“The first transition is from resident to patient”: understanding the decisional needs of long-term care residents preparing for hospital transitions

BACKGROUND AND OBJECTIVES: Long-term care (LTC) residents are frequently transferred to hospitals, yet these transitions do not always align with residents' care goals or preferences. This study aimed to assess the decisional and informational needs of LTC residents, focusing on their decision-making priorities and knowledge gaps when facing hospital transition decisions. RESEARCH DESIGN AND METHODS: The researchers conducted 28 semi-structured interviews with residents (n = 9), care partners (n = 8), and staff (n = 11) across three LTC homes in Ontario, Canada. Guided by the Ottawa Decision Support Framework and the Decisional Needs Assessment Workbook, the interviews explored participants' experiences, decision-making needs, and information requirements for LTC-to-hospital transitions. Interviews were transcribed verbatim and analyzed using reflexive thematic analysis. RESULTS: Participants were predominantly white and female, with 68.3 as residents' mean age and 70.5 as care partners' mean age. Staff (mean age: 46.5) were more ethnically diverse in a range of clinical and leadership roles. Four interconnected themes about resident needs during LTC-to-hospital transitions emerged: (a) communication and transparency, (b) continuity of care between LTC homes and hospitals, (c) awareness of ageist assumptions and conflicting priorities, and (d) trust building during care transitions. DISCUSSION AND IMPLICATIONS: This study highlights the persistent challenges that residents, care partners, and staff face in preparing for and making decisions regarding LTC-to-hospital transitions. The findings emphasize the urgent need for decision-support tools that empower LTC residents to feel better prepared to make decisions that reflect their values, priorities, and goals of care.