This study examined pain experiences and treatment for older adults in long-term care or rehabilitation settings 3 week after surgical repair of a hip fracture. Pain report and pain treatment for cognitively intact residents were compared with cognitively impaired residents. Two thirds of all participants reported pain. Most rated pain as slight or mild in severity. Pain report was similar for cognitively impaired and intact participants. Pain was reported as severe or worse by 17% of the residents. Nursing care plans documented comfort as a goal for fewer than half the participants. Almost 40% (n = 23) of the participants were receiving no pain medication 3 weeks postoperatively, five of these rated their pain as moderate or severe. Pain documentation, including effective non-pharmacological treatments, needs to be improved for cognitively impaired and intact older adults who are recovering from hip fracture surgery.