Reference no: EM132434619

Questions will follow the below story:

Background

Doug 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 phase

In 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 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 phase

Doug 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 phase

Doug 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 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.

• 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.).