We have a plan for staff absences, so sessions are not run short of trained people.

Your checks and notes stay on this device only. Nothing is sent to us.

From plan to first patient

Program launch plan

Expert opinion

Work through these steps in order. The time each step takes depends on your site, your payers and your local rules, so set your own dates.

1. Decide
Ask referral sources which patients they cannot place now, and write down their answers.
Pick the patient groups and programs you will start with.
Choose two or three matching research reviews, limits included, to share with decision makers.
Decide whether to rent pool time first or plan a pool of your own.
2. Secure the water
Visit candidate pools at the times you would treat, or start plan review and design for your own pool.
Sign a written agreement, or get written estimates and approvals for building.
Confirm insurance, payer rules and any Medicare requirements in writing.
3. Prepare the team
Train each treating clinician in aquatic therapy.
Write and practice the emergency and evacuation plan with everyone who will be on deck.
Set up screening forms and documentation templates.
Book regular time blocks, with room for transfers and changing.
4. Open
Tell referral sources the start date, the patients you can take and how to refer.
Start with a schedule you can staff every week.
Track referrals, sessions held, cancellations and hours used.
5. Review
Compare the year’s results with the measures you set at the start.
Decide whether to add hours, add programs, change pools or plan a pool of your own.

Your checks and notes stay on this device only. Nothing is sent to us.

Courses for new aquatic programs

Starting a new program? These Aquatic Therapy University courses cover the basics a new team usually needs first:

Aquatic Therapy Essentials Bootcamp: the introduction to aquatic therapy that starts the ATU credential pathway.
Aquatic Therapy Essentials: an on-demand introduction to aquatic therapy fundamentals.
Documentation and Billing for Aquatic Therapy Practice: documenting and billing aquatic therapy clearly.
Aquatic Therapy Precautions and Contraindications: a free archived webinar on safety screening.

Business consulting: Want help with the launch itself? Our business consulting covers program launch, from the first plan to opening your schedule. Call 865-204-0618, email info@swimatu.com or use the Contact Us form on our Private Training page.

Browse all courses About the ATU credential

Common questions

Do we need our own pool to offer aquatic therapy?

No. Many programs rent time in an existing pool. Medicare allows therapy in a community pool when the practice or provider rents or leases the pool, or a specific part of it, for the use of its own patients at set times (Medicare Benefit Policy Manual, chapter 15, section 220 C).¹⁰ See Renting a Pool for Therapy.

What water temperature should a therapy pool be?

This page does not give one number, because the right range depends on your patients and programs, and your local code may set limits. The Aquatic Therapy Association of Chartered Physiotherapists guidance asks that water and air temperature be part of each pool user’s screen.⁶ Set targets with current professional guidance, and make sure the heating and air handling can hold them.

How many ways into the pool do we need?

Under the 2010 Americans with Disabilities Act Standards, a public pool with 300 linear feet of wall or less needs at least one accessible means of entry, a lift or sloped entry, and a larger pool needs two.⁷ Many therapy programs plan for more than the minimum.

What does a therapy pool cost to build and run?

We do not publish a figure, because costs vary widely by region, pool size and building. Use the cost worksheet above and get local written estimates for both building and each open hour.

Can Aquatic Therapy University design or build our pool?

No. Aquatic Therapy University offers business consulting for aquatic programs: program business planning, deciding whether to build or rent, budgeting and cost questions, Medicare and billing setup, staffing and training plans, and program launch. ATU does not design or build pools, act as a pool designer or engineer, or find or broker pools. For pool design, work with a licensed aquatic designer or engineer. Ask us about consulting.

Next steps

Ask your referral sources which patients they cannot place now.
Pick two or three matching reviews from the Aquatic Therapy Foundation’s free Evidence Library, limits included.
Consider renting pool time first to test demand.
Ask your health department about plan review, and talk to a licensed aquatic designer or engineer early.
Write a one-page case for the people who will decide.

If you are starting an aquatic program, Aquatic Therapy University offers continuing education courses, private on-site training for teams, business consulting for aquatic programs and an aquatic therapy credential. You do not need any of them to use the tools on this page.

Have a question about your pool plan?

Ask us. Tell us what you are planning, such as renting time at a local pool, opening a new program or training your team, and we will point you to what fits: a course, private training for your team or business consulting for your program.

Call 865-204-0618, email info@swimatu.com, or use the Contact Us form on our Private Training page.

Call 865-204-0618 Email us Send a message

Informational only. This page is general education, not legal, financial, insurance, engineering, reimbursement or medical advice. Talk to qualified professionals before you sign or build anything.

