Background: Australia has a growing aging migrant population and rates of dementia in residential care are high. The communication of persons with dementia and limited English language proficiency in residential care is an area that has received little attention in the research literature.

Method: Thirty-nine Italian-background older persons with severe dementia residing in either mainstream (n = 20) or Italian-specific (n = 19) aged care facilities were observed and language use was recorded. Medication regime and language proficiency information was obtained.

Results: Participants in mainstream facilities engaged in less communication with co-residents and were prescribed daytime benzodiazepines at a higher rate than those in Italian-specific facilities.

Conclusions: Older persons in mainstream facilities with dementia and lower levels of English proficiency may benefit from additional language-relevant resources. The finding of higher prescription rate of daytime benzodiazepines requires further investigation.