Increasing Hospice CAHPS Scores Through Enhanced Caregiver Training

Improving education and training for family caregivers may give hospices’ quality scores a boost.

Maryland-based Hospice of the Chesapeake has introduced a standardized caregiver training program designed to enhance the work they had previously done in this area. After a review of scientific literature, it became clear that nationally, caregiver training was spotty, and this affected families’ perceptions of the care their loved one received, Monica Ferebee, clinical manager of hospice at Hospice of the Chesapeake said at the National Hospice and Palliative Care Organization (NHPCO) Virtual Interdisciplinary Conference.

“As a clinician, we’re often expecting these untrained, informal caregivers to do what it took some of us years in school to be trained to be able to do,” Ferebee said at the conference. “We’re asking them to assess the needs of their loved one and then implement intervention based on it. About half of the untrained caregivers report that they feel like they have unmet educational needs after the clinicians provided information to them.”


More than 70% of hospice patients are primarily cared for by untrained family caregivers with no medical background, Ferebee found. She led Chesapeake’s change project to address these concerns, and thereby improve performance on Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys.

The rationale underlying these efforts was to ensure that information being communicated to families by clinicians is consistent and timely, as well as implementation of evidence-based best practices, she said.

One key element was standardization. To achieve this, Ferebee, and a steering committee that guided the project, worked with other experts to develop a caregiver training manual that included information that families needed to know about symptom management, medications, personal care, durable medical equipment and other considerations.


Nurse case managers would also review a checklist with caregivers during their first visit. This allows clinicians to assess families’ current knowledge as well as identify gaps that require further education, Ferebee said. This also helped to establish relationships between the clinicians and the untrained caregivers.

Chesapeake provided families with multimodal educational materials, including text, pictures and links to three- to five-minute videos that are accessible with mobile devices and YouTube. Families were also given ample opportunities to ask questions or refresh what they’ve learned, according to Ferebee.

“[Caregivers] might be in need of support themselves. Oftentimes, they let their health go by the wayside. They’re not able to work, and so they also have certain issues that they need to work through,” Ferebee said at the conference. “When we do such a good job of caring for the patient, we also have a due diligence and a responsibility to provide intentional support of the caregiver. This change project is for the interdisciplinary team to help alleviate some of that burden and stress of caregiving.”

To get her colleagues on board, Ferebee developed a “pitch video” designed to educate staff about the project, as well as training on how to implement the new tools and processes. Also, the project appointed staff members to serve as champions to guide and promote the changes.

The initiative did come with some challenges, chief among them was staffing as workforce shortages continue nationwide, Ferebee said. The project led to some increases in caseloads, and a major EMR upgrade within the organization affected continuity.

However, the program did find some success, according to Ferebee.

“There was an increase in the score overall from 83% to 85% in one team in that quality measure of training a family to care for patients,” she said. “There were specifically increased scores in the responses for discussion of pain medication side effects, which increased by 7%, and the training provided about when to get pain medication, which increased by 3% and patients’ restlessness or agitation which increased by 5%.”

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