Fecal impaction caused by years of constipation. What type of paid care is available to accomplish what the unit is unable to provide?

When my Husband was on Hospice they suggested "the bomb"
1/4 cup Milk of Magnesia
1/4 cup Prune Juice
1/4 cup orange juice
That was heated to about body temp and he would drink that. Worked in about 15 to 30 minutes.
Lactulose also helped a LOT once I started giving that to him daily there were no more real problems.
Also not sure if it was the position or not but quite often when he was done with his nice warm shower and was in the Hoyer Lift he would often have a BM. (if you think about it the knees were up a bit higher than the hips .. think of the product Squatty Potty..)

Suppositories were an option as were enemas.

When my husband was under hospice care and his fentanyl pain pump had to be increased towards the end of his life, he became very constipated. The hospice nurse had to give him injections of Relistor, which would work in about 15-20 minutes. It would clean him out real good.
Now this medication is used for opioid induced constipation, and I don't know if your mom is on any kind of opioids, but if she is it may be worth asking about, as it's response time is very quick.
I tried everything your mom has tried for my husband, including lactulose, and the Relistor was the only thing that worked for him. Good luck.

Stool softener is crucial to this person; stool that stays too long has move and more fluid removed from it. Constant digital disimpaction is exceptionally dangerous and is not something that can be done/should be done by someone without medical training due to the fact that this can trigger heart incidents. Many people of this age have absolutely no way of having enough strength to apply any pressure during movements; a stool that raises the knees a bit often helps. Speak to an MD. This is a serious medical concern.

For a long time I seriously thought my mother was going to die on the toilet. Ask about putting her on lactulose. A probiotic wouldn't hurt either.

There is a procedure that is done to help with this but probably can't be done by a CNA. Your Mom, yes, may need more care than a MC unit can give. Your Mom is on a lot of stuff. They did this with my Mom and the only thing that worked for her was Milk of Magnesia.