This national survey examined the job satisfaction of 228 home health social workers in the restrictive reimbursement environment of the Medicare interim payment system. Administrators' helpfulness in resolving ethical conflicts between patient access to services and agency financial priorities contributed significantly to greater satisfaction in regression analysis. Supervisors' helpfulness in resolving the conflict moderated the difficulty of resolving the conflict. The frequency with which workers believed they had to compromise professional ethics contributed significantly to less satisfaction. Implications for practitioners, supervisors, administrators, and educators are discussed.