LTC-to-hospital Transfer Decision-making

This trial will evaluate whether the Supporting Transitions and Empowering Preferences (STEP) toolkit can improve decision-making about hospital transfers in long-term care residents and their substitute decision-makers and enhance decision self-efficacy in nursing staff. The trial will answer the questions: * Does the STEP tool reduce decisional conflict in residents and care partners at the time of transfer decisions? * Does it improve nurse self-efficacy related to hospital transfer decisions? Participants will: * Use the STEP tool during key moments of care planning (admission, care conferences, and acute events) * Complete a short survey measuring their decisional conflict * Be supported by trained nurses who use STEP to guide hospital transfer discussions Researchers will compare data collected before and after the STEP tool is implemented at two long-term care homes to see if it improves shared decision-making related to hospital transfers by reducing decisional conflict.