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She can’t understand where she is...

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You ask your question under the "cancer" forum but you don't mention that in your profile. At 89 yrs old, however, she may have undiagnosed dementia. If she has dementia, the symptoms of not knowing you or where she is, is certainly a common symptom, one that can be heartbreaking for the caregiver. Introduce yourself to her and tell her you are taking care of her. If it's not dementia related, let the hospice nurse know what's going on and get her advice.
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What she on Hospice for? If on pain killers maybe the problem. Kidney's shutting down could do what u describe.
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Very common. Very sad, but normal. Stay strong.
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Get her checked for a UTI, this is common behavior with one.

It is also common when they are shutting down.

I am so sorry for your loss.
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