Part III: The Long Arc of Caregiving for Eleanor Neil

This is the last part of a 3-part story. To read part two click here. To read part one click here.

For a long time, Eleanor Neil’s* team at Project Guardianship measured progress in small steps: a door opened, an appointment kept, a conversation sustained. 

Then, gradually, the scale shifted. 

“This past spring, everything changed,” her case manager recalled. 

Ms. Neil’s depression began to lift. But what followed was not equilibrium. It was movement—rapid, expansive, and at times, unpredictable. 

“She entered a manic phase,” the case manager explained. “And from her perspective, it felt good.” 

After years of isolation, Ms. Neil was suddenly out in the world again. She left her apartment daily—sometimes multiple times a day and at night. She took spontaneous trips, including a late-night ride on the express bus to Manhattan. She began to talk about auditing a class at a nearby community college and sharing her newest collection of poems. 

“She wants to reclaim those parts of herself,” the case manager said. “And that’s meaningful.” 

But with that energy came new risks. Sleep became irregular. Interactions with neighbors grew strained. Boundaries—once defined by isolation—blurred in ways that others in her building did not always understand. 

She invited the couple next door over for drinks, but she misjudged the timing and annoyed them with her late-night knocking.

“She meant it as a gesture of connection,” the attorney said. “But it was received as a disturbance.” 

Now, Ms. Neil faces the possibility of eviction again—this time not because of neglect, but because of behavior shaped by unmanaged mental health challenges.

For the PG team, the challenge is different, but no less complex. 

“A lot of what we do is harm reduction,” the case manager said. “We can’t eliminate risk. We try to reduce it while still respecting her choices.” 

That requires flexibility. Creativity. And constant communication. 

Home care arrangements are revisited again and again in search of the right fit. A housekeeper now comes twice a week. The housing specialist works closely with building management and attorneys, trying to preserve Ms. Neil’s tenancy. The finance associate tracks spending patterns as her activity increases, ensuring stability without imposing unnecessary restrictions. 

Across all of it, the team stays coordinated. 

“There are overlaps in what we do,” one team member said. “That’s intentional. No single role is enough.” 

That overlap has not always been seamless. 

“There have been moments of tension,” another staff member acknowledged. “Moments where it felt like we weren’t aligned.” 

But the person-centered model itself provides a way back. 

The guiding principle remains unchanged: Ms. Neil has the ability to participate in decisions about her own life, and the PG team supports that participation even when it’s hard.

“Ms. Neil has untreated mental health issues that have interfered with her ability to obtain and retain the services she needs to live safely in her apartment. It’s been challenging for the team to navigate how to best keep her safe, respect her personal choices, and work with her to encourage behaviors that would improve her wellbeing,” shared PG’s Chief Program Officer, who oversees Ms. Neil’s team.  

“We’ve also learned that Ms. Neil can take big steps—when she’s ready,” added a staff member. 

They have seen it before. 

And so the work continues: adaptive, patient, and deeply human. 

“There is no formula for Ms. Neil,” one team member said. “There’s only the question: what will help, right now?” 

It is not perfect work, and it is not finished work. 

But it is the kind of work that keeps someone in their home, in their community, and in conversation with the people trying—day after day—to support them. 

“We do what we can,” the attorney said. 

And together, what the Project Guardianship team can do is often the difference between crisis and continuity, between isolation and connection, between being acted upon—and being heard.