Mom (96) with stage 4 dementia lives in her home with 24/7 care. She has become harder for the caregivers to manage. Any advice?

Mom needs supervision 24/7/365. It sounds like she is beyond medicating for this. No medication works forever and Mom may have developed a tolerance. If she has become combative and a fall and flight risk, she needs to be in a locked Memory Care Unit. You will have a difficult time finding new caregivers to take her on with these issues. And, there is always the chance she could fall or escape the house when their backs are turned. Frankly, it’s asking a lot of her caregivers to have them tolerate being hit or worse. I believe her doctor is telling you he/she thjnks Mom needs a facility. .

She needs a more sympathetic doctor - a gerontologist or perhaps even a geriatric psychiatrist. It isn't just about the caregivers (although they are important too!), but her agitation has a negative impact on her own well being and quality of life.