Objective: To investigate the current status of discharge readiness among elderly stroke patients and their primary caregivers, and to develop and validate an intervention program for discharge readiness in this population. Methods: A cross-sectional study assessed the level of discharge readiness among elderly stroke patients and their primary caregivers, analyzing influencing factors. Based on findings, an intervention program was developed, integrating literature and expert input. A randomized controlled trial validated its efficacy, enrolling 138 elderly stroke patients and their caregivers (intervention group = 69; control group = 69) from two Grade A tertiary hospitals in northern China between January and June 2025. The intervention group received the developed program, while the control group received routine discharge guidance. Outcomes were assessed using the Discharge Readiness Scale, Caregiver Readiness Scale, and Transition Adaptation Scale, with data collected pre-discharge and at 1 and 3 months post-discharge. Results: On the day prior to discharge, the intervention group demonstrated significantly higher scores than the control group in patient discharge readiness, caregiver readiness, total self-management behavior scores, and satisfaction (P < 0.05). Conclusion: This intervention program, designed for elderly stroke patients and their primary caregivers, effectively enhances discharge readiness, post-discharge adaptation capacity, and self-management behaviors.