Homeless hostel residents (HHR), particularly long-term and episodic residents, experience disproportionately high levels of morbidity, multimorbidity, and premature mortality. There has been little research into HHR in Northern Ireland (NI). This qualitative study explores barriers and enablers to healthcare access for people living in homeless hostels in four rural health trusts in NI, drawing on the perspectives of community-based support staff. Using an exploratory qualitative design informed by social constructivism and underpinned by Levesque et al.’s client-centred framework for access to healthcare, eleven semi-structured interviews were conducted with eleven experienced hostel support workers for HHR. Data were analysed using Braun and Clarke’s thematic analysis. Findings highlight intersecting personal, structural and systemic barriers, including stigma and discrimination, fragmented service provision, GP registration difficulties, geographical displacement and workforce pressures. Key enablers included the advocacy role of hostel support workers, access to Homeless Health Nurses, and collaborative in-reach services.