Mom is starting to think I’m her boyfriend. Advice?

It sounds like it's past time to have her placed in a memory care facility, where she will receive the 24/7 care she needs, and you and your wife can get back to some sort of normalcy in your lives. Your mom's brain is broken and it will only continue to get worse, so now is the time to do what's best for all involved.
And if mom doesn't have the money, you will have to apply for Medicaid for her. Your mom I'm sure wouldn't want you or your brother giving up your lives to care for her, so time to make some major changes. Best wishes.

Your mother shouldn’t be directing things at this point. Her decline comes with losing her demands. Has her doctor seen her to get an update on her condition? Have meds been tried to help calm her anxiety? The mistaking of who you are is common, very uncomfortable for you, but another sign of her broken brain. There’s no cause for guilt, but plenty of sadness that you can’t fix this. Don’t cave to her demands, accept that she’s in another place mentally, and get more help, either in her home or her moving to a place with help

Someone living with daily delusions does not sound safe to live alone IMHO.

Regarding the 'boyfriend' issue - I think if me, I would take this as a cue to step back a bit & find replacement caregivers.

So... What's the main priority as you see it?

Sometimes I hear 'keeping Mother at home'. If so, then round the clock caregivers will be soon needed (if not already) to enable that to be realistic. This will be your challenge - to have them acceptable to Mother & even be let in the door!

Sometimes that statement can be tweaked to: Mother to remain at home *as long as possible or practical*.

Or is it 'keeping Mother calm, safe & comfortable'. If so, that can be done in another setting.

It IS sad to move people from their homes but this is the dilemma: Duty of Care vs Dignity of Choice.

Ok your mother is not capable of making the decision of who will stay with her; Feel guilty about not taking care of yourself and the subsequent consequence to your mother if you are not healthy enough to take care of her or manage her affair.

If you are saying that you're leaving your Alzheimer's ridden mother alone at night b/c she's 'not letting anyone stay with her' anymore, then you're making a big mistake. Her thinking you're her b/f is the least of the issues you have to deal with.

Mother doesn't get to make decisions of this caliber anymore. It's no longer about what she WANTS but about what she NEEDS to keep her safe. You are taking orders from a mind that's now addled with a disease, and no longer making rational decisions or choices.

Mother either 'allows' full time, 24/7 help inside of her home OR she gets placed in Memory Care immediately where there is a 24/7 staff of caregivers to care for her all night long.

It's time for you to make decisions FOR your mother that keep her safe. AD is a horrible disease and one that requires placement when it becomes advanced, in most cases.

Good luck

When ideas like this take hold for someone with dementia, there is no real way to convince her otherwise. No matter how many times you tell her that you are her son, it won't make any difference. I don't know that any medication would stop her advances on you, but it's worth a chat with her doctor(s) to see if they can suggest anything.

Of concern is leaving her alone at night. While it is a relief to get out, is it possible to "pretend" to leave, and just wait outside for her to fall asleep, then go back in, quietly? Too many people with dementia end up wandering, sometimes in the middle of the night. That would not end well.

In the meantime, it would be best to start searching for a facility for her. It isn't safe for her to remain in the home. Additionally, it WILL take some of the onus off of you AND allow you to resume your relationship with your angel of a wife!

Once she is safe in a MC facility, you can try visits, but perhaps it would be best to have someone else join you during those visits (sadly not the wife.) It will be better for you to be able to try to be a caring person who visits (you will likely never be son in her mind again) VS a strung out stalked "lover" who provides care-giving!

I'm going to share a humorous anecdote about this in our own situation. My husband's mom, with Alzheimer's, often thought he was her husband. One day we were visiting her in her Assisted Living Facility, and she pointed to me and told him to "Get that 'heifer' out of here." I let him have it when we got back in the car. How dare she say that to me! I told him that I was used to playing tennis 2-3 times a week, and for a variety of reasons I had stopped, and pounds can come on overnight after that. He said , "No, to her "heifer" isn't a pudgy woman, it's the "other woman." I'm thinking, "Gee, thanks." Isn't that sad, that I'd rather be known as a home wrecker, rather than as a woman with a middle age spread. I've been able to put heifer behind me though, (in more ways than one). I included this in a book about taking care of my mom, who also had Alzheimer's called, "My Mother has Alzheimer's and My Dog has Tapeworms: A Caregiver's Tale." I'm sorry I have no advice to give on your situation, but I thought a little humor might help.

Your mother has dementia and it is going to get worse and her behavior and actions will get worse with time. I think you should consider a caretaker for her to leave you out of the loop. And if that does not work, I think for everyone's safety and well being, she needs placement into a dementia facility. I don't know what else to tell you but worse is on the way so act now to stop it before it gets out of control.

Imho, the premise of your mother not knowing who you are AND wanting to stay alone at night is enough to tell you that her living arrangement may have to be amended.

This is such a difficult stage. The spectrum of behavior that occurs can range from confusing to bizarre to down right dangerous. First please know that you are not alone. We are all dealing with “some form” of strange behavior with our loved ones. And I don’t know what it is about night time.... but evenings are often when it’s the worst. (Sundowners)
This is going to require you to take a long look at your mom’s circumstances and possibly have to make some difficult decisions. Your mom may not necessarily need the full time care of facility yet.... I’m not sure. I think if she is still capable of handling her ADL’s then perhaps just supplemental in home help will suffice. There are many benefits to this. An occasional helper can provide positive social interaction that can benefit her mental and physical wellbeing. She may resist at first but she should adjust and hopefully eventually even look forward to it. Finding the right person is key. They have to have good chemistry with her. This will take the attention and stress off of you and give you the needed break. You don’t have to suffer the entire burden and live with guilt. You obviously love your mother and are trying your best to care for her. Guilt is just a natural part of the grieving process we go through as we watch them struggle through this and feel them slip away. But remember to be kind to yourself and protect yourself and your family.
Have you looked into Palliative Care? Sometimes insurances will cover this. We have it for my Father in Law and it’s been a a lifesaver. It was referred to us by his Primary Care Physician. They operate under the service of hospice care but they are not hospice. They come in and offer assistance a few days a week with dressing, bathing (if necessary) light help around the house.... they can help make a bed and help them fix a bite to eat. They engage them socially and can also do exercises and range of motion as well. In addition they have nurses come and make sure all their physical health needs are being met and make sure meds are in order. Even if you think she doesn’t need all this right now sometimes you are surprised at how quickly the situation can progress and then you realize how much your loved one really does need the added support. And so do you. Also, pay attention to meds. Sometimes they need to be adjusted. Meds can play a crucial role in how our loved ones behave. Make sure you or your brother are closely monitoring them. I don’t believe in overmedicating them but I do think if properly prescribed and administered they can make a world of difference.
Good luck🙏🏼