Help me understand how a niece of my elderly neighbor can just let everyone else help yet she tells the lady, "I will help you". The niece is out of state and is great at letting everyone else do the work. Now the state is going to get guardinship unless me (which I don't want) or the niece steps up (which she hasn't yet). Any suggestions?

A guardianship sometimes is an ok route to go. It establishes who is actually in charge and provides oversight.