Older Black patients are at increased risk for experiencing a hospital readmission. This disparity may be related to a variety of factors, including care received during hospitalization. The purpose of this study was to elicit the perceptions of older Black patients at high risk for readmission, and explore their nursing care needs and preferences during and following hospitalization. A qualitative descriptive design was used, including individual interviews with 19 Black members of a Program of All-Inclusive Care for the Elderly facility located in a northeastern urban setting. Four themes were captured encompassing characteristics of nursing care quality, unmet care needs, nurse–patient communication, and observations of competing nursing demands. Efforts to improve care transitions and prevent readmissions must address the needs and preferences of high-risk older Black patients while also attending to system-level inefficiencies that decrease the ability for nurses to complete all aspects of care.