Background Falls in older people result in a substantial use of resources in the NHS and care homes. One way to reduce the burden would be to identify the factors associated with the likelihood of being discharged to a care home rather than being discharged home after fall-related hospitalization. We investigate the associations between discharge destination after fall-related hospital admission with ecological factors (area deprivation, ethnicity and rurality) and individual level factors (age, gender and co-morbidities). Methods We extracted data for patients aged over 50 admitted from their ‘usual residence’ with a fall-related diagnosis from the Hospital Episode Statistics (HES) database. Results Increasing age, people with severe co-morbidities and people who live in less deprived, predominantly white or rural areas, were more likely to be discharged to a different residence (all P-values 5% Asian would return home, compared with 78.0% from least deprived, village/isolated and all white area. Conclusion Further research is required to examine whether these patterns reflect appropriate care or alternatively that some sub-groups of society have less access to care homes than others. These factors may have public health implications for the equitable allocation of budgets for the provision of care for elderly patients discharged from hospital after a fall.