Objective We examined multilevel factors associated with hospital discharge status among older adults suffering a fall‐related hospitalization. Data Sources The 2011–2013 (n = 131,978) Texas Inpatient Hospital Discharge Public‐Use File was used. Study Design/Methods Multilevel logistic regression analyses estimated the likelihood of being discharged to institutional settings versus home. Principal Findings Factors associated with a greater likelihood of being discharged to institutional settings versus home/self‐care included being female, white, older, having greater risk of mortality, receiving care in a non‐teaching hospital, having Medicare (versus Private) coverage, and being admitted from a non‐health care facility (versus clinical referral). Conclusions Understanding risk factors for costly discharges to institutional settings enables targeted fall‐prevention interventions with identification of at‐risk groups and allows for identifying policy‐related factors associated with discharge status.