Differences in power are frequent in institutional care settings and provide contexts in which conflict can occur. In order to examine the power imbalance between residents and caregivers and the consequent potential for verbal conflict, this paper first discusses the situations in which persons with dementia (PWD) find themselves within long-term residential care institutions and the interactions they commonly experience with those who care for them. It then examines strategies commonly used by conversational partners that either support or hinder the attempts by PWD to interact competently. The strategies may lead to cooperative conversations or verbal conflicts. They include caregiver marginalization as well as joking and teasing, both of which may serve to positively support PWD or can minimize conflict (Offord et al. 2006; Schnurr and Chan 201l) and can be initiated by both residents and caregivers. The final section contains case studies of interactions with two PWD, “Madge” and “Maureen”, to illustrate the minimization and the positive and negative use of joking and teasing in interactions with PWD. The paper concludes with a brief discussion with “Maureen” on joking and deliberate repression of conflict.