My brother lives with mother- she insists on this. This mess has been brewing for a long time- since I grew up there (me and only sibling are in our 40's). My brother's mental illness has always "the roost". Per my mother's rules, everyone must defer to him since "he can't help it".

In addition to having a mental illness, he is also abusive. Now that he is medically needy, he is primarily verbally abusive. I feel the abusiveness is a separate issue, 1. because obviously most people with various mental illnesses are not abusive and 2. because he can seem to curb these behaviors (now pretty much limited to screaming and demeaning her and anyone else he feels he won't get in trouble for abusing) in the presence of people outside the family. Since he can turn that off and on, I'd say the abusive verbalizations are under his control and not a symptom of poorly (now untreated) mental illness.

I live in another state and have responsibilities to my family which prevent me from going back to my former role of trying to run interference between my mother and brother. Being there growing up came at a high price to me as I am diagnosed with PTSD from the chaos I grew up in.

My mother never allowed "outsiders" to intervene. According to her, only she could properly manage my brother's issues. So when the opportunities for a more structured living situation that might better shape my brother's behaviors (this was back in the 80's), she declined that preferring to do that in house.

Now that her health is declining (she has cancer), the whole situation is obviously not better. He drives home health workers away from caring for him. I would not doubt that his being there impedes her getting what she needs too, though people do still come in.

She would never come live with me, and I am told that unless she is deemed incompetent, I would not be able to require her to do so. I realize that with my own responsibilities I would not be able to manage her day to day care, even if she would agree to that. She does have friends and non-family care givers in her area. None of us know what to do to make this better.

Reading the wording of her state's adult protective services laws, if she tells people to "mind your own business" and declines care, we are prevented from doing anything. It is clear to me in retrospect that she likely has her own mental health issues (prior to the situation of caring for my brother as an adult). Still, it is improbable that she would be deemed incompetent.

Thank you for any input you can give. I have always told people my only inheritance would be an endless list of problems to fix. Seems this has come to pass.

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A number of doctors, social workers, etc. have been told. The PD won't help unless they actually see something or she presses charges. At this point it might be argued that they both just like to bicker, but one person clearly makes this much worse for the other.
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Does your mom's doctor know the whole story of your brother's state of physical and medical health? If so, could he report the his abusive behavoir to a mental health agency? (or even the PD)
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You seem to have a good read on this- thank you GardenArtist. This as you might imagine is not the kind of situation that can be understood by most.

Her cancer has returned and she has done all that radiation and surgery can do. Now it she will be getting palliative chemo. You are not being maudlin, what will happen to him is a logical question to ask since we know that caregivers (as she now does, to her own detriment) do suffer the effects of stress, layered on top of whatever else they have going on. She refuses to even think about that eventuality, which seems less and less far off. Like maybe not thinking about it means it won't happen.

I have put it out there that I will not due to his abusive nature, be on the hook for taking over his care. Feel like I paid my dues with that for the first third of my life (33 years) trying to superimpose some "normal" or "functionality" into their situation, to no avail.

No, they don't live in the South and fortunately they are not isolated. They live in a small community where people do know what's going on, but nobody knows what to do since my mother refuses intervention.

She probably does feel responsible to him and possibly guilty as you say. She has always designated herself over and above professionals as knowing what was best for him, which ironically cut him off from the types of programs that might have helped him to develop skills of independence and better socialization. As bad as it probably was to be ignored as a kid (me) by my mother, it seems in a way it was much worse to be the target of her over-focus.

Probably some type of terrible repetition compulsion on my part, but I ended up teaching as an adult in just the type of school which I believe might have helped his situation. Obviously, we can never know. Doing that I got to see what types of limits can be set to help people learn self control to whatever degree they can do that. With my brother, that never happened.

It's not good for either of them. I have some level of sympathy toward the situation, but (please forgive the insensitivity of the wording) I have no intention going back to being the "bouncer in the looney bin" as I had done for far too long for my own health and happiness.

I'm kind of wondering if the APS thing could be flipped on it's ear to "protect" him because I think he's the one who would be more easily determined to be not competent of choosing his own situation. I'm not wanting to create trouble (though my mother would not see it that way), but I'm thinking that together neither will get appropriate care because he drives people away.

Thanks for re-reading, responding, and listening to my ramblings.
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This is a tough situation. Your mother is determined and won't give up on your brother, so I honestly don't know what you can do unless he becomes physically abusive, which I hope he doesn't. It seems as well that he's learned to capitalize on his mental issues through manipulation.

What stage is your mother's cancer? Is she in chemo or radiation?

I'm wondering if your mother isn't overcompensating for your brother because she may feel responsible as she was the one who gave birth to him. For whatever reasons, his mental issues are likely separate and apart from her being his mother, so she doesn't need to be as protective of him as she is, nor does she need to jeopardize her own health to overcompensate for his shortcomings.

But she'll probably never recognize that or change, so the question is what can you do with 2 people who aren't going to change. I wish I knew; I've read your post a few times and other than contacting APS, I don't really have any suggestions.

Just out of curiosity, do your mother and brother live in an isolated community in the south someplace? Her protectiveness and refusal to allow "outside" intervention almost seems like something that occurs in communities which resent intervention by any governmental agency.

I do think that one thing you can address is what will happen to your brother when your mother eventually passes. I don't intend to be maudlin, but in the scheme of life, it does happen to each of us at some time.

Has she created a special needs trust for him, or made other arrangements for his care?
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