Consider the income tax consequences to all concerned.
If she takes money out of her traditional IRA to gift it to you and her other heirs, it'll be taxed at her tax rate; if you and the other heirs inherit the IRA after she passes away, then it'll be taxed at your tax rate over 10 or 11 years. She's probably in a higher bracket than the heirs average brackets.
She can pay college and medical expenses directly to the universities or medical providers and that does not count towards either the $11.7M lifetime exemption nor the $15K annual limit.
Consider QCDs to charity if she has a charitable bent. Or if the kids have a charitable bent, she can QCD to that charity and the kids can keep the money they would have given, and it's effectively a wealth transfer from her to kids.
Consider giving to kids, grandkids, kids' spouses, nieces, cousins, etc. since it's $15K per year per person. The per person thing can really multiply.
Don't give away any amounts that would result in her feeling insecure or dependent, or any amounts that would be bad for the recipients to receive. But giving away sooner means the growth happens in the heir's net worth, not in hers. It sounds like she might be in a runaway freight train of net worth situation, which can require effort to slow down. If she's at $5M and the market gives 10%, that's $500K of growth, which may be hard for her to spend or give away.
If her health is declining it'd be good to get the health care paperwork in place. Whatever her state uses - medical POA, living will, POST, DNR, etc. Also a springing or durable financial POA if appropriate and if she doesn't have one yet.
Try to divvy up the traditional IRA among as many heirs as possible, to lessen the income tax spike for the heirs. Consider adding grandkids to the IRA beneficiary list if appropriate.
I'd personally stay away from any products like life insurance or annuities or trusts unless recommended by an estate planning attorney that I really trusted and was well trained and the product made sense to me.
