This study examined nursing home (NH) providers’ experiences as they implemented Preferences of Activity and Leisure (PAL) Cards, an innovative communication tool, during the COVID-19 pandemic. The project provided the 11 participating NHs with training and monthly coaching calls as they created PAL Cards for a subset of residents. Researchers recorded, transcribed, and coded the coaching calls and identified three themes related to COVID-19 burden: Structural Changes, Resident Burden, and Provider Burnout. Providers reported that PAL Cards helped staff to learn about and honor resident preferences during the pandemic. They aided in reducing provider burnout by maximizing staff time and energy and promoted preference information sharing during staff changes. PAL Cards were a useful tool when the COVID-19 pandemic placed new burdens on organizations, staff, and residents.