Aging neighbor and caregiver boundaries question: What boundaries might be good, and how do I implement them?

Your neighbor has complained that she is doing too much and that your Mother needs better care and that she "just can't do it".
She has told you all you need to know.
Your Mom's neighbor is doing too much and has told you so.
Your Mom's neighbor has told you that she needs more care, and has told you so.
Your Mom's neighbor has told you she can't do it, and has told you so.
May I ask what the question is here, really, because you have admitted that without this neighbor this cannot go on as it is, and that you are not close to the area, and are currently dependent on the care of this 81 year old woman. Who has TOLD YOU all the facts you need.
So I guess I would just like to repeat, Your Mom's neighbor is doing too much; she has said your Mom needs more care; she has told you that she cannot go on doing this. I am afraid the ball is now in your court. I am sorry. It will be sad for your Mom to have to leave her home and she will mourn that, as will you. I am afraid there is, however, no other answer I can think of. I wish you the best in finding a facility where she will be happy.

You are living in the land of denial. You mother's neighbour, elderly herself, has flat out told you that she can't keep doing this and yet you have somehow convinced yourself that you are doing HER a favour, give me a break! The fact is you are taking advantage of the empathy that causes her to step in when she sees a need and clearly makes it difficult for her to set boundaries, that's not cool. If you don't want to burn through all the friendship and good will offered by this kind woman then get your mother the care you admit she needs.

make a plan. You are not far from necessary changes coming. As your mothers health changes , so is your neighbors

Your comment about the neighbor stating she needs better care and that she just can’t do it, is an alert for your mom…and an alert that the neighbor is tiring?

I too lived out of state. My moms neighbor kept on eye on my mom. Helped her get the trash to the curb , brought newspaper from end of driveway to door, got her mail. And of course I could always count on being able to call them. This wonderful couple helped others as well in the Mobil home park… I finally got my mom in AL , a number of months later the neighbors wife died… I could not vision my mom still staying in her mobile home without that generous neighbor.. it may sound like they didn’t have to do a lot, but in my eyes , they were great security for me. (Neighbors wife was in better physical health, but died of cancer… )

I would have a heart to heart, frank discussion with the neighbor, by phone and not through an impersonal tech device or communication back and forth, and raise the issue of whether or not she wants to continue to be involved, and at what level.   Ask for instances, specific situations which challenge her ability.  et HER define her parameters.

I wouldn't include the term "boundaries"; that sounds too dominating and restrictive.  This woman has apparently helped of her own volition, and needs to be recognized as a genuinely good person.  "Boundaries" in this case seems to be too confrontational.  I'm not criticizing you, just offering a suggestion from someone not involved.

I think that you also need to advise her of the recording devices, especially if she's been seen on any of the tapes or videos.    I don't know what laws in your and your mother's states are, but I'm not sure that any personal entities who aren't involved in law enforcement can record someone, in someone else's house, without advising the neighbor this is occurring. 

Perhaps  the neighbor just wants to continue as a friend, and that's acceptable.   But give HER the chance to identify, specifically, and enumerate the areas in which she feels she's being challenged beyond capacity.

Over the years and from many threads I've read here, it seems that negotiation and meeting of the minds is often absent from relationships, often b/c of the personal nature of those involved.   But in this case, it might be a workable option.

You said " But I really think it's best for my neighbor's mental wellness to have my Mom there." I find that very presumptuous. And this is after she's told you she "just can't do it". I understand we all want to think we can find the perfect situation, and that our loved one's decline won't continue, you won't have to maker harder and harder decisions. But it sounds like it's time.

"Sometimes she does too much and complains that my Mom needs better care and that she just can't do it."

What, it's the caregiver's fault because she should be standing back more?

Nope. Be told. Your mother needs more support than the neighbour can give. Get a proper assessment done, and hire care.

Honestly, the "I would just like to encourage her to do more for herself and maybe require my Mom to do more things independently" ALWAYS comes from the person who isn't right there with boots on the ground seeing and truly understanding what the loved one can and can't do for themselves. The fact is, at this age and after a crisis such as a broken hip, your mother likely will not be able to do more things independently. Every crisis leads to a minor recovery and perhaps a plateau, but it's never one that takes them back to their pre-crisis level of health and independence. That's just how it is.

I think the neighbor is doing you a huge favor by speaking up as she has. No doubt she will indeed miss your mom and it may lead to a bit of a decline on her part as they have been mutually dependent on one another, but you need to do what's best for Mom, and living independently in her own house may no longer be viable. Look into in-home help, or an assisted living situation. Maybe the neighbor would like to come along, and they can continue living near one another.

