1. [From 10$/Pg] Two Couples Would Get
[From 10$/Pg] Two Couples Would GetParkinson’s Disease Case Study [WLOs: 1, 2, 3]
[CLOs: 1, 2, 3, 4, 5, 6, 7]Prior to beginning this assignment, read Chapter 9 from the course
textbook, The Stigma of Parkinson’s Disease (Links to an external site.) blog
post, Neurodegenerative Diseases (Links to an external site.) web page, and the Instructor
Guidance.As the average life span increases, the likelihood of developing a chronic disease
increases as well. This assignment focuses on Parkinson’s Disease (PD), which is a
neurodegenerative disease. Neurodegenerative disease causes dysfunction and death of
nerve cells in the brain and can affect motor, cognitive, and behavioral or psychological
functioning. Usually, such disease has a profound impact on the family, as well as the
affected individual. The case study below gives you the opportunity to learn more about
issues faced by people who have PD as well as exploring the impact of PD on the micro-,
meso-, and macro-level systems and the reverse – the micro-, meso-, and macro-level effects
on the individual.Parkinson’s Disease Case Study Details:BackgroundDoug and his wife
Maria have three adult children, all of whom are married with young children of their own.
Doug works as a regional sales representative for a chemical company that produces
plastics, chemicals, and agricultural products. He has been in the position for 15 years,
having moved into this job after leaving a different company doing similar work. The job
requires him to travel to give demonstrations of the products across a six-state region. This
requires him to fly and drive in unfamiliar areas. Maria works as a junior high school
principal. Doug and Maria are financially set for retirement at age 65. Overall, they are in
good health. At the age of 60, Doug received a diagnosis of Parkinson’s Disease (PD).Early
phaseIn the year before his diagnosis, Doug had three minor car accidents while he was
traveling in unfamiliar territory. Maria was suspicious that the accidents were related to his
PD and, after consulting with the neurologist and Doug, they decided he should no longer
travel alone out of his immediate area. After a few months of traveling with a colleague, he
reluctantly stepped down to a district sales representative position to stay closer to home.
Within the next year, Doug started experiencing exacerbated (worsened) symptoms related
to fine motor coordination, changes in speech, as well as anger, anxiety, and depression. The
neurologist placed Doug on short-term disability at the age of 61. After six months on short-
term disability, the law mandates that the individual must apply for Social Security
Disability. Therefore, due to Doug’s health continuing to decline and his inability to return
to work, Maria had to file for long-term disability for Doug. At first, Maria attempted to work
with Doug to complete the disability paperwork. Doug was easily frustrated with

2. formulating the responses to the questions on the forms; he did not know how to answer
the questions nor where to find the information within their household records, so Maria
hired a lawyer to complete the paperwork.Three months after submitting the application,
Doug was approved for Social Security Disability Income (SSDI). This was a significant drop
in income. Doug’s employment income was twice that of Maria’s; he was bringing home
$7500 per month. His SSDI income is $2788 per month. Since Doug left his full-time job, he
was no longer eligible for health benefits from his employer. He is not eligible for Medicare
under the disability guidelines until two years after payments begin. Maria completed the
paperwork to add him to the health insurance through her job, which doubled her monthly
contribution to health insurance. The decrease in household income required them to
utilize their retirement funds earlier than planned. In addition, Maria knows, as the disease
progresses, she may have to make decisions about her own full-time work as a principal,
which will further strain their financial situation.Middle phaseDoug and Maria enjoyed
playing Scrabble with their friends Susan and Bob, who lived nearby. The two couples
would get together every Saturday for some friendly competition along with dessert and
lively discussion. A year after his diagnosis, Doug was exhibiting stooped posture and
changes in his speech, which made it difficult to understand what he said. These were clear
signs the disease was progressing. In some aspects of his life, he appeared to function well
enough, such as easily performing most activities of daily living, but it became clear he
struggled with activities in the game of Scrabble. For example, he was having a difficult time
creating words from the tiles he chose, where to place them on the board, and he could no
