We reviewed clinical evaluation practices and documentation of fever (>100.2°F) in all febrile patients over a two-month period in a hospital-based nursing home (HBNH) compared with a community-based nursing home (CBNH). Results showed 38 febrile (mean 101.9°F) HBNH patients and 26 febrile (mean 101.5°F) CBNH patients. Median time from fever onset to physician contact was 4 hours in HBNH and 12.5 hours in CBNH episodes (P<0.01). Laboratory studies were initially performed in 68% of HBNH and 31% of CBNH episodes (P<0.005), and diagnosis of fever source was documented in 76% of HBNH and 16% of CBNH episodes (P<0.005). Overall assessment stratification showed 81% febrile HBNH patients had both evaluation and therapy performed compared with 38% in CBNH (P<0.0001); 39% of febrile CBNH patients had no evaluation or therapy performed. Results indicate lack of documentation, and fever evaluation in CBNHs may preclude complete detection of nursing home-acquired infections and thereby hamper preventive responses to potential infection problems.