With the projected increase of an aging population in the upcoming decades, coupled with increasing elderly longevity, the incidence of hip fractures among this vulnerable population is expected to grow. Current evidence reveals high mortality rates within 6 months to 1 year among frail elderly patients who suffer hip fracture. In addition, the presence of multiple chronic conditions negatively impacts mortality rates in this vulnerable population. The purpose of this article is to discuss both the importance of integrating early palliative care and the appropriateness for hospice referral among frail elderly hip fracture patients. Moreover, the role nurses' play in early recognition of the need for palliative and/or hospice services among this vulnerable population will be explored.