Nursing home (NH) residents routinely complete surveys that assess their health, well-being, preferences, and care needs. These surveys reveal important information but are largely based on provider rather than resident concerns. This case study shows how the spontaneous commentary of NH residents (n = 370) was used to refine the Preferences for Everyday Living Inventory (PELI) during key phases of measurement development. The experience shows how spontaneous comments hold particular value in ensuring that measurement tool development is guided by residents’ needs, concerns, and priorities.