This article describes the rate of falls and adverse outcomes following falls, such as fracture, hospitalisation and death, among residents of 88 aged-care facilities in the Lower Hunter region of NSW from July to December 2005. A high rate of falls was observed with a crude incidence of 171 falls per 1000 beds per month. Around 40% of the falls resulting in hospitalisation were for fractured neck of femur. Estimated 3-month survival following fractured neck of femur was low, with a rate ratio of around 1 : 3. The data indicate an urgent need for falls injury prevention in aged-care facilities.