Background: Older adults living in long-term care facilities often contend with multiple chronic conditions and complex care needs. The added burden of low health literacy may pose significant challenges to their health. The aim of this study is to investigate health literacy challenges experienced by people living in long-term care facilities. Methods: Twenty-one interviews were conducted with residents (n=7), advocates (n=5) and long-term care facility staff (n=9). Participants were recruited from two facilities in Victoria. An inductive thematic analysis approach was utilised. Results: Key themes identified from the interviews included: 1) Trusting relationships underpin effective communication between residents, advocates and staff; 2) General practitioners are the most valued medical professional by residents; 3) Health understanding is driven by residents’ and advocates’ active questioning and advocacy; 4) Residents’ choice and personal agency shape engagement with care; 5) Organisational processes both enable and constrain care. Conclusion: Health literacy in long‑term care facilities is not solely an individual attribute but is shaped by relationships, agency, and organisational context. Supporting trusting communication, opportunities for questioning and choice, and systems that enable (rather than constrain) engagement may help residents better understand and act on health information. Health literacy interventions should not focus solely on individual skills but consider relational and organisational factors within long‑term care facilities.