Project Summary/Abstract 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. Black SNF patients and caregivers, compared to their White counterparts, experience lower access to ADRD care and worse outcomes after SNF discharge. 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 and reach in a population of Black and White 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 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 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 disparities by race in Connect-Home ADRD outcomes and implementation. (3a) Determine intervention impact by patient race and other factors for caregiver and patient outcomes. (3b) Identify factors at the dyad-level (e.g., social determinants) and SNF-level (e.g., staffing) contributing to fidelity to the C-H ADRD protocol. IMPACT: C-H ADRD has potential to improve health outcomes and health equity for people with ADRD and their caregivers.