When do you get government, such as adult protective services, involved?

Every article says to get others involved such as clergy, doctors, relatives. In this case there is none of those helpful folks. There is me 3000 miles away and my brother who lives in the house but is overwhelmed by her. She is starting to show signs of paranoia in the extreme getting into arguments with police, neighbors, and total strangers. When I was there this summer I was amazed that this warm woman was content to live in a two story home where the only working bathroom as the walls crumbling down, the house not cleaned in over 25 years, her bedroom reduced to a 3 foot wide strip on her bed with the mattress reeking of urine. Literally the house is standing only because of all the stuff keeping the walls up. The stairs up to her room are covered with stuff making it a guartee that someone is going to fall either herself or a fireman if she ever needs help. I asked her to get a doctor that I can talk to about my concerns. She has refused. She actually hasn't seen a doctor at all in 5 years. I don't think she knows how to fill out the medicare papers and refuses to let anyone else help her with it. She seems to be getting the bills paid on time so I know there is some connection to reality there. She still drives and goes once a month to do her laundry, goes out every couple of days to go shopping for more ladybug nicknacks. She is still feeding the cats although probably better than herself. When I was there I offered to help clean one 4 foot by 4 foot corner of the livingroom. It took us a month. We ended up getting everything into 27 boxes labeled miscel including all the papers the cats had been using as a litter box that she would not let me throw away as there may be a phone number in there she doesn't want to lose. I'm not rick, I can't afford an attorney to get the court to help nor can I move back there, not that moving back there would help as she won't let Chris do anything. Do I just let her suffer out her life or do I get adult protective services involved. Not sure they can help if Chris isn't actually beating her. Please, someone help. this back and forth in my own mind is starting to drag on me.