To sack my cleaner?

I have a number of cognitive disabilities and physical health issues, possibly auto immune disorder that causes joint pain. I’m over sharing but this is anonymous. I still turn up for meetings and answer my phone calls and emails even if I don’t feel up to it and I work around it. I have techniques in place that she also needs to use. I only don’t attend only if I absolutely can’t due to something unforeseeable and out of my control

Is it possible that because you are always nice about it, she sees her arrangement with you as flexible?
Also the comment about you being lucky to have a cleaner makes me think that you are (a bit like me) almost apologetic about having one, and are trying so hard not to be the lady of the manor about it that you are letting her take advantage.

You are hiring a professional so do not have any qualms about sacking her just because she is a 'nice person'!

You need a service and she is not fulfilling it.

Sack her and find someone reliable.

Why do people put up with cleaners taking the piss when they wouldn't if it was any other paid for service?

id feel terrible letting go of someone who probably needs the job now more than ever! but im not sure what else you can do. if she's not providing the cleaning that you need her for, what choice do you have? what is the nature of the health issues -- is it something that will be over and unlikely to be a problem by, say, next year, or is it a very long-term thing? can you get a new temporary cleaner (no idea if this is actually a thing!) until she's better and more reliable again? i'd just feel awful letting someone go who had been with me for 8-9 years because she got sick.

"Loyalty" doesn't clean your house in my opinion I would find the unreliability really annoying.

I would find a new cleaner asap. Her no show rate is appalling. You can be polite and tell her you really valued her work but unfortunately the number of no shows is not working for you. Give her the figures you have given us.