It's pretty much the nature of the job, but it's not as bad as it sounds. You can avoid it mostly by working in hand therapy or outpatient therapy. But if you work in a SNF or inpatient, it will be one of your main treatment goals. But really, if you're going into a field that works to have people become independent, what's more important than going to the toilet independently? Even a physical therapist will usually take their patient to the bathroom if they have to go during a treatment. You might really consider if healthcare is a good choice for you. There's more to being a COTA than a steady job and decent paycheck. You'd be doing yourself, your patients and your co-workers a disservice by going into healthcare and not wanting to get your hands dirty. That being said, it gets easier with time, but if you don't think you can get use to it, then I'd recommend another field.