OBJECTIVE To determine the factors responsible for mortality and characteristics unique to patients with nursing home acquired pneumonia (NHAP). METHODS A prospective study of 71 patients with NHAP, 79 patients admitted from nursing homes for conditions other than pneumonia (NP), and 93 patients with community-acquired pneumonia (CAP). METHODS A teaching hospital that serves as the community hospital for the City of Halifax. RESULTS The 32% in-hospital mortality rate for NHAP was higher than the 14% rate for CAP (P < .05) but not significantly higher than the 23% mortality rate for NP patients. The most important determinants for long-term (52 weeks) outcome were complications during hospital stay, odds ratio for mortality 3.55, and self sufficiency at time of admission, odds ratio for mortality 0.306. While bacteremia rates were similar at 8% for NHAP, 13% for CAP, and 17% for NP, there was a trend toward a higher rate of pneumococcal bacteremia in the CAP group. CAP patients were more likely to receive ventilatory support, 13% versus 3% for NHAP and 4% for no pneumonia patients despite similar levels of hypoxemia in the two pneumonia groups. CONCLUSIONS The in-hospital mortality rate for NHAP is higher than that for CAP. The 1-year survival rate is determined by self-sufficiency at time of admission and absence of complications during hospital stay and is not group (e.g., nursing home) dependent.