The purpose of this prospective, ethnographic study was to describe and analyze the care of residents with dementia in an assisted living facility (ALF) providing dementia care. Participant observation and interviews with 20 employees were used to obtain data. Data were collected and analyzed over a period of 6 months. Four major themes emerged from the data: (a) Caregivers' Level of Knowledge of Dementia, (b) Caregivers' Lack of Knowledge in Preventing or Assessing Acute Illnesses, (c) Limitations in Monitoring and Reporting Resident Changes, and (d) Inappropriate Medication Administration. Forty percent of the residents (N = 35) were admitted to the hospital over 6 months. The problems in providing quality care in this facility demonstrate the need for gerontological nurses in ALFs, who would improve care by assessing and monitoring the residents and by supervising and educating the caregivers.
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