The data revealed three main themes consisting of several sub-themes; (1) social and economic system, (2) care home organisational issues and (3) a fragmented approach to care. A top-down hierarchical structure of how societal attitudes and the governmental system can influence the organisation within care homes and a fragmented approach to care is illustrated in Figure 1. The care home setting and fragmented approach to care also interact reducing the capacity of the care system to meet the end of life care needs of those with advanced dementia. Figure 1.Barriers to integrated care for people with advanced dementia residing in care homes.