Caregiver singing and background music were incorporated into the interaction between caregiver and patient, the aim being to illuminate the meaning of verbal communication between persons with severe dementia and their caregivers. In the absence of music, patients communicated with cognitive and behavioral symptoms associated with dementia. In these situations, caregivers devoted their verbal communication to narrating and explaining their caring activities to the patient. The patient and caregiver, however, had difficulties understanding one another. In the presence of background music, caregivers decreased their verbal instructing and narrating while the patient communicated with an increased understanding of the situation, both verbally and behaviorally. During caregiver singing, a paradoxical effect was observed such that despite an evident reduction in the amount of verbal narration and description by the caregiver, the patient implicitly understood what was happening.