Why Rural Communities Are Being Left Behind in Parkinson's Care — And What We're Doing About It
Parkinson's disease doesn't care what your zip code is. But access to quality Parkinson's care very much does. That gap is exactly why the Andrews Impact Foundation exists.
The Numbers Are Stark
A landmark study analyzing 2019 Medicare data, published in the peer-reviewed journal npj Parkinson's Disease, found that of the roughly one million Americans living with Parkinson's, only about 9% ever receive care from a movement disorder specialist — a neurologist with advanced, specialized training in conditions like PD. Most people instead see a general neurologist, and nearly a third receive their Parkinson's care from a primary care provider alone.
For people living in rural areas, the picture is worse. The same research found that only about 660 movement disorder specialists practice in the entire United States — and just six of them practice in rural areas. Rural Medicare beneficiaries with Parkinson's were measurably less likely to see a movement disorder specialist, or even a general neurologist, than their urban counterparts.
The consequences of that gap are real. Other research has linked rural living to lower reported quality of life among people with Parkinson's, along with reduced use of outpatient care and a higher reliance on emergency departments — a pattern that often signals people aren't getting the ongoing, proactive care they need until a crisis forces the issue.
And it's not just about seeing a neurologist. The same national study found that supplemental therapies — physical therapy, occupational therapy, speech-language therapy — are dramatically underused across the board, rural or not. Only about one in five people with Parkinson's studied were seeing a physical therapist at all, despite how central movement-based therapy is to managing the disease.
Why This Happens
Specialists — both physicians and specially certified therapists — cluster in urban and suburban areas, near major hospital systems and universities. That's simply where training programs, referral networks, and patient volume are concentrated. For a family in a rural community, "seeing a specialist" can mean a multi-hour drive, time off work, and lodging costs — barriers that stack up fast, especially for a condition that requires ongoing, regular care rather than a single visit.
Rehab professionals face a related but distinct barrier. A physical therapist, occupational therapist, or speech-language pathologist already working in a rural community may be exactly the person best positioned to serve local Parkinson's patients — they just may not have access to (or funding for) the specialized certification training, like LSVT BIG or LSVT LOUD, that would let them deliver gold-standard, Parkinson's-specific care close to home.
What We're Doing About It
This is the exact gap the W.A.D.E. Initiative was built to close.
Instead of only trying to recruit more specialists into rural areas — a slow, difficult undertaking — we fund the certification training for the therapists, nurses, and soon-to-graduate students who are often already there, or who are willing to go there. Every LSVT BIG, LSVT LOUD, or CNRN certification we help fund is a small, direct investment in expanding the map of where expert Parkinson's care actually exists.
We believe no one should have to drive three hours for basic Parkinson's care. Closing that gap, one certified provider at a time, is what the Andrews Impact Foundation is working toward — and it's a big part of why we exist as an organization at all.
If you're a rehab professional, nurse, or student in a rural or underserved community considering LSVT or CNRN certification, we'd love to help make that possible. Visit our Grants page to learn more.
Sources: npj Parkinson's Disease (Ferdows et al., "Care access and utilization among Medicare beneficiaries living with Parkinson's disease," 2023); Parkinson's Foundation.