The purpose of this study was to explore perceptions on effectiveness of telehealth for Heart Failure (HF) management beyond the initial acceptance phase in a home care setting. Participants included 31 home care nurses for surveys, 9 nurses for focus groups and 4 patients with HF and the telehealth nurse for interviews. Telehealth was perceived to benefit by contributing objective assessments, timely information regarding patient status, a sense of security, and patient accountability. However, barriers to use of telehealth included inadequate staff training, lack of guidelines for client referrals and integration of telehealth in nursing workflow, lack of trust in equipment’s accuracy, and certain patient characteristics. The study exposed the role played by inadequate systemic guidelines and patient characteristics as factors affecting long-term use of telehealth for HF.