Key Messages 

• training for heart failure is often designed for acute settings rather than care homes 
• care home staff navigate complex clinical decision-making with limited tailored guidance 
• communication with residents and families is a central part of managing heart failure care 
• staff described both barriers and facilitators to delivering appropriate care 
• role clarity and access to support influenced confidence in practice. 

Policy implications

• training for long-term health conditions should be adapted to care home contexts 
• clearer pathways between health services and care homes could improve care continuity 
• communication skills training may support discussions with residents and families. 

Gaps

• findings are based on qualitative accounts 
• recruitment through an independent network may limit representativeness 
• the study focuses on heart failure and may not transfer to other conditions 
• limited insight into organisational and system-level variation. 

Commentary 

• This study provides insight into the everyday realities of delivering heart failure care in care homes. It shows that staff are required to make complex judgements in settings that differ significantly from the acute environments where most clinical training is focused. 
• Participants described the challenge of adapting condition-specific knowledge to residents with multiple needs, alongside the emotional labour of communicating with families about changing health and care requirements. These responsibilities often sit outside formal role definitions or training expectations. 
• From a care equity standpoint, the findings highlight how gaps in training and support can lead to uneven care experiences for residents. Where staff lack access to appropriate education or specialist input, residents with heart failure may receive variable levels of care depending on the confidence and experience of individual workers or teams. These inconsistencies reflect broader inequities in how clinical expertise is distributed across care settings. 
• Overall, the study underscores the importance of recognising care homes as complex clinical environments. Supporting the workforce with tailored training and clearer integration with health services is essential for delivering equitable, high-quality care to residents living with long-term conditions such as heart failure.