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Involvement of employees, residents, and relatives in digital transformation at long-term care institutions for older adults - A cross-sectional survey Abstract. Background: Long-term care institutions for older adults are currently undergoing a digital transformation process. But who are the decision-makers in this transformation process?, Aim: The aim of the study was to determine the role of employees, residents, and their relatives in the provision of the technical solutions used in long-term care institutions., Methods: The standardized online survey was conducted at 466 long-term care institutions throughout Switzerland. The respective managers were surveyed., Results: The majority of the managers surveyed saw more advantages than disadvantages in the use of technical solutions. Nevertheless, the results also show that while 52 % involve their staff in decisions about the acquisition of technology, only 11 % involve their residents, and 8 % involve the residents' relatives. This involvement depends on how much technology has been used so far and what leeway the managers themselves have in making such decisions., Conclusions: It is apparent that residents and their relatives are involved very little in decision-making processes. This can mean that the organization's digital transformation ultimately depends on just one person, the manager, and that the wishes of the people who are directly affected by these technical innovations are not considered in such decisions.