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Older adult recipients of long-term services and supports (LTSS) are a medically vulnerable population with prolonged needs for supervision, services for health maintenance, and assistance with activities and independent activities of daily living (Reinhard, Kassner, Houser, & Mollica, 2011 ). For older LTSS recipients, acute changes in health and related transitions between hospitals and LTSS settings of care (e.g., nursing homes [NHs], assisted living facilities [ALFs], care homes, care coordination programs, their own homes) are common (Coleman, Min, Chomiak, & Kramer, 2004 ; Murtaugh & Litke, 2002 ). For example, nearly 10 million older Medicare recipients are hospitalized each year, and among these, 20% are readmitted to hospitals within 30 days of hospital discharge (Jencks, Williams, & Coleman, 2009 ). Studies have shown that this revolving door between community and hospital settings is an independent risk factor for poor health outcomes among older adults and health care inefficiency (Coleman, 2003 ). For example, in 2006, the cost of hospital readmissions for Medicare recipients older than 65 was estimated to be $17 billion (Jencks et al., 2009 ).
A range of time-limited services, known as transitional care, fosters the safety and cost effectiveness of older adult transitions between settings and providers of care (Chiu & Newcomer, 2007 ; Coleman & Boult, 2003 ; Kripalani, Jackson, Schnipper, & Coleman, 2007 ; Naylor, Aiken, Kurtzman, Olds, & Hirschman, 2011 ). Studies have shown that transitional care interventions, such as discharge planning, patient and family teaching, and home visits, after discharge improve continuity of care and prevent poor health outcomes among older adults (Coleman, Parry, Chalmers, & Min, 2006 ; Jack et al., 2009 ; Naylor et al., 2004, 2011 ). To date, however, studies have not explored older adult and family caregiver perceptions of transitional care services received during transfers between LTSS and hospital settings. Studies have emphasized the importance of patient centeredness in transitional care services (Coleman et al., 2006 ; Jack et al., 2009 ; Naylor et al., 2004 ), but few describe care recipient perceptions of transitional care services; thus, the preferences and needs of LTSS recipients remain uncertain. Moreover, lacking these care recipient voices, data are not available for accurately describing the barriers and facilitators...