In my humble opinion, I think that this could end up on your kids's face and their lives too. So I would sit with her and talk about some things that may not be DBing, but are very important to have it resolved.
It's upsetting what is happening, but she needs to have some reality check and have some respect for her children in the first place. I think you do not need to go hard on her because you know it is not going to resolve anything.
Maybe you need to think hard of how to do this and how to get it across that she will understand you don't want things to get ugly. That even being separated, her actions and behavior can damage your life and her kid's life.
By other hand, I think that if she does not want any help directly from you, it may be possible to involve S20 on that. He is a big boy and probably understands a million % more then you think. Maybe he can talk to her, give some cash and say that she needs to accept this, that he does not accept no for an answer.
You guys could also get some groceries and drop off at her place. Lets say you can load the pantry, the freezer, whatever.
Now, you may say. So now I need to buy stuff and give to her so she will share with OM and his sister? It's possible, but there is where you may do all this and in the same time talk to her and let her know some boundaries, even if it is her own life.
There is also a question that she may be using money to buy week and sometimes it can get expensive (at least here, it depends how much you use.
Besides all this, resolve this issue is just on drop of rain in the middle of a huge storm. She is sick and with the terrible MLC, she is depressed and probably is dealing with anxiety.
Is it your problem? No, of course not. But she is the mother of your children, she has been married to you for 24 years and besides all the above, you love her, still loves her.
So do what is right and won't leave any more wounds in your heart. You will feel better helping her, even if indirectly, then regret it once she does something bigger and worse.
By the way, you said you had a good R with your sister in law, maybe it is time to have some heart to heart talk and let her know how worried you are with you W. How things are going and that you fear for her sanity, well being and her life at some point.
It's obvious your W needs help, a very concrete help that will take her out of this horrible depression nightmare.
Like I said, this is my opinion and it is a very hard situation for you. Maybe you will need to question your heart and find out what and how much you live with tomorrow.
I don't know if you share stuff with your kids (as you know, I do), each person have their own opinion about this. But, if you do, or if you think would help, talk to S20 and see his view about his mom.
He is the older son and he has a say about what she is doing, even if she does not want to hear it, he has the right to tell her the way it is. Again, I do not know your kids, and I do not know if he would be willing to face it.
Things will get better one day RD but right now you will need to look for other people's help. It is becoming too big for RD to think it is just about OM, there is a lot more to it.
Please, fell free to disagree with me (I'm not Toots, so no need to agree with it), I don't know your family and maybe it is not the right approach.
Just know that whatever you decide, we will be here for you and hold you tight so it does not hurt much. Best of luck RD.