Occupational therapists play a critical role in determining which assistive devices are provided to older adults and when and how instruction occurs during rehabilitation. This exploratory qualitative study used focus group methodology and Fleming’s concept of the therapist with a three-track mind to examine how occupational therapists describe the process of issuing assistive devices to elderly persons in rehabilitation. We identified six interrelated steps involved in issuing an assistive device to an older person with a cerebrovascular accident. These steps were the selection of a device, an activity, a site for instruction, a method of instruction, the time to introduce a device during hospitalization, and reinforcement of its use. Therapists used procedural, interactive, and conditional reasoning to make decisions within each step and individualize device training. The findings from this study underscore the complex series of decisions and skilled clinical judgments involved in issuing assistive devices to older persons. Additionally, the study shows that focus group methodology is a valuable approach by which to identify how therapists reason about specific therapeutic practices.