The other thing that can very easily affect anyone doing custom freehand work is stress.
Stress destroys creativity. I had a friend's quilt this fall for close to 3 months. She gave it to me right after my DH's accident. The quilt was beautiful and right up my alley. I know that under normal circumstances, I'd have had tons of ideas. Instead I stared at it, doodled stuff and came up with nothing. Nothing at all. I finally broke out of it in early December and got the quilt to her this week.
If your LAer is overwhelmed by how much work she has or other things in her life, she may not be producing the work she has in the past. Some of it can be compensated with by experience but this sort of work is relatively unique in that you need to be technical enough to be able to manage a machine temper tantrum effectively and quickly but also a creative who can envision then translate that vision to your hands to capture it on a quilt.