Culture is simple. They prefer moist, but not wet, rich, organic soil in full to light shade. In areas where winter is severe and there is no reliable snow cover, a mulch of shredded hardwood bark provides a warm blanket. They are greedy feeders, and when using a timed release fertilizer such as Osmocote, I recommend the highest range. Soil Ph in the range of 5.5-7.0 is fine.
Hellebores have relatively few pest or disease problems.
In some areas, they may be prone to an attack of Aphids, but the usual remedies will take care of this problem. An occasional bout with Botrytis which can be caused by poor air circulation in a cool damp area can be cured with copper sulphate, a relatively innocuous fungicide. In these West Virginia mountains the deer populations are very large, but hellebores are the one plant that they turn their noses up at. It's hard to find a more captivating, easy to grow plant. Even if they never flowered, these garden gems would be a worthwhile addition to virtually any garden.