She ended up with 24-hour care because she was having panic attacks and using her medical alert button to get someone to come right now instead of waiting 15 minutes for her morning caregiver to show up. She went to the ER for no reason. She doesn't have the financial resources to keep home care 24/7. There are several communities in our area where she can have a fine place to live for half the cost. She is spoiled and doesn't do much for herself. Her dementia is advancing rapidly as well. I'm not sure she would grasp the concept of "you can't afford this any more". And that's the only way I can see of approaching this. She's continually making comments like "You're just going to throw me away". We have been procrastinating this discussion and it cannot wait any longer.