Respondents reported that the commercial priorities of care homes negatively influenced staff career development leaving a considerable gap in training opportunities. These included training sessions on dementia, documentation completion, compassionate care and pain recognition. However, high staff turnover was a major obstacle to training. Conversely, lack of training may contribute to turnover.[if I could ask you to name a couple of top priorities that you think will improve care for this very vulnerable group of patients, particularly those approaching the end of their life, what do you think you'd say?] Staff - really well trained staff. Really well trained staff. Of all the stuff that you've said, I think that well, well trained staff (Specialist Mental Health Professional).There's such a high turnover of staff at that level [care homes], as you probably know. We have to do it [training] regularly, but we have to do some kind of toolkit which is really train the trainer with the toolkit, champions – it is a real challenge (Commissioner for Older Adults Services).