Background <p>The transition from hospital to home presents significant psychological and practical challenges for older heart failure patients living alone (OHELP), who must navigate complex self-care needs within a socially isolated context. Although discharge preparation is a critical period for adapting to solitary living, the psychological and behavioral coping mechanisms of this vulnerable population remain underexplored.</p> Objective <p>This study aimed to explore the psychological experiences during the pre-discharge period regarding self-care readiness, and to describe the behavioral strategies preferred by the OHELP.</p> Methods <p>This descriptive qualitative study employed purposive sampling to recruit 26 participants from a geriatric hospital in Zhengzhou, China, between January and June 2025. Interview data were systematically organized and coded using NVivo 12, and reflexive thematic analysis was conducted through the research.</p> Results <p>Four themes and twelve sub-themes emerged from the analysis: (a) anticipated psychological burden of living alone, (b) perceived deficits: needs vs. resources, (c) coping strategies for self-care and the defense of autonomy, (d) reconstructing one’s self-worth and meaning.</p> Conclusions <p>The OHELP addressed anticipatory psychological burden during discharge preparation through adaptive strategies such as reestablishing daily routines and enhancing technological literacy, thereby reconstructing self-worth and maintaining autonomy.</p> Clinical trial number <p>Not applicable.</p>