Lilac’s Doctor’s Letter for Home Care

To Whom It May Concern

Lilac Flowers is my patient at Spruce Healthcare. I recommend Ms. Flowers receive 50 hours per week in disability home aide services.

Ms. Flowers has a primary diagnosis of Chronic Fatigue Syndrome (Myalgic Encephalomyelitis) a systemic neuroimmune condition characterized by post-exertional malaise – a reduction in functioning and a severe worsening of symptoms after even minimal exertion. 

Her medical records document severe Fatigue and Muscle Weakness, along with Myalgia, Orthostatic Dizziness, Anxiety Disorder, Panic Disorder, Headaches, Foot and Leg Pain, Post Exertional Malaise, Adrenal fatigue, Food Intolerance, and Compound heterozygous MTHFR mutation. Additional symptoms and diagnosis include orthostatic intolerance; pain in the muscles and joints; headaches; cognitive symptoms including spatial instability and disorientation; hyperacusis including severe sensitivity to sound and vibration; gastrointestinal symptoms including nausea and abdominal pain; muscle fatigability and weakness; poor coordination; and cold and heat intolerance.

Functional Limitations: Due to severe fatigue and muscle weakness, she relies on medical equipment and assistance from home aides for mobility. She is frequently bedbound with symptoms that fluctuate and are unpredictable. When severe, she requires assistance in mobility and all activities of daily living, including assistance with bathing, dressing, toiling, transferring, mobility and eating. She has limited joint motion due to muscle weakness. 

Health Status: Her current health status is unstable. Due to orthostatic intolerance, standing or sitting fully upright can cause severe dizziness. She has experienced several falls and continues to be at risk for falls, as well as risk for impaired skin integrity. Without support from home aides, she would be at risk for increased anxiety and social isolation. She continues to experience debilitating fatigue and muscle weakness, and post exertional malaise causing a worsening of symptoms after any minimal exertion.  

Medical Needs: Her current medical needs include multiple, complex, interrelated medical conditions, placing her at high risk of medical instability. She requires supervision for nutrition and hydration and without home aide assistance, she would be at risk for malnourishment / dehydration. She requires an aide, caregiver, or family member, to be onsite with her throughout the day and night to ensure she is able to safely remain in her home in the community and avoid nursing home placement. 

Her medical condition is worsening and care needs cannot be adequately met at home without assistance from Medicaid waiver home aide services.


Alder Trees, MD