Every year 400,000 people with Alzheimer’s disease and related dementias (ADRD) are hospitalized, transfer to a skilled nursing facility (SNF), and transition to home, assisted living, or long term care. After discharge, one in five patients are re-hospitalized within 30 days, and their caregivers experience high levels of strain and psychological harm. To promote effective transitions from SNF to home and other destinations, we designed the Connect-Home ADRD transitional care intervention (C-H ADRD), an adaptation of Connect-Home transitional care. Our recent trial of Connect-Home generated evidence for intervention efficacy in a population of 327 patient and caregiver dyads. In a supplemental award, we identified unique needs of SNF patients with ADRD and their caregivers. We designed the C-H ADRD intervention to address those needs: (1) before discharge, SNF staff develop an ADRD transition plan with patient and caregiver dyads and (2) after discharge, a Dementia Caregiving Specialist provides phone-based support for the ADRD transition plan. In a pilot study, we demonstrated C-H ADRD’s feasibility, acceptability, and potential to reduce caregiver strain and patient neuropsychiatric symptoms (NPS). The next logical step is an efficacy test of C-H ADRD. Our Objective is to conduct a parallel arms, cluster randomized trial (CRT) of C-H ADRD, enrolling 360 ADRD patient and caregiver dyads in 12 SNFs. The Specific Aims are: Aim 1: Conduct an efficacy CRT of C-H ADRD (intervention) vs. usual discharge planning (control) and compare caregiver outcomes 30 days after discharge: (1) caregiver strain (primary) and (2) depression and preparedness for care transitions (secondary). Aim 2: Compare patient outcomes between intervention and control arms 30 days after discharge: (1) patient NPS (primary) and (2) quality of life and acute care use (secondary). Exploratory: Examine whether caregiver strain modifies intervention effect on patient outcomes. Aim 3: Examine potential variability in Connect-Home ADRD outcomes and implementation. (3a) Determine intervention impact by patient discharge destination and other factors for caregiver and patient outcomes. (3b) Identify factors at the dyad-level (e.g., patient discharge destination) and SNF-level (e.g., quality rating) contributing to fidelity to the C-H ADRD protocol. IMPACT: C-H ADRD has potential to improve health outcomes of people with ADRD and their caregivers.