Purpose: Radical cystectomy is a high-risk procedure commonly followed by discharge to home with home care or long-term care facilities. The coronavirus disease 2019 (COVID-19) pandemic disrupted healthcare delivery and discharge practices, offering a natural experiment to assess flexibility in postoperative care pathways. This study evaluates changes in discharge disposition during the pandemic and examines associated patient outcomes. Materials and Methods: We conducted a retrospective cohort study using statewide data from Pennsylvania. Adults who underwent radical cystectomy between quarter (Q) 1 2017 and Q2 2022 were categorized into prepandemic, height of pandemic, and COVID-19 vaccine periods. The primary outcome was discharge disposition: to home with home care, home, or long-term care. Secondary outcomes included 90-day readmission and 90- day mortality. Multinomial logistic regression assessed associations between pandemic period and discharge disposition, adjusting for demographics, comorbidity burden, cancer stage, and length of stay. Results: Among 1,755 patients, discharge to home with home care increased during the pandemic (71% prepandemic, 81% height of pandemic, 74% COVID-19 vaccine period), while long-term care use declined (18%, 5%, 13%). Compared to the prepandemic period, patients were significantly less likely to be discharged to long-term care during the height of the pandemic (odds ratio [OR], 0.22; 95% confidence interval [CI], 0.12–0.42) and in the COVID-19 vaccine period (OR, 0.61; 95% CI, 0.42–0.88). Patient-level predictors of discharge to long-term care included older age, female sex, higher comorbidity burden, and longer hospital stays. Despite changes in disposition, 90-day readmission and 90-day mortality remained clinically stable. Conclusions Discharge disposition patterns following radical cystectomy did not fully return to prepandemic norms, reflecting lasting changes in healthcare delivery beyond the acute phase of COVID-19. While the use of long-term care declined, outcomes remained stable, supporting the safety of expanded home-based recovery in selected patients. However, a consistent subset of patients continued to require institutional postacute care, suggesting that long-term care utilization is primarily driven by clinical need.