Conversations regarding end-of-life preferences among nursing home residents, families, and staff are frequently overlooked, leading to a critical gap in understanding resident wishes and potentially compromising the quality of care at the end of life. This qualitative study sheds light on the reasons for these missed conversations. Residents, families and staff seldom discussed end-of-life care preferences, and often did not share information about preferences or initiate conversations about end-of-life care. The study highlights barriers and facilitators, such as leveraging experiences of other residents and families and fostering trust with conversation partners. This research highlights the pressing need for systematic processes and comprehensive staff training to ensure resident-centered end-of-life care.