Holding one of the most developed health care and welfare systems of the world Austria still lacks adequate capacity, structures and funding for palliative care for heart failure patients. Hospices and palliative services still remain mostly reserved for cancer patients and some neurological cases like ALS. The failure to adapt the system to the needs of non-cancer patients arises from the scattered competence in regulation, organisation and funding between health care and welfare systems on the one hand, and the national level opposed to the federal state level on the other hand. Additionally more emphasis should be put on education and training in palliative care of health professionals in their regular curricula. Despite these circumstances “Geriatric Hospitals” – combining features of nursing homes, rehabilitation centres and hospitals – have emerged in Vienna, pioneered by Haus der Barmherzigkeit. These institutions would be very suitable for the care of the described heart failure patient. However, financing remains problematic and requires out of the pocket contributions by the patient including private asset claims by the federal states.