Skip to content
Umbrella Aged Care
← Falls and frailty

Falls: a guide for facility leadership

Facility leadership Aged care staff 7 min read

By Dr Josh Hatch, FRACGP

Falls sit in the Quality Standards, the mandatory indicator program and the national clinical guidelines at once. The three ask for slightly different things, and the trial evidence points to a short list of actions that do most of the work.

Numbers in the text link to the 13 sources listed at the foot of this page.

What applies

  • Quality Standards, Outcome 5.5. Action 5.5.4 requires documented processes for minimising falls and harm from falls by maximising mobility to prevent functional decline, delivering effective and timely post-fall care, and monitoring falls and injuries and reviewing their reasons and consequences 43.

  • Quality Standards, Outcome 1.3. Residents are to be supported to take risks that maintain their independence and quality of life 43.

  • Quality Indicator Program. Each quarter, providers report the number of residents who had one or more falls and the number whose fall caused major injury: a fracture, a joint dislocation, or a closed head injury with altered consciousness or a subdural haematoma 45.

  • Restrictive practices. Any restraint used in the name of falls prevention must meet the requirements for a restrictive practice, including use only as a last resort and with informed consent 46.

  • National falls guidelines. The 2025 guidelines for residential aged care give evidence-graded recommendations on exercise, nutrition, vitamin D, medicines and post-fall care 1.

What the indicator does and does not tell you

The national figures give a reference point: 31.1% of residents with one or more falls and 1.7% with a major injury in the January to March 2025 quarter 4.

A raw falls percentage is hard to interpret alone. Fall rates are about three times higher among respite residents than permanent residents, so case mix matters 1. A home that supports frail people to keep walking may also record more falls than one where residents spend the day seated.

The major injury figure, the pattern of when and where falls happen, and what was done after each one are likely to say more about the quality of care than the headline count.

Where the evidence says effort is best spent

  • Exercise that continues. Supervised strength and balance exercise reduces falls while it runs, and the effect is gone once it stops 2. The Cochrane review reports a cost of about 18 Australian dollars per fall avoided from one Australian trial 2.

  • Plans fitted to the resident, with staff engaged. Multifactorial programs worked when they were tailored to each resident’s circumstances and delivered with facility staff engagement, and did not reliably work otherwise 27.

  • The menu. At least 3.5 servings of dairy foods a day is recommended 1. In the Australian trial this cost about 66 cents per resident per day and was cost-saving through fractures avoided 89.

  • Vitamin D. Daily or weekly supplements, and no monthly or yearly large doses 12.

  • A least-restraint policy. Organisational programs to implement a least-restraint policy probably reduce restraint without increasing falls 1819.

  • Access to medication review. The guidelines ask facilities to facilitate access to a medical practitioner, nurse practitioner and pharmacist for a review of all medicines at least yearly, after a fall and after a new medicine is started 1.

  • Post-fall analysis. Each fall is investigated for its cause and the analysis is used to evaluate what is being done 1.

What has not been shown to work

Bed alarms and low-low beds did not reduce falls in the hospital trials that tested them 1617.

For restraint reduction, simple staff education had uncertain effects, and giving staff information about each resident’s fall risk made little or no difference to restraint use or falls. Organisational programs that changed policy and culture were the ones that worked 18.

Medication review tested as a single intervention has a very uncertain effect on falls, although it was part of all seven tailored multifactorial programs that reduced them 2.

Working with visiting clinicians

A medication review after a fall depends on the visiting clinician hearing about the fall promptly, with what was observed. A reliable handover of falls, and of the facility’s own post-fall analysis, is the part of this that the facility controls.

Goals of care that are recorded and easy to find make the decision about hospital transfer after a fall quicker and more likely to match what the resident wanted.

Sources cited on this page

  1. 1 Australian Commission on Safety and Quality in Health Care. Preventing Falls and Harm from Falls in Older People: Best Practice Guidelines for Australian Residential Aged Care Services. Sydney: ACSQHC; 2025. View source
  2. 2 Dyer SM, Kwok WS, Suen J, et al. Interventions for preventing falls in older people in care facilities. Cochrane Database Syst Rev. 2025;8:CD016064. (104 randomised trials, 68,964 participants; search to May 2024.) View source
  3. 4 Australian Institute of Health and Welfare, GEN Aged Care Data. Residential aged care quality indicators — January to March 2025. (2,593 services; 220,707 residents assessed for falls: 31.1% had one or more falls, 1.7% a fall with major injury; 19.8% subject to physical restraint, 15.3% through a secure area only.) Reported quarterly; later quarters are available from the same page. View source
  4. 7 Logan PA, Horne JC, Gladman JRF, et al. Multifactorial falls prevention programme compared with usual care in UK care homes for older people: multicentre cluster randomised controlled trial with economic evaluation (FinCH). BMJ. 2021;375:e066991. View source
  5. 8 Iuliano S, Poon S, Robbins J, et al. Effect of dietary sources of calcium and protein on hip fractures and falls in older adults in residential care: cluster randomised controlled trial. BMJ. 2021;375:n2364. View source
  6. 9 Baek Y, Iuliano S, Robbins J, Poon S, Seeman E, Ademi Z. Reducing hip and non-vertebral fractures in institutionalised older adults by restoring inadequate intakes of protein and calcium is cost-saving. Age Ageing. 2023;52(6):afad114. View source
  7. 16 Shorr RI, Chandler AM, Mion LC, et al. Effects of an intervention to increase bed alarm use to prevent falls in hospitalized patients: a cluster randomized trial. Ann Intern Med. 2012;157:692–9. View source
  8. 17 Haines TP, Bell RAR, Varghese PN. Pragmatic, cluster randomized trial of a policy to introduce low-low beds to hospital wards for the prevention of falls and fall injuries. J Am Geriatr Soc. 2010;58:435–41. View source
  9. 18 Möhler R, Richter T, Köpke S, Meyer G. Interventions for preventing and reducing the use of physical restraints for older people in all long-term care settings. Cochrane Database Syst Rev. 2023;7:CD007546. View source
  10. 19 Köpke S, Mühlhauser I, Gerlach A, et al. Effect of a guideline-based multicomponent intervention on use of physical restraints in nursing homes: a randomized controlled trial. JAMA. 2012;307:2177–84. View source
  11. 43 Aged Care Quality and Safety Commission. Strengthened Aged Care Quality Standards (commenced 1 November 2025): Outcome 1.3 Choice, independence and quality of life; Outcome 5.5 Safety of clinical care services, Action 5.5.4. View source
  12. 45 Australian Government Department of Health, Disability and Ageing. National Aged Care Mandatory Quality Indicator Program: quick reference guide — falls and major injury. 2025. View source
  13. 46 End of Life Law for Clinicians, Australian Centre for Health Law Research, Queensland University of Technology. Restrictive Practices in Aged Care (factsheet). November 2025. View source

See every source cited across the falls and frailty section →

Written by Dr Josh Hatch, FRACGP. General information only, reflecting his reading of the published evidence as at October 2026. It is not individual medical advice, does not create a doctor–patient relationship, and must not be used to start, stop or change any treatment. Evidence and Australian regulatory and PBS arrangements change — always confirm current advice with the treating GP, pharmacist or specialist.

This is general education, not a clinical protocol. The doctors who practise with Umbrella Aged Care are independent general practitioners, and each makes their own clinical decisions with the resident and family. Your GP’s advice for an individual may differ from what is written here. If it does, please ask them to talk it through with you.

Enquire about care