References

Every source cited on this page, in American Medical Association style. Each link goes to the publisher, PubMed or the official free copy.

Deng X, Li Y, Wu Z, Wang Z. The dose-response relationship of aquatic exercise for musculoskeletal pain relief: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskelet Disord. 2026;27:698. doi:10.1186/s12891-026-09953-0. PubMed: 42265644. Open access under a Creative Commons Attribution-NonCommercial-NoDerivatives license.
Du W, Zhou J, Chi A. Comparative rehabilitation benefits of water-based versus land-based exercise in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Life (Basel). 2026;16:207. doi:10.3390/life16020207. PubMed: 41752845. Open access under a Creative Commons Attribution license.
Amaral M, Correia B, Oliveira M, et al. Comparative effectiveness of aquatic versus land-based exercise on pain, physical function, and quality of life in people with knee osteoarthritis: an updated systematic review of randomised controlled trials. Healthcare. 2026;14:3388. doi:10.3390/healthcare14203388. Open access under a Creative Commons Attribution 4.0 license.
Kutzner I, Richter A, Gordt K, et al. Does aquatic exercise reduce hip and knee joint loading? In vivo load measurements with instrumented implants. PLoS One. 2017;12(3):e0171972. doi:10.1371/journal.pone.0171972. PubMed: 28319145.
Torres-Ronda L, del Alcázar XS. The properties of water and their applications for training. J Hum Kinet. 2014;44:237-248. doi:10.2478/hukin-2014-0129. PubMed: 25713684.
Aquatic Therapy Association of Chartered Physiotherapists. Guidance on Aquatic Physiotherapy Practice 2021 (amended March 3, 2025). Accessed October 19, 2026. Guidance (PDF).
U.S. Department of Justice, Civil Rights Division. Americans with Disabilities Act requirements: accessible pools, means of entry and exit. ADA.gov. Updated February 28, 2020. Accessed October 22, 2026. ada.gov.
Centers for Disease Control and Prevention. Chloramines and pool operation. Healthy Swimming. June 23, 2025. Accessed October 22, 2026. cdc.gov.
Centers for Disease Control and Prevention. About the Model Aquatic Health Code. Updated November 6, 2024. Accessed October 22, 2026. cdc.gov.
Centers for Medicare & Medicaid Services. Medicare Benefit Policy Manual, Chapter 15: Covered Medical and Other Health Services, section 220 C (Revision 13889, issued July 30, 2026). Accessed October 22, 2026. cms.gov (PDF).
Ramont D. Swim toward success. Recreation Management. November 1, 2018. Accessed October 23, 2026. recmanagement.com.

How to cite this page

Last reviewed October 23, 2026 · Permanent URL: https://www.aquatictherapyuniversity.com/building-a-therapy-pool

How to cite (American Psychological Association style)

Salzman, A. (Ed.). (2026, October 23). Building a therapy pool. Aquatic Therapy University; ATU Educational Services, LLC. https://www.aquatictherapyuniversity.com/building-a-therapy-pool

Date reviewed: October 23, 2026. Outside sources were checked on October 23, 2026 and may have changed since then. Cite the date you accessed this page, because content may change.

Permissions: You may quote and cite this page with attribution, and print the checklists for your own planning. Reproducing or adapting the page, or any substantial part of it, requires written permission from ATU Educational Services, LLC.

Copyright: © 2026 ATU Educational Services, LLC. All rights reserved. Free to read, quote and cite with attribution; copying, republishing, adapting or selling the page or its content requires written permission. Cited third-party works keep their own copyright and licenses.

Editor: Andrea Salzman, MS, PT · ORCID: https://orcid.org/0009-0009-5255-7074

Competing interests: ATU Educational Services, LLC publishes this page and sells aquatic therapy continuing education, private training and business consulting, which this page links to. Practical guidance on this page comes from its experience, is labeled Expert opinion and is not rated as evidence. This page does not sell, rank or recommend any consultant, pool, builder or product.

This page was drafted with AI assistance under the editorial direction of ATU Educational Services, LLC, checked against its cited sources, and corrected when errors are reported. Report errors to info@swimatu.com.

Building a Therapy Pool

When does a pool make sense?

Patients are waiting

The evidence fits your patients

The hours will fill

Build or rent: a decision checklist

Build or rent decision checklist

Plan the program before the pool

Depth

Water and air temperature

Access and entry

Air quality

Codes and plan review

Pool design checklist

Cost and return worksheet

Cost questions worksheet

Is your team ready?

Staffing and training readiness check

From plan to first patient

Program launch plan

Common questions

Next steps

Have a question about your pool plan?

References

How to cite this page

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