Older people in care facilities fall about three times as frequently as those living in the community (Handoll 2010; Cameron et al, 2010) and have consistently been the biggest single category of reported incidents in acute and longer term settings since the 1940s. Despitemany intervention studies there has been very little reduction in the number and/or severity of falls over the last 50 years (Cameron et al, 2010; Hignett, 2010). The NPSA reported for 2005-06 that falls accounted for 33% of incident reports to the NRLS (Healey et al, 2007) with over 70% un-witnessed. Although only a small percentage of falls result in death and serious injury they represent a serious financial, governance and resource burden in terms of on-going healthcare costs and litigation (Boushon et al, 2008). Most of the contributory risk factors for falling were identified in the 1960s. Interventions have predominantly focused on (a) assessment, (b) communication, (c) monitoring, and (d) changing (treating) the patient with medication review, continence management and impact protectors (Hignett, 2010). Previous outcome measures have been high level parameters, for example the number of falls (incidents of slips, trips and falls) and/or the severity of injury (usually hip fracture) (Oliver et al, 2007). These both lack sensitivity and require lengthy study durations to recruit sufficient numbers of participants. Recent research has shown that the level of confusion and agitation can be reduced through environmental design (Torrington, 2006).