How does a person with the decline inherent in aging, progressive disease, or a terminal illness continue to maintain mobility, safety, and independence in the face of the affronts to their physical ability and personal dignity? Falls, with the identification of risk and strategies for management during hospice, palliative, and end of life care, are the focus of this course. Patient and family engagement reveal areas of concern along with appropriate therapy assessment tools; clinical interventions achieve patient-centered goals. Particular attention is applied to unique transitions experienced during decline with practical education options. The course concludes with a discussion of the therapist role in supporting patient autonomy, family concern, and acceptable fall risks during the natural end of life path.