Good enough care: The morality of working with limited resources

“If you care about the residents you are looking after and are not able to deliver the care they need, that just sucks the soul out of you.” Grace Welch, co-chair of a family council in Ontario’s long-term care system, was not speaking in metaphor. She was describing a reality faced daily by aged care and home care leaders: knowing exactly what good care looks like, yet being blocked from delivering it.

This is the territory of moral injury – the harm caused when you are forced to act against your own sense of right and wrong. It is a term borrowed from the battlefield, but it now haunts care homes, hospitals and community services.

When doing the right thing is out of reach

Moral distress happens when you can see the ethical course of action, but staffing levels, budgets or regulations make it impossible to take it. Left unresolved, it curdles into moral injury: guilt, shame, and a slow erosion of one’s moral identity.

In a British Medical Association survey, 78% of doctors recognised moral distress in their work, most citing chronic understaffing. Leaders in aged care often feel this more sharply than most – caught between the needs they witness on the floor and the limits handed down from above.

Best practice meets budget reality

Person-centred care – treating older people with dignity, attention and engagement – is the ideal. In reality, many providers struggle to meet even basic standards. The Royal Commission into Aged Care highlighted alarming cost-cutting in food and nutrition with some providers spending as little as $6 per resident, per day on meals, well below what’s needed to ensure safe and nourishing care.

For managers, this becomes a daily exercise in compromise. They may know that more staff, more training and richer activity programmes would improve residents’ lives, yet rosters and budgets dictate otherwise. During COVID-19, these pressures hit breaking point, with some leaders describing “impossible moral burdens” in deciding who would get care and who would go without.

The 15-minute visit

In-home care, the compromises can be even starker. Some clients in the UK receive just 15-minute visits – barely enough to tick off essential tasks, let alone offer human connection. While this practice isn’t common in Austrlaia, the new funding model for Support at Home will stretch providers, creating similar pressures in-home care workers.

Neil Taggart, a UK non-profit operations director, describes the dilemma: “Do you give the bare-minimum care and leave them with needs unmet, or stay longer and risk the next client complaining because you’re late?” For many housebound people, the carer may be their only contact all day. Reducing that to a rushed quarter-hour is to strip away what little connection they have.

For leaders, enforcing these times can feel like complicity. Yet contractual terms with funders often leave no alternative. Some staff leave the sector entirely, unable to reconcile their compassion with the constraints.

The double burden on leaders

Moral injury does not spare those in charge. Aged care managers must make decisions they know will fall short – accepting more residents than staff can realistically care for, cutting activities to save costs, and reducing visit lengths. Publicly, they reassure staff and families; privately, they grapple with whether they are still “good” leaders if compromise becomes routine. 

Ethicist Matthew Beard puts it bluntly: “Good people are forced to do bad things for good reasons.” That moral dissonance can be corrosive.

From injury to leadership

Fixing this cannot be left to individual resilience workshops or wellbeing campaigns. The system itself – funding models, staffing ratios, regulatory frameworks – must be reshaped so that doing the right thing is the easiest option. 

Leaders can start by naming the problem, creating spaces where staff can voice ethical concerns without fear. 

There is also a role for moral resilience – peer support, ethics debriefs, and celebrating small victories to keep values alive, even in constrained systems.

Beyond “good enough”

“Good enough care” is not an aspiration; it is a reluctant compromise. Closing the gap between what is possible and what is right will take political will, organisational courage, and leaders willing to speak uncomfortable truths.

As long as leaders and carers are left to carry the moral burden alone, the system will continue to erode the very compassion it relies on. The real measure of reform will be whether aged care workers can go home at night knowing they have provided not just the best they could under the circumstances, but the best that should be expected in a decent society.