We use the falling leaf at our facility also. We use little laminated cards with green leaves on them & attach them to the resident's walker or wheelchair & these residents also have bed & chair alarms for added safety. There is also an info sheet in the MAR for each resident such as high fall risk, DNR, allergies, etc. (sort of like a quick reference sheet), these are coordinated with colored "dot" stickers that are also on the resident's ID bracelet (red=DNR, green=high fall risk, allergies=purple, etc.)
We use an assessment chart in the admission assessment based on criteria such as dx., previous hx. of falls at another facility or from family info, # of medications/type (side effects) & info based upon PT/OT evaluations. Of course this also works with the current residents too, staff can give input on transfers, behavior, ADL's, etc. Resident's status is discussed at various meetings with staff & family.
I agree that all are at risk, some more than others. This system works fairly well for us as long as all staff is aware that these residents need extra help & supervision. If someone is a high risk for fall & confused & wants to go to the bathroom now someone needs to assist quickly or they'll try to do it themselves. Tab alarms should be responded to immediately by any staff who hears it. The leaf card is helpful to other staff like recreation for off the unit activities (once saw rec. staff try to get a man who was paralyzed from waist down up to dance
Hope this helps, good luck!