Respondents described how a low-skilled workforce hampered the potential of care home staff to deliver high-quality care resulting in poor symptom recognition and management. Care home staff argued that they were not provided with the training or support from external service providers to recognise and respond to symptoms presented by people with advanced dementia as they approached the end of life.When someone says, ‘Oh, no, she’s not in pain,’ oh please - the nurses - ‘What do you mean she’s not in pain?’ They need to be more educated with dementia, because they can’t cope. There’s certain people that can cope with dementia, and a lot of people can’t cope with dementia. A lot of people do not like working with them, because they can’t cope with them. They don’t know how to respond to them (Health Care Assistant).