This study describes new problems emerging over 6 weeks for nursing home residents with advanced dementia and factors associated with time to identify the problems. The sample of 65 developed 149 new acute problems or exacerbations of existing conditions over the 6 weeks of data collection. The majority of these problems involved uncontrolled pain, new infections, and severe psychoses. Nurse assessment skill was associated with a shorter time to identify the new problem and more time spent on the problem. A higher ratio of new to existing interventions was also associated with a shorter time to identify the problem. Other patient characteristics associated with time to identify problems included nonspecific vocalizations, physical signs, cognitive status, and length of stay. While future research is warranted, findings from this study highlight the frequency of problems requiring treatment and suggest that improved assessment of residents may decrease the time to identify new problems.