longer add up his points correctly. In addition, Doug was embarrassed because he
continually knocked tiles out of place on the board, struggled to communicate clearly and
interact with friends in a social situation. Doug felt a great deal of shame due to the changes
and told Maria that he no longer wanted to participate in the weekly game night. This meant
that Doug and Maria had less interaction in their own community and became more socially
isolated, which is not uncommon for families with a chronically ill member.Late phaseDoug
was in charge of managing his own medications, which he needs four times a day. One day,
about four years after his diagnosis, Maria was away from home at noon when Doug called
her to ask what he was supposed to do with the noon pills. “I’m supposed to throw them
out, right?” That was an early sign of dementia. It was a signal for Maria that Doug could no
longer control his own medications and that he probably shouldn’t be left alone for very
long. The incident marked the start of a steep decline in Doug’s cognitive and emotional
abilities, and the couple’s relationship changed from one of partners to one of patient and
caregiver. Maria relied on their children and other family members to help with Doug’s care,
and she began looking for support groups to help her figure out how to handle the
deteriorating situation. Even though she had a rotation of helpers, most of the work of
Doug’s care was Maria’s responsibility.Doug’s condition progressed to the point of needing
full-time care in a skilled nursing facility a little more than a year later, after he lost the
ability to stand up, even with help. He always needed two people to help him, and that just
wasn’t possible at home. In addition to the tremendous emotional stress on the family,
moving Doug to a skilled nursing facility further increased the financial burden. Maria made
the decision to sell the house and move to a small apartment by herself. She had to spend

3. the proceeds from their home to pay for Doug’s nursing home care before Medicaid would
help pay for his care, due to the Medicaid eligibility spend-down requirements. Doug passed
away five months after moving to the skilled nursing facility. Maria was still paying for his
care out of the proceeds from the sale of their home, so she never received Medicaid
assistance for Doug’s care.Address the following within the required Parkinson’s Disease
Case Study template:Briefly define Parkinson’s Disease.What physical changes occur related
to the onset of the disease?What are the possible psychological changes with PD?What
system(s) are affected?What are the treatments and therapies?The case study shared
details that indicate Doug is no longer able to identify and resolve problems.Identify two
examples in the study that indicate Doug is losing this ability.Provide two other examples
that may arise as the disease progresses that are related to identifying and resolving
problems.Discuss possible feelings and stressors Doug may be experiencing as the disease
progresses and he must rely on caregivers more.Refer to the required reading list for the
topics related to this assignment for ideas.Discuss the effects of the diagnosis of PD and its
progression can have on a spouse and family (micro-level).Refer to the chapter and
required readings regarding caregiving and caregiver burden (e.g., employment,
psychological effects, financial stressors, role in the marriage, etc.).Locate two services in
your own community that offer assistance to people with PD and their caregivers (meso-
level).Describe the services available, cost, and eligibility requirements.In your opinion, are
Doug and Maria eligible for the services? Explain your answer based on your findings and
the knowledge of Doug and Maria.At the macro-level, research the state and federal
programs, legislation and initiatives that affect chronic illnesses. Discuss the pros and cons
of two of the following items as they affect patients and caregivers.Legislation and lobbying
efforts (e.g., changes to the Affordable Care Act [ACA], stem-cell research, etc.)Requirements
to qualify for Social Security Disability Income (SSDI)Requirements to take advantage of the
Family and Medical Leave Act (FMLA)Requirements to qualify for Medicaid/Medicare.What
are the requirements of these programs in terms of paying for skilled nursing for Doug? Do
Doug and Maria qualify for assistance through these programs? Why or why not?Americans
with Disabilities Act (ADA).A program, legislation, or initiative of your finding.Use a
minimum of three scholarly sources. List references in APA format within the response box
on the template.The Parkinson’s Disease Case Study assignmentMust be completed within
the Parkinson’s Disease Case Study template.