Your mother' neighbor, although kind, cannot provide your mother with the type of care she requires on a daily full time basis. Dementia does not get better, but slowly gets worse -sometimes in such small increments that it isn't immediately noticeable. This type of arrangement has the potential of being dangerous. The neighbor is not spending the night there - what if you mother puts on a kettle of water for tea and forgets to turn it off? What if the neighbor herself has a medical emergency and can no longer care for your mother....you don't want to be in the panic mode in trying to make new accommodations for your mother - you may not find what you want when you are in such a state.

If your mother can somewhat function on a daily basis, she probably needs assisted living, not a nursing home yet.

Why are the only 2 options a) the neighbor provides any help needed or b) mother goes into a nursing home on Medicaid?

Why can't you hire her some in-home support?

Gb, you keep telling us what this neighbor does. But you have also told us that this neighbor is no longer willing to do this, and believes your Mom needs to be in care. I think that your Mom's home is not hers? As you mention that she cannot afford ALF. Were the home hers, and the mortgage paid, I think the excellent idea here would be ALF on the assets of her home. OR living more near to you where you can manage her care, doing the things that the (now unwilling) neighbor does. By the by, if it is you paying for this neighbor's labor, I think that's great. If it is your Mom there needs to be some sort of contract so that medicaid lookback will not be a mess, and she will qualify.
Important thing here is that the caregiver hands-on, the neighbor, recognizes that your Mom is likely no longer safe enough, nor any longer able to sustain herself on only the care of an 81 year old, who apparently is no longer willing to do this amount of care.
Your Mom may not like it, but that larger question is her safety. If you think, knowing your Mom, that you would "risk" anything that may happen as long as you can, and perhaps get in help that would be "willing" now to help her (the neighbor I think may be trying to remain civil, and may love your Mom and feel responsible, but yet seems from what YOU yourself tell us to no longer be willing in this responsibility), then that is your assessment to make. It is a hard decision to make.
Discuss this with your Mom and with the neighbor, then trust you to make the best decision you can for your Mom. It is never easy. Best of luck to you.

When my MIL and her husband both started having health and cognitive issues, I too was blessed by willing neighbors who checked in on them, shopped for them, etc. I also am PoA for 2 very elderly aunts in FL (and I live in MN). Again, blessed by a neighbor couple who were my eyes and ears until things changed.

Eventually your mom will need more care than can be given by an untrained person who is 81 years old. You have stated that right now your mom cannot afford AL. Have you checked into something called an Elder Waiver?

"The Elderly Waiver (EW) program is a federal Medicaid waiver program that funds home and community-based services for people 65 years old and older who are eligible for Medical Assistance (MA), require the level of care provided in a nursing home, and choose to live in the community."

source: https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=id_056766#:~:text=The%20Elderly%20Waiver%20(EW)%20program,to%20live%20in%20the%20community.

Also, contact her local area's Agency on Aging for other resources. Medicaid is run by each state and I have heard that some state's MA program will pay for AL.

I have read your prior response that you are concerned that facility care is suboptimal. My MIL is in one 3 miles from my home. She's on Medicaid in LTC in a private room. She gets awesome care and lots of social exposure and options for activities, events and outings -- something your mom won't get cloistered in her home with only her 1 friend feeling the pressure to be her entertainment committee. Not to mention the friend is only 1 sudden health crisis away from putting your mom and you into crisis mode. That's what can happen at 81, no matter how healthy she seems right now. Loneliness is crushing to the elderly.

If I were in your situation I'd start having the conversation with your mom that, base on lots of research you've been doing, it would be best to *eventually* move her to a care community near you. Are you her PoA? Hopefully so. Research and visit facilities local to you. Talk to an elder law attorney and Medicaid Planner for your state. For Medicaid She needs to medically and financially qualify, and some states have a 5-year financial look-back period on the app. There are many ways one can easily screw this up.

I would call up the friend and let her know that it's ok if she's feeling like your mom's care is overwhelming her, that you are looking into options and how can you help her in the interim? I totally understand that you wish to help your mom stay in her home but eventually she won't be able to so better to work on the solution for this now rather than in a crisis. I wish you much wisdom as you ponder her future care, and bless you for doing what you're doing for the both of them right now.

What I see here is the use of the word ""boundaries". Don't think thats the word you should use. Do you think she is out of line because she feels Mom needs care that the neighbor is not willing to do? She is the one that checks on Mom and as you say is a companion. But she probably sees things you don't on cameras. Neighbor is 81 so is very aware what an 80 yr old should be able to do for herself.

Maybe visit Mom. Find out her needs and go from there.

