The team approach is the hallmark of hospice and palliative care at Delaware Hospice. Together, our nurse practitioners, nurses, CNAs, social workers, chaplains, and volunteers take a holistic approach to caring for our patients and their families. Guiding those teams, you’ll find our team physicians. But what exactly is their role?
Dr. Ralph DeMario is our team physician for Kent County, Sussex County, and the Delaware Hospice Center. Let’s take a closer look at what he does to better understand the role of your Delaware Hospice team physician in both hospice and palliative care.
Hospice: Support the Patient and Family’s Goals
When patients are referred for hospice care, Dr. DeMario conducts the patient intake and certifies them for care. Along with the hospice team, Dr. DeMario meets with the family unit to establish the patient’s goals—like what symptoms they want to manage and the balance they’re seeking between pain management and alertness.
Patients who come to Delaware Hospice often have a long history with their doctor, a relationship that Delaware Hospice works to preserve. The patient’s doctor, the family, and Dr. DeMario work together to decide Dr. DeMario’s role in the patient’s care.
In some cases, the patient’s doctor remains their attending physician and continues to write all orders, changes in pain medication, etc., in consultation with Dr. DeMario. More frequently, patient’s primary doctor requests assistance in providing end-of-life care and in that case Dr. DeMario or other hospice physicians will act as the attending doctor.
Whether he acts as the patient’s attending physician or just provides consultation for the patient’s own doctor, Dr. DeMario supervises the patient’s hospice nurse case manager and their hospice team to see that we achieve the patient’s and family’s goals.
Palliative: Consult on Symptom Management
Because palliative care patients continue receiving curative treatment for their condition, the patient’s personal doctor remains the attending physician in coordination with the palliative care team. Each palliative patient is assigned a nurse practitioner from Delaware Palliative, who coordinates care with the patient’s doctor. Dr. DeMario oversees the patient’s palliative care team and is available for consultation on matters of symptom management. The patient’s own doctor remains in charge of writing all orders.
Delaware Hospice Center: Oversee Care
In addition to supporting the home-based hospice and palliative teams in southern Delaware, Dr. DeMario is the director of our inpatient facility, the Delaware Hospice Center. At the Delaware Hospice Center, he sees patients and supervises the hospice staff, including the two nurse practitioners who serve as care providers. Our second team physician, Dr. Altamuro occasionally covers the Delaware Hospice Center, but primarily supports the home-based teams in our northern service area.
“I Wish I’d Known Sooner.”
Dr. DeMario has focused on hospice and palliative care for the last 13 years. Prior to that, he spent 21 years in private practice as a general internist. His career move was prompted by a desire to help patients die a good death.
“As a general internist, I saw too many patients in the hospital who didn’t have good deaths,” explained Dr. DeMario. “For my hospice patients, I’m here to do whatever I can to give them the best, most pain-free death possible, addressing whatever the patient sees as important to a good death.”
“The biggest complaint I hear from the bereaved is that they wish somebody told them about hospice earlier,” Dr. DeMario added. “It is important for the community to know, that our prime focus is to improve the quality of life and to maintain an optimal functional state, for as long as possible for those suffering with an advanced or terminal illness.” We work closely with patients and families to integrate their wishes and goals of care, with our team support, during the final days.
For more information about Delaware Hospice’s home-based hospice care, home-based palliative care, or in-patient hospice facility, call us at 302.478.5707.
