The aim of the study was to explore perceptions and experiences of older adults, families and aged care workers in communicating about psychotropic medications in residential aged care. A qualitative exploratory study was conducted comprising interviews with older adults, families and aged care workers (nurses, medication endorsed enrolled nurses, pharmacists, unit coordinators, geriatricians and general practitioners), situated in Australian private, not-for-profit and public services. Fifty-nine participants were interviewed. Generated themes were: Involvement of older adults and families in psychotropic medication decisions; and Communication challenges about psychotropic medications. While decision-making enabled information to be conveyed about medication changes, communication was hindered by time and resource restraints. Behaviour support plans were employed by nurses, where they regarded psychotropic medications as a last resort. Some nurses lacked confidence in their knowledge of psychotropic medications, which influenced their ability to converse openly with older adults and families. Older adults felt they had limited time to enquire about psychotropic medications during routine medication rounds, not wanting to be a hindrance, despite desiring further information. Furthermore, older adults were frustrated about memory concerns affecting their involvement in psychotropic medication conversations, and they appreciated having adequate time for responses. Findings highlight the need for consistent and person centred communication about psychotropic medications. While older adults and families valued involvement, meaningful participation was constrained by time pressures, limited staff confidence, and cognitive challenges faced by older adults. Strengthening staff training, allocating protected time for medication discussions, and embedding communication within routine activities may enhance shared decision making about psychotropic medications.