One thing that you are doing by sending checks to a senior in HUD housing is jeopardizing her housing. That is probably why she is tearing some of them up. She knows what could cause her to lose her benefits.

Maybe, find another way to compensate her. Gift cards, grocery cards, cash. Besides, checks mean a trip to the bank.

Seems like it's time for a friendly chat with the neighbor. If you want her to continue in a caregiver role, make it official: contract, pay, list of duties, dates and times she will "be there."

I would also encourage you to consider hiring some home health help - an agency might be the best way to go - that comes in regularly to the the things the neighbor can't. Since the neighbor is older too, there will come a day when the neighbor won't be able to come by and your mom will suffer neglect. "That day" will come without warning.

My suggestion would be to take the pressure off of the neighbor by getting enough professional or compensated help in to do the “ work” so the neighbor can really just be a companion. This way the neighbor still has responsibility without as much work? My guess is she will still do hair, check on her etc but there should be less pressure and they can simply enjoy each other’s company. In the meantime it would probably be a good idea to start your research, get mom on a list or two for the facilities you prefer (it can always be delayed once she moves to the top) so your plan is ready to go when the time comes that your mom can no longer stay at home.

I would contact elder care get meals on Wheels . Search online for people that you can hire . Elder services get a CNA in there to help with bathing and cleaning and food shopping . You could ask the neighbor what her concerns are ? Is it time for assisted living ? Maybe hire someone to come in as a companion or assistant . Be thankful you have a kind neighbor that checks in on your Mom . Also visiting nurse if she has meds . Maybe you can speak with her Doctor about physical therapy . There are options .

Lots of good ideas here as to what you might explore. I hope you can keep her in her own space, and if not, find what you need. I’m glad you are thinking about the value of caregiving to your mom’s neighbor. Without a doubt it is good for all of us to be useful to others, and she’s probably ambivalent about even stepping back. She wants to be involved, but at times it seems like too much, just as is the case with many family members. If your mom moves, I would expect that it will affect your neighbor’s mental health. You are not presumptuous in thinking (knowing) that helping your mom is of value to her.
Keep in mind that people on this forum are all offering advice only out of their personal context and their own issues, so just pass by the unhelpful comments. Why anyone would think you are making this up is beyond me; I can certainly imagine this scenario, and have seen similar.
All the best to you, your mom, and her neighbor.

It sounds like you’ve been doing your research. I found I was able to get my brother into a really nice AL facility with his social security and a Medicaid waiver. I contacted the Area Agency on Aging. There are usually a limited number of Medicaid beds but they are out there. Assisted living offers activities and meeting other people her age, as well as health care. My brother had a little one bedroom apartment that we moved his things into. The AL will likely assess her to find the level or tier of care she needs. Good luck!

I think a good solution would be for you to hire qualified home help for your mom and to thank the neighbor for her help and her advice - give the neighbor some credit for the idea to hire qualified help to slow down any future complaining. Boundaries are not for you to set for other people, but are for you to set for yourself - you set boundaries around what you will or will not let impact you. You can't control neighbor lady. If she wants to help and complain about the care your mother needs - then, if it bothers you, which is should, you should hire an at-home-caretaker. If she keeps complaining after you've hired qualified care, then you can set your guilt aside and just be thankful you have someone supervising the care provided by the qualified help. I understand where you are coming from. I've actually been the child of someone who needed more care than I could give them living on the other side country while trying to balance my career (totally felt the guilt from the neighbors and friends of my mother) - and the child of someone who was taking too much responsibility for the care of a neighbor because the neighbor's children were states away raising their own families. I know this is hard, but your mother is your responsibility. Here are your choices...(1) Hire qualified help for your mother. Visiting Angels or the like. And allow the neighbor to be your mother's friend...less of a caretaker. Again, I suggest thanking the neighbor for her advice and for looking after your mother so your neighbor can take some ownership over the decision to hire qualified help, which will hopefully reduce the complaining. There are probably affordable options that you don't even know about, so do some research. (2) Move mom in with you. (3) Put mom in assisted living. (4) Do nothing and wait for social services to be called on you...because either your neighbor or your neighbor's family will call at some-point. Seems like the best solution would be to hire at-home-help. AgingCare offers lots of assistance. I'm sorry you're going through this. Reality sometimes sucks.

You seem to feel entitled to have this neighbor help your mother by cleaning, vacuuming, doing her hair, fixing her food and the rest of it, then wanting to enforce 'boundaries' on her in the process! Never mind the woman is 81 years old herself & telling you your mother needs more help than she's willing or able to give her! Then you come back with a sarcastic remark saying, "But according to everyone here, having the neighbor do anything is presumptuous and apparently "evil" on my part. I'll start looking into nursing homes and try to do better. Thanks for all the help."

