Background: Caregiver competency for hemiplegic patients would be enhanced and sustained with structured educational approach with step-by-step competence confirmation and telehealth communication for follow-up. Aim: Evaluate the effectiveness of a structured educational development approach in enhancing the care competency among caregivers for patients with hemiplegia. Research Design: Quasi-experimental (one group pretest-posttest). Sample & Setting: 70 caregivers, purposively sampled, at neuropsychiatric and neurosurgery inpatient and outpatient units in Minia University Hospital, Egypt. Study Tools: 1) Structured interview questionnaire 2) Knowledge and practice competency tools (≥ 80% is cutoff competency score). Method: Pretest data was collected. Three educational sessions administered, each requiring competency before proceeding. A fourth session tested the third one, followed by two months of telehealth support, then a post-test. Results: Caregivers were mostly aged 30-39, female, married, housewives, with basic education, and reside in rural areas. Post-intervention, caregiver competency improved significantly: overall care competency rose from 11.4% to 75.7%; knowledge from 18.5% to 72.9%; practice from 21.4% to 81.4%. Knowledge scores increased from 13.5 ± 5.48 to 20.6 ± 2.75, practice scores from 37.4 ± 9.30 to 66.8 ± 4.5, and total care competency from 50.9 ± 14.78 to 86.4 ± 7.25. Effectiveness was 36.5% ± 16.46, with significant t-test values (p <0.001). Conclusion: The structured educational approach significantly increased the caregiver care competency for hemiplegic patients. Recommendations: Implement structured educational programs with telehealth follow-up for sustainable caregiver competency in inpatient discharge plans and outpatient services.