Perceived experiences of health care for older people who need support to live at home can illuminate areas needing improvement in quality of care, and guide towards better ways to support ageing populations to live at home. This systematic review synthesized findings from the qualitative literature about perceived experiences of health care for older people who need support to live at home, from the perceptions of older people, carers and health providers. Searches of electronic databases and eligibility screening produced 46 included studies for review. Thematic synthesis revealed how health care impacts on the older person's sense of autonomy, both in health care decisions and everyday life. Autonomy is empowered by the older person's own capacity and by respectful conduct of health providers. Engagement between older people, carers and health providers is a negotiated interaction, affected by multiple factors.