Really? You already have 'all the answers' so what kind of help are you looking for from US?

Your mother is fully functional yet has no short term memory, THE most dangerous kind of memory loss to have, even though you are watching her via video cameras and alert systems. Being sent off to rehab in a SNF, she is furiously calling 911 and others to get her out of there and tried to escape twice. Yet she can do a 300 piece puzzle, so all's well! Denial is not just a river in Egypt, you know.

You can be as sarcastic as you'd like, but the truth of the matter is, your mother is suffering from at LEAST moderate dementia and should not be living alone. That does not mean you should "put" her in a horrible nursing home where she'll "get care from people she doesn't know, doesn't have a personal connection/friendship with, and the neighbor is left in her apartment being bored and feeling lonely. Ok, noted. " You can hire in home help from someone who's not 81 years old and doesn't need 'boundaries', but who can provide the sort of care you'd like her to get. Or, you can find her a suitable SNF that may not be perfect, but would keep her safe and cared for.

Dementia is a losing situation for EVERYONE, you, your mother, the neighbor, all involved. It worsens with time and causes all sorts of potential dangerous situations your mother can DIE from while alone in the house. That's the truth. Take it or leave it. "Put" your mother in a nursing home or leave her alone in her home with you watching her over a device & her 81 y/o neighbor helping her out while she still can. There's no great answer or easy solution here, in all honesty.

But change your attitude b/c you came to a forum to ask for help but then choose not to listen. To people who have either traveled this horrible road before or who are traveling it now. It sucks, no matter what you do or how you do it. We lose our mothers to a very ugly disease that wipes out who they once were entirely, leaving a husk of a person in their place. So we all know what it feels like and how much money, time, head space & worry it truly causes. Don't shoot the messengers you came to for help.

I hope you can find a solution that works for you, and that keeps your mother SAFE, above all, b/c that should be your only real goal here. Not to find & implement boundaries with a neighbor who's going above & beyond the call of duty to care for your mother out of the goodness of her heart!

I suggest you read this 33 page booklet which is a download and very informative. It's called Understanding the Dementia Experience by Jennifer Ghent-Fuller. It may offer you some enlightenment on what your mother is going through, and what lies ahead. Knowledge is power.

https://www.smashwords.com/books/view/210580

Best of luck, whatever you choose to do.

It must be a man thing. My Mother lived with us for 20 months and I don't think my DH still understands Dementia. It is very unpredictable. No rhyme or reason to it. You are soooooo lucky that a neighbor loves ur Mom enough to help out. But I doubt an 81 year old can help Mom with a shower or toilet her. I did it at the age of 65 and it tired me out. Two friends retired at 60 from being CNAs because they just didn't have the strength anymore. The neighbor is not crossing boundries, she is telling u how it is. Family in denial is not unusual. Even the person suffering from a Dementia is in denial they have it. Problem is because of that denial something bad can happen.

If you love your Mom you will spend time with her. Take her to a neurologist and have her evaluated. Once you know how things stand, then you can make decisions concerning her care.

You expect a neighbor - and an elderly one at that - to be mom’s on call companion and helper for which you send her “some money” -- presumably under the table because otherwise this would be a discussion about your hired employee. In addition, you claim you’re doing the neighbor favor when she has told you it’s too much and you want to layout your expectations.

Tell the neighbor to join this forum. We’ll tell her she’s being taken advantage of, dissed and suggest she walk away or call 2-1-1 and let them intervene.

I see where you’re coming from but you appear quite clueless. If mom’s not independent, it’s not your neighbor’s job to make the impossible possible and you’ve moved her from being a concerned neighbor to the responsible caregiver.

gb4au1: Perhaps you cannot expect an elderly neighbor to continue in this role. This individual is already informing you that your mother requires more care.

I think that the helpful neighbor has quietly let you know tha,t while she enjoys your mother's company, she can no longer do all the things that your Mom needs. It's always hard to watch a parent who has been a fully functioning tower of strength decline and we all tend to try to "put it off" but it is inevitable. It's even harder when you are far apart. As you have said it is time to think about transitioning Mom into a new, safer environment. One of the things you will have to do is decide if Mom should stay in the area where she is now (which means she could stay connected with any friends she may have) or should she move closer to where you live (where she may meet new friends). For your ease in management and advocation.... it may be easier to consider moving her closer to you. Sounds like she might be more at the AL rather than MC level now but call the local Agency on Agency (in her current state) and see if they can get a needs assessment done. Also ask her current PCP if she has had a recent neurological eval and what her mental capacity is at this time (I am presuming that you have her current DPoA, and Medical proxy.... if not............. speak with a certified, elder care attorney and get them.......... fast!!) If Mom is currently in HUD housing, there may be a service coordinator on staff (it depends on the type of HUD housing) who can give some ideas about how to get her needs assessment done.

