Assessing nursing home (NH) residents’ preferences is a cornerstone of person-centered care (PCC), yet little is known about how cognitive ability influences the importance of reported preferences. This study examined the effect of cognitive ability on the level and stability of preference ratings. NH residents (n = 255) with no/low, mild, or moderate cognitive impairment completed PELI interviews twice. The study found no significant differences among cognitive groups in importance ratings at baseline and over 3 months. Findings underscore the value of assessing preferences to support PCC for people with and without cognitive impairment.