Sorry that your post seems to have fallen through the cracks for a few days.

My 74-yr old mother also suffers from paranoia, usually accompanying her depressions. Something like what your sister has gone through would send my mother over the edge too. My sympathies are with you.

A few questions: do you have any sort of power of attorney over her, or does everything go through her son? Would he be open to you stepping in to help? Is there a larger city with a dedicated psychiatric hospital that she could be transferred to if you don't think she's getting good care at the local level? Possibly something closer to you? Does she have a regular psychiatrist that she sees?

As far as you being able to do anything, it sounds like that might be up to her son and how comfortable he is in letting you into the situation. They should be having family meetings at the hospital periodically. I would first try to get to one of those meetings to get a good idea of whats going on with her there. Your nephew might be relieved at having someone there to help support him and help him make some difficult decisions. Also, if you don't feel like you're getting anywhere with the hospital, some places have patient advocacy programs to help intervene when problems arise.

It sounds like you might be her biggest advocate right now. There may be some red tape to sort through, but there should be a way for you to have a voice in this. You might also want to look up your local NAMI chapter (National Alliance on Mental Illness) at www.nami.org . They may have other social resources for you to access.