Does every fall require a trip to the ER?

I have been told a visit to the ER should be made after each fall that involves my husband's head because there could be bleeding in the brain. The hard part is if I don't see him fall, he often is not sure what he hit his head on or if he even hit his head. If I decide not to take him, I try to watch him closer for the next 24-48 hours for any symptom that may be related. Problem is, I am not sure any symptom will show unless it is an obvious lump or bruise, etc. Many times he does not complain of pain even when it appears to me he should be feeling pain.

UPDATE: Hospice nurse visited today. My mother's only apparent injury appears to be to her confidence. She absolutely refuses to try to walk now (has used a walker for a number of years). I suspect she's afraid of falling again. She denies any pain; there was no wincing or grimacing as we transferred her from recliner to wheel chair to take her down to dinner.

Another example: this past spring my mom lost her balance in her carpeted bedroom, fell backwards, hit her head on the dresser on the way down and cut open the back of her head. She's a retired RN so she just wanted to go to Urgent Care but they made us go to the ER as part of their protocol for head injuries. She got 8 stitches. But then 2 days later another pain showed up -- broken ribs.

Falls in the elderly need attention because it doesn't take much for them to have a bigger or undetected injury. And, if they have any amount of cognitive or memory impairment, they are less able to identify how they fell, what they hit on the way down or other pains they are having. I know it's also a financial consideration for many people, but I'd err on the side of safety if it were me.

Is the LO your mother that you mention in your profile?
My opinion is...
If your loved one is cognizant enough to tell the staff who to call in a case like this then they should be the one to determine if they want to go to the hospital or not.
Does your LO have a POLST (more detailed than a DNR)? That details what treatment they want and for how long if any treatment is chosen.
IF there were a head injury (we are not talking an open bleeding wound that would necessitate a trip to the ER) what would the treatment be? Most likely a Wait and See approach would be taken. That can be done at the AL. Without the probably 4 to 6 hours in the ER, the MRI, X-ray that would be done.

If she is on Hospice the Hospice IS the 911 call and unless they think it is necessary there will be no more trips to the ER. (because it is me, a proponent of Hospice, it might be worth it to have her evaluated for Hospice. All the supplies would be provided and you would have another set of eyes on her watching for changes that her day to day caregivers might miss.)

I would say no to an ER trip.
My Husband "fell" 9 times and I did call non emergency for a "Lift Assist" and they came, helped him up and asked me if I wanted him transported to the hospital and each time I said no. They did not question my decision, I signed a release form and they were on their way.

Falls vary.
Causes vary: from trips & slips, loss of balance, legs give way or loss of conscience.
Results of fall varies too.

Obviously as you said, head strike, injury or loss of consciousness needs medical assessment & treatment.

As for the rest, it's a case by case thing.

If there an RN on staff at the AL? If so, RN will assess if Dr or ER is required. If not, a call can be made to the AL Dr or if this was left up to me, I would call a nurse 24hr call line to discuss. They seem to always say when I have called 'if any doubt, go get it checked out'.

Take extra care if someone cannot verbalise well - tell you what happened, seems in any way confused, cannot describe pain. Take more care if osteoporosis or blood thinning meds are in the picture.

Even if no ER is required, a visit sooner (rather than later) by the AL Doctor could be arranged for piece of mind.

My mother fell twice at a skilled nursing facility. 1st time they just called to inform me about it. They asked her if she wanted to go to the hospital. 2nd time she complained of pain so they sent her&called to inform us. What's the AL policy regarding falls?