Person-centred care is a holistic care approach that aims to build up and support the personhood of residents with dementia, and thereby enhance quality of life. Through a review of the literature on mealtimes in long term care homes, four main aspects of person-centred mealtime care were identified: providing food choices and preferences, supporting residents’ independence, promoting the social side of eating, and showing respect. Using a critical realist lens, this descriptive qualitative study examined current implementation of person-centred mealtime care, the influences on its implementation, and steps to more fully adopt a person-centred approach. Semi-structured interviews were conducted with 52 staff from four diverse long term care homes in southern Ontario. Participants included frontline workers, registered health care professionals, and managers. Interviews were transcribed and analysed for themes. A conceptual framework was developed through analysis of the interview data, identifying five key ways to support staff to provide person-centred care: forming a strong team, working together to provide care, enabling staff to know the residents better, equipping staff with a toolbox of strategies, and creating flexibility to optimize care. Specific strengths and areas for improvement in implementation of person-centred mealtime care were identified and explained using this conceptual framework. Elements of the framework were also applied to explain important considerations for hiring staff, educating and training staff, developing a culture of good teamwork, and involving family members and volunteers in mealtime care.