BACKGROUND: The purpose of this study was to explore the actual timing of the initiation of advance care planning (ACP) discussions by experienced visiting nurses for older homebound patients. METHODS: Semi-structured interviews were conducted with 12 home visit nurses, followed by a qualitative, inductive analysis. RESULTS: Four ACP initiation timing patterns were extracted. CONCLUSIONS: Home visit nurses used the following timing patterns differently depending on each patient's situation: "Starting when visiting nurses get to know the patients," "Waiting for a change in the patient's medical condition," "Waiting to begin ACP discussions until the patient and nurse are emotionally ready," and "Starting ACP discussions in a proactive, but non-shocking manner."