Is there anything my sisters and I can do to make our brother get help for himself?

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My brother is the oldest of four children at 59 years old. He injured his back I don't know how many years ago and never had it checked out, and is now having severe pain, legs going out from under him and making him fall. Six months ago he had scheduled the surgery to fix his back but then called and cancelled the surgery. Our youngest sister was there with him to help him after the surgery, and he told her that his wife (who had just had a stroke and wasn't talking yet) cancelled the surgery. I know he has a couple other physical issues as well, Hyperthyroid, and Cholesterol are two that I know for sure.
We are also seriously concerned about his mental health as well. He is very paranoid, saying things like a person walking down the street was the one that caused the fire in his truck (it was electrical), or that someone else was trying to break into his house. At one point he accused his wife of poisoning the morning coffee, trying to kill him, so after she poured her own cup, he would make a new pot so he knew that it had not been tampered with.
My main question is with us (his three sisters) in Ohio and he in Indiana is there anything we can do to make him get help for himself, or be able to put him in a nursing home either there in Indiana or here in Ohio?

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CM, I think the accusation that she cancelled the surgery arises from the delusion and paranoia that caused him to think she was trying to poison him.

Your point of helping her is well taken. I would fear for her safety.
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accidental duplicate post; deleted.
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The OP's SIL is blameless - at least as far as cancelling the back surgery goes. The OP points out that the poor woman had just had a stroke when this happened and had not recovered the power of speech.

Becky, what sort of relationship do you and your siblings have with your brother's wife? How is she doing, and are you able to offer her direct support?
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Becky, you really are dealing with two different issues, which may even have a similar source- the physical pain and the mental confusion, specifically the paranoia. I believe he needs to be examined, probably by a neurologist, to determine if there are what's really happening to his spine and nerves as well as in his brain.

Untreated back injuries can cause a lot of problems down the road. If his legs are collapsing beneath him, he could have nerve injuries arising from the back injury. This is NOT something he should be ignoring, if he were able to reason (this is not a criticism by any means, but rather an observation and expression of concern).

It occurs to me also that the back injuries might have caused nerve injury in the areas leading to the brain, and that his paranoia might be brain damage as a result of the old back injury.

Caveat: I don't pretend to have a lot of medical knowledge; what I write is just from experience and what I've read when exploring back injuries that I've had.

Is his wife the kind of person to have cancelled the back surgery, or do you think he believes that she did and doesn't recognize that he was the one (if in fact he did cancel his own surgery)? If so, it sounds like one of the sisters needs to intervene again.

If you don't know of a good neurologist, and if one of the sisters is close by or staying with him temporarily, suggest that the next time his legs go out from under him that EMS be called to transport him to the hospital.

That way you can get some direction from knowledgeable people.

The leg collapse could also arise from weakness or dehydration, or even "near syncope." These have been causes of my father's legs collapsing and causing a fall.

Is he taking meds for his hyperthyroidism? If not, that should be addressed as well.

There could be so much going on - your brother needs a really good workup, which could start in the ER. If he does goes, one of the sisters should brief the ER staff on the mental issues as well. He might be kept longer for a more thorough eval, including an MRI which it sounds like he needs for both the legs and brain issues. And from what you wrote, I think he needs to be in a facility for serious evaluation of his paranoia. It sounds as if he's a danger to others, including his wife and perhaps your sisters.

I honestly don't think any facility other than one with capacity for treatment of mental patients would take him; his paranoia would threaten the staff and other patients. Any AL facility would probably take this position. If he goes to the ER post leg collapse, they'll have the authority and knowledge how and where to place him for an in-facility mental eval.

And it's better to do it now before he runs afoul of the police. BTW, does he have guns in the house? If so, you might seriously consider contacting the local police, even anonymously if you have to to protect yourself, sisters and his wife. If he thinks someone is breaking into the house, he might shoot someone.

BTW, when did the paranoid delusions begin? Recently? Has this been going on for years? Did he have any military service in country? Is he a Vet? Any PTSD diagnosed?

Good luck; I can't imagine how distressing this must be for you and your sisters.
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Dear Becky,

What a lucky man to have three caring sisters. I wonder if he is taking pain killers and this is affecting his personality. It does sound like he needs help. Are you able to have a family meeting to make some decisions together. You could call Adult Protective Services to check on his welfare. Maybe a social worker could help him see what is needed.

I know you mean well, so hopefully he will get the help he needs.
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