Self-care is fundamental to achieving optimal outcomes in patients with heart failure. Unfortunately, self-care among patients with heart failure is commonly poor, and patients have considerable difficulties performing self-care skills. Elderly patients, in particular, face a number of challenges trying to engage in adequate self-care. Heart failure self-care is an intricate process that is the result of decisions made on many levels by patients. Little is known about self-care decision making in patients with heart failure, and the existing literature does not take into account the complexity of interrelated factors that affect self-care decision making. In this article, a model of factors affecting self-care decision making that include aging status, psychosocial status, health literacy, current symptom status, and prior experiences is proposed.