A case control study was undertaken to examine the prevalence of transfer limitations and home risk factors for falls in 50 men and women aged 60 years and over who had been admitted to an acute hospital due to a fall in the previous year, and 45 age and sex matched non-fallers who were recruited from community organizations. The assessments were carried out in the homes of each subject using standardized protocols. Subjects who had fallen in the home reported significantly more difficulties with transfers than subjects who had fallen outside or non-fallers (Chi-squared = 33.9, d.f=2, P<0.001). In contrast, no significant differences were found in total home hazard scores among the home fallers (mean=2.8 hazards, s.d.=1.3), outside fallers (mean=3.4, s.d.=1.70), and non-fallers (mean=3.2, s.d.=1.70), and only one hazard (lack of a bedside light) was significantly more prevalent among the home fallers compared with the non-fallers. The findings suggest that a non-specific approach to environmental risk factors in the homes of older people may be an ineffective public health measure. Alternative strategies that include the targeting of home hazard identification and home modification for older people with physiological impairments and transfer limitations may be more effective for preventing falls. Such approaches may complement other interventions aimed at maximizing balance and mobility.