["Australasian Journal on Ageing, Volume 45, Issue 3, September 2026. ", "\nABSTRACT\n\nObjective\nThis study explored the complex decision‐making processes underpinning hospital‐to‐permanent Residential Aged Care Home (RACH) transitions from the perspective of RACH managers.\n\n\nMethods\nUsing a critical realist methodology, semi‐structured interviews were conducted with 15 RACH managers on the Gold Coast, Queensland, Australia. Data were analysed inductively using reflexive thematic analysis to identify patterns and underlying causal mechanisms that shape admission practices.\n\n\nResults\nFive interrelated themes emerged: (1) structural and organisational constraints; (2) screening as organisational risk; (3) resident–facility compatibility; (4) relational and legal negotiation; and (5) logistical coordination. Findings revealed that hospital‐to‐RACH admission decisions are influenced not only by observable procedural elements but also by deeper systemic mechanisms, including funding structures, staffing limitations, resident mix and policy constraints, which contribute to prolonged hospital wait times for patients awaiting permanent placement.\n\n\nConclusions\nThe study presents a conceptual model of hospital‐to‐RACH placement, highlighting the operational realities faced by RACH managers. Findings underscore the need for integrated discharge planning, flexible funding arrangements, and systemic support such as workforce training and cross‐sector collaboration to improve the efficiency and quality of care transitions.\n\n"]