The purpose of this study was to develop a pain assessment tool utilized by certified nursing assistant (CNA) direct-care providers for nursing home residents with dementia and to examine the impact of such a tool on their function, behavior, or medication use. In the first phase, 41 items from an observational pain assessment tool were correlated with an objective pain "gold standard"; 12 statistically significant items were retained and used in the CNA pain assessment tool. Symmetry analysis was then conducted to determine if this resulted in any significant change in resident function, behavior, or medication use. This failed to detect significant change in these characteristics. A pain assessment tool utilized by CNA direct-care providers can be developed for use in nursing home residents with dementia. Further study is required to determine whether the use of such a tool will improve their function or quality of life.