Purpose: The purpose of this study was to identify feeding difficulties and related factors in older adults with dementia who reside in long-term care facilities. Methods: Participants were 149 older adults with dementia residing in long-term care facilities and 93 certified caregivers working in five long-term care facilities. Data were analyzed using descriptive statistics, t-test, ANOVA, Scheffé test, Pearson correlation coefficient and multiple regression by SPSS 21.0. Results: The mean score for feeding difficulty was 7.26±4.30. The highest for a feeding difficulty item was, "Does the patient require/close supervision while feeding?". The variables related to the feeding difficulty were physical function (β=0.37, p<.001) and certified caregivers' attitude towards feeding older adults with dementia (β=0.31, p<.001). These two variables explained about 44.0% of total variance (F=24.26, p<.001). Conclusion: The results suggest the need for nursing interventions to prevent aggravation of physical function related to feeding skills. In addition, systematical and practical education and training programs are needed for certified caregivers to help maintain positive attitudes. These programs should lead the certified caregivers to accept that feeding is not just a task but a relationship between certified caregivers and older adults with dementia.