Care homes have become a dominant site of care provision for older people with multiple morbidities and limited life expectancy. These settings are shaped by demographic change, shrinking availability of unpaid care, and high staff turnover. Within these settings, the triadic relationships between residents, relatives, and staff frequently generate conflict around clinical decision-making, care priorities, and resource allocation. Such tensions can compromise resident well-being, exacerbate family distress, and reduce staff morale. This chapter situates these dynamics within the literature on systemic theory, relational practice, and healthcare conflict, proposing systemic psychotherapy as an underutilised but potentially transformative intervention. By attending to context, diversity, and the genealogy of beliefs, systemic approaches enable a more nuanced understanding of how meaning is constructed in care homes and disagreements escalate. A composite case study illustrates how therapeutic practices, such as systemic assessment, reframing, and narrative exploration, can recalibrate relationships and support decision-making in the face of illness, grief, and end-of-life care, concluding by reflecting on practitioner positioning, supervision, care home staff training and provocations for embedding systemic approaches.