This study compared the factors influencing the clinical reasoning skills of qualified occupational therapists and support staff working in community rehabilitation teams with elderly service users. The study used a qualitative approach. Data were gathered from semi-structured interviews conducted with a convenience sample of 20 London-based respondents.The results showed that although the support staff interviewed were competent in their approach to the provision of treatment, they followed treatment plans provided by their qualified colleagues. Furthermore, the support staff felt themselves unqualified to make treatment decisions without first seeking the advice and approval of a qualified therapist. These findings suggest that occupational therapy support staff cannot be expected to perform the same duties as qualified occupational therapists in community rehabilitation settings.