 This is a two-arm, multi-site randomized controlled trial of 1,350 older adults 65 years with either advanced cancer defined as metastatic solid tumor or end-stage organ failure New York Heart Association Class IV Heart Failure, End Stage Renal Disease defined as GFR 15 mlminm2; or oxygen-dependent chronic obstructive pulmonary disease COPD who present to the Emergency Department ED, along with 675 of their informal caregivers, to compare nurse-led telephonic case management to facilitated, outpatient specialty palliative care. Investigators will compare effectiveness of two distinct palliative care models that vary by provider type nurse versus physician-led and mode of delivery telephonic versus in-person: a nurse-led telephonic case management; and b facilitated, outpatient specialty palliative care. 