Medicaid is adminstered slightly differently in every state so you need to check with both states (yours and Mom's) as to what is available in terms of ALF and MC assistance. In most cases, Medicaid beds are limited in availabilty.
ALWAYS visit any facility you are considering at least twice (difficult during covid but things are opening up a bit now) and listen to the marketing talk you will get but use your other senses to see how clean the facility is, how it smells, how the residents and staff interact with each other. Ask for a list of activities scheduled for the month and ask for the weeks menu.
Since dementia is progressive try to find a place that has both AL (if that is what is currently recommended) and a secured MC unit so you can reduce the number of moves required as her care levels increase. Don't expect her to be happy about moving.... put your head down and plow along with your research - however.... unless she is judged incompetent by her doctors, she can't be forced to move (but she might be cajoled into it .... so try to work that show).
Like people.... there are bad facilities out there and good facilities. You have to research them and you have to stay in touch (which is why it is easier to have a LO nearer to you) or at the very least pay a case manager to visit and advocate for her regularly............. that is needed in the best of facilities. Also just based on past experience - caring for my Mom and working in the health care industry... it seems that care, at least in LTCs, is better in non profits even though they might not be as pretty. Big scandal (which may lead to nothing) in NJ right now about the abysmal care at 15 one star Medicare rated LTCs - 14 of them are for profits.

Good luck on this journey. You may have to weed through some of the comments on this site but most people are here to help not judge; but they all have their experiences with caregiving some of it good some of it bad. Let us know how it works out for you.

Everyone should be so lucky. I think your emphasis is on the wrong thing.

These situations are tricky. Having lived in an apartment dwelling for over 25+ years I have been in the trenches and have seen it all. Basically it starts out do you need anything at the store, milk or bread? Then during the snowstorm you do the wellness check on the elderly in the building. You then actually start building a "family" in the building and/or complex. "Junior" who went off to College and his fabulous job offer took him out-of-state. The Sunday night phone calls, a tablet for Christmas, all the latest technology does not replace an actual "show up in person" visit.

"Gladys" make believe name next door knows the family dynamics. She knows who's sitting alone on Christmas Eve and who is wearing the same blouse again for the 4th straight day in a row. She doesn't say too much but notices.

It's obvious to me, you love your mother. You are trying to cover all of the bases. The neighbor is trying to "help out". You in turn feel well their friends, neighbors perhaps even confidants but really we appreciate your help but you're running yourself into the ground. Let me show her my appreciation, a gift card, etc. Bottom line = Who shows up in life? Who shows up with soup, prescriptions from CVS and if the newspaper is left on the step for 2 days who starts the telephone tree.

People need people. The technology doesn't cut it. Men and women look at this very differently. My brothers every time they show up they bring my mother this enormous tv that she doesn't even need. It's kind of funny. They think the bigger the better.

How about calling your mother's PCP (primary care doc) and write a scrip for services--order P/T, O/T, homemaker, cleaning and keep the neighbor as a neighbor. Maybe you could order food delivery from a restaurant and they could dine once a week together. It would be a visit. Is your mother getting exercise. An UpWalker Lite is fabulous. Again your PCP can write the scrip.

The local Church brings my mother Communion and the bulletin each week. They rotate 10 different people. Keeps Mom tied to the Parish!

Women need companionship not a tv or more electronic stuff. This works for you but we are not robots. You need the human touch, conversation. Your mother's neighbor gets it. She sounds like a beautiful person and friend to your mom that you want to keep in the picture. Everyone should be so lucky.

When I moved to a new building I let family members know (the lady I checked on) that we will no longer be living in the same building. Previous to that I would check her blinds every morning that they were open so that she made it through the night. Just her seeing my car out in the parking lot gave her solace. If we went away for a few days I always informed her ahead and called when I got in. We exchanged Christmas and Birthday gifts, food, cookies, etc. Both love "Call the Midwife". I bought her Thanksgiving Dinner the day before Thanksgiving as she is alone. "Junior" missed calling one day and she was found on the floor in her own feces and urine. This could have all been avoided. Now in a NH, we call her on the phone.

The VNA will assess your mom and check her vitals.

You may have to make changes as your mother's needs change. Always keep the neighbor in the loop as to your mother's whereabouts as she is a treasure and what I like to call "an unsung hero". Amen...