Aim In Japan, many elderly patients are managed at home, and fever is a common problem. This study examined the incidence of fever events in elderly patients on home medical management, and underlying disorders from the pragmatic standpoint. This study also investigated whether the care‐need level determined at the start of home care predicts fever onset. Methods The participants were patients aged ≥65 years who received home medical management from one clinic from 1 July 2008 to 30 June 2009. End‐points were onset of fever, diagnosis at time of fever onset and outcome. The incidence of fever was determined using the Kaplan–Meier method and compared using the log–rank test. To evaluate the effect of care‐need level on fever, Cox's proportional hazards model was used to adjust for confounding variables. Results A total 105 patients were included, with 100% follow up. The median observation period was 364 days. There were 64 fever events, for a fever incidence of 2.3/1000 patient‐days (95% CI 1.8–2.9); fever occurred at least once in 42.6% of participants. Fever was significantly more likely to occur in care‐need level 5 than in ≤4, with a risk ratio of 2.4. The most common diagnosis for all fever events was pneumonia/bronchitis, followed by urinary tract infection, and skin and soft tissue infection. Nearly 80% of cases were cured at home. Conclusions Fever occurred in approximately half of the participants over 1 year, and was more likely in patients requiring the highest care level; nearly 80% of cases were cured at home. Geriatr Gerontol Int 2013; ●●: ●●–●●.