Research has not fully examined barriers to the delivery of nursing home (NH) care that honors everyday health care preferences. This qualitative study identified barriers and dependencies that NH residents associate with preferences for seeking mental health services, choosing medical providers, and choosing individuals involved in care discussions. For these preferences, residents cited barriers and dependencies in three domains: within-person, facility environment, and social environment. They also reported a range of situational dependencies related to participating in mental health care. The study recommends improvements in organizational practice and policies that promote person-centered care.