Purpose: The purposes of this study were to understand (1) emotional expression of older adults with dementia and (2) communication between long-term care workers and older adults with dementia. Methods: Ten long-term care workers who provided care services for older adults with dementia in long-term care were interviewed. Qualitative content analysis was conducted to reveal themes and subthemes. Results: Participants stated that they tried to learn emotional expressions in older adults with dementia, but it was difficult due to emotional fluctuation in older adults with dementia. Care workers attempted to interact with older adults with dementia using verbal and non-verbal communication skills. They stated difficulties in verbal communication with older adults with dementia. In addition, care workers improved their tailored communication skills with the accumulation of care experience and noticed their care service value. Conclusion: It is meaningful to understand long-term care workers’ perceptions of emotional expression and communication among older adults with dementia in long-term care. Well-organized communication protocols should be provided for long-term care workers to enhance emotion-oriented and person-centered care services based on the needs and preferences of older adults with dementia.