This article is sponsored by Betterleave. It is based on a discussion with Cara McCarty Abbott, Founder and CEO at Betterleave; Sara Nigro, Director of Partnerships at BetterRX; and Lloyd Wilson, CEO at Sonder Hospice & Palliative Care. This discussion took place on April 10, 2025, at the Hospice News ELEVATE Conference.

Hospice News: I’m pleased to introduce our panel. We’re going to be talking about the unsung heroes of home-based care: the caregivers at home. Without them, of course, a lot of the services you all provide would not be possible. So this is an important topic. I’m pleased to introduce Cara McCarty—Cara McCarty Abbott, Founder and CEO of Betterleave; Lloyd Wilson, CEO of Sonder Hospice & Palliative Care; and Sara Nigro, Vice President of Partnerships at BetterRX. Thanks to each of you for being here.

When we talk about end-of-life care, the focus is usually on the patient, as it should be. But the experience of the family caregiver can have just as much impact on outcomes. What are some of the hidden costs—emotional and financial—of under-supporting family caregivers at the end of life? Cara, would you begin?

Cara McCarty Abbott: Yes, absolutely. As a technology partner, it’s our mission at Betterleave to enhance and build that human connection between your clinicians, your staff, and the family members of your patient. Typically, what we see is that family members want to be involved—they want to be engaged—but sometimes they don’t necessarily know how. You might have a patient in assisted living or a nursing home, and the family member isn’t there during your visit. That might be the one experience where they say, “Oh, man, I wish I had been there. I wish I had known. I wish I knew what the recap was.”

Maybe your clinician calls and leaves a voicemail, but they don’t actually get to connect. That’s just one example of a hidden cost you might not realize is happening in real time. You don’t have insight into that—where Betterleave can come in as a text-based communication platform and bridge that gap. We can let them know, “Hey, this week a clinician is going to visit Mom. If you want to be there, here’s the time.” Or, “Here’s a recap from the visit. Do you have any questions?”

Really, think of us at Betterleave as that wraparound support. From a hidden cost perspective, you may or may not know the family member’s experience or satisfaction. That’s definitely a hidden cost.

HSPN: Lloyd, from the provider perspective, can you talk a little about the burdens families face and what you’re seeing?

Lloyd Wilson: Yes. I think one of the most difficult times in the hospice space is when services begin. Internally, we talk about something called the “hidden jackpot”—that’s a family member who isn’t supported. They have high anxiety and frustration. They often feel undereducated. What’s happening below the surface is escalating, and we can’t always see it because we’re not there.

Our nurses do a great job, but maybe they missed something. Or maybe the family feels like, “Okay, I had the initial meeting, but I still don’t understand what I need to do or feel confident in the care.” One of the things we get with Betterleave, because it’s a customer engagement tool, is they’ll send a text in week one: “Do you feel like you or your family members received adequate training on the care of your loved one?” That triggers a response. If it’s yes, great. If not, we send someone out.

The long-term benefit is that we earn their trust, and they learn they can solicit feedback and get a response. Once they know you’ll be there for them, they’re more likely to reach out again.

HSPN: Thank you. Sara, of course, medication is a big part of hospice care. I know there was an incident when I was helping to care for someone where medication arrived late—it was a really horrible experience for that patient. Can you talk a little about the intersection between providing medication and caregiver support?

Sara Nigro: Absolutely. This hits home for us. Our founder launched BetterRX because of a mail-order model that failed his father. As a pharmacist, he knew what was happening and how to help—but legally, he couldn’t. His ethics and licensure prevented him from intervening. So he started this company believing there had to be a faster, more efficient way to deliver care closer to the patient.

Medication isn’t just a cost driver—it’s about dignity and comfort at the end of life. Hospice gives you one chance. Driving team efficiency is important, but getting the right meds, at the right time, in the right amount is what we anchor on.

I’ve experienced these communication gaps personally. My grandfather went through hospice in Miami, and we had huge language barriers with the nurses. It created frustration for my mom and family. My mom didn’t even know how to use the comfort kit. What good is a bag of meds if they’re not labeled and you don’t know what to do?

Seeing that professionally and personally has shaped our work. It changes your drive to ensure faster, better care.

HSPN: Absolutely. In a perfect world, we’d see seamless collaboration between clinical teams and family caregivers—but it doesn’t always work that way. Let’s talk about operational burdens. How does a lack of caregiver support create inefficiencies for hospice teams?

McCarty Abbott: Yes. What we’ve all talked about today—and what I heard in the previous panel—is the importance of real-time feedback. A lot of our hospice partners receive feedback through lagging indicators, like surveys and quality scores. That’s helpful for a look-back, but not for real-time support.

So how can you build mechanisms and operational processes that allow you to get that feedback without overburdening your staff? I think Susan said earlier, “I know when my pizza is going to get delivered, but I don’t know when the hospice nurse is coming.” That illustrates the need for a real-time communication loop.

If you can build a program that allows your nurses to focus on bedside care while support partners like us handle automation, efficiency, and communication—whether it’s text updates or refilling medications—you’ve created a win-win. You lighten your staff’s load, preserve their core mission, and make their jobs more sustainable. It’s not about replacing them—it’s about helping them do what they love more effectively.

HSPN: Excellent. Lloyd, how does this show up with your care teams?

Wilson: Yes. We talked earlier about unsupported caregivers creating anxiety, which drives more visits, more phone calls, more rework. We did a pilot with Betterleave, and we actually saw a reduction in after-hours calls—from 42% down to 26%. Most of those calls were for care clarification or non-emergencies that felt urgent to the family.

We’re also a customer of BetterRX. Timely med requests are a huge help. With Betterleave, we’re getting accurate, timely information, so things don’t escalate. Our care coordination calls dropped from 42% to 18%.

That’s a meaningful reduction in team stress—and an assurance that we’re doing a great job. These tools give us performance analytics so we can drill into issues early, whether that’s logistics, training, or a staff member not meeting expectations. These are things we usually don’t discover until CAHPS surveys come in. Now we’re getting ahead of them. It’s given us more pride in our work.

Nigro: Thank you.

HSPN: Sara, how about from the medication standpoint?

Nigro: Medication adherence is a huge issue. It’s one thing to prescribe and deliver the meds, but you don’t always know if they’re being administered. A platform that enables check-ins or clarifying conversations can help.

You’re also dealing with tough conversations—like stopping a med the family believes is life-saving. For example, removing Eliquis can feel terrifying to a loved one who doesn’t understand why. But in hospice, that med may now present more risk than benefit. We’re shifting from prolonging life to ensuring comfort.

When caregivers aren’t supported, patients can end up in the ER—that’s the opposite of what we want. We want to keep people comfortable at home. Just that extra step to check in and ensure the caregiver understands the care plan can make all the difference.

There’s still stigma around hospice. Supporting caregivers better—with clarity and compassion—helps shift that.

Betterleave delivers expert digital communication and support for families navigating serious illness and loss. To learn more, visit: https://www.betterleave.com/.