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A Family Guide from Apex Home Nursing Services

The Real Cost of Waiting: What Families Do Not Calculate Until It Is Too Late

Written by Halston Juracka, RN-BSN, CBIS, Co-Owner of Apex Home Nursing Services · Las Vegas, Nevada · Updated June 2026

Most families do not run the math on home care until a fall, a hospital stay, or a frightening phone call forces their hand. By then the cheapest, gentlest options are usually off the table. This guide lays out what care actually costs in Las Vegas right now, what a single crisis can trigger, and why a small amount of the right support early almost always costs less than the emergency it prevents.

The number nobody runs until the crisis hits

Here is the uncomfortable truth after years at the bedside: the families who struggle most financially are rarely the ones who planned for care. They are the ones who waited. They told themselves Mom was "fine for now," that they would "deal with it if something happens." Then something happened, and the decision got made for them in a hospital hallway, under pressure, with no good options left.

Roughly 7 in 10 Americans who reach age 65 will need some form of long-term care in their lifetime. This is not a rare event you can gamble on avoiding. It is the statistical norm. The only real question is whether you shape that care on your terms, early and affordably, or have it shaped for you during an emergency.

What care actually costs in Las Vegas right now

These are 2024 to 2025 figures from the CareScout (Genworth) Cost of Care Survey, the most widely cited long-term care pricing study in the country, plus Nevada-specific data. Note that these are medians. Premium settings in Summerlin and Henderson routinely run higher.

In-home care, Nevada

~$33 / hour

Statewide average; Las Vegas trends a bit lower than Reno and Carson City

Memory care

+20% to 30%

Generally runs 20 to 30 percent above standard assisted living due to added supervision and security

Assisted living, Las Vegas

~$4,523 / month

Nevada statewide average is about $5,000 per month

Nursing home (skilled), national

$111k to $128k / yr

Median was $111,325 semi-private and $127,750 private in 2024

By 2025, the national median for assisted living had climbed to about $6,200 a month, and private duty nursing reached roughly $90 an hour nationally. Costs have outpaced general inflation across almost every care type for several years running

$111,325 to $127,750

The 2024 national median annual cost of a nursing home, semi-private to private room. That is the bill a preventable crisis can hand a family, often for years.

Source: Genworth and CareScout 2024 Cost of Care Survey

The single fall that resets everything

If you want to understand the cost of waiting, understand falls. A fall is the most common event that turns a stable, independent older adult into a long-term care patient overnight.

  • More than 1 in 4 adults age 65 and older fall every year. That is over 14 million people.

  • Falls cause roughly 3 million emergency department visits and about 1 million hospitalizations among older adults each year.

  • In 2024, more than 43,000 older adults died from falls, which remain the leading cause of injury death in this age group.

  • Falls are the most common cause of traumatic brain injury, and nearly 319,000 older adults are hospitalized for hip fractures annually.

The financial picture is just as stark. The average older-adult fall costs about $1,100 per emergency room visit and roughly $18,000 per inpatient hospital stay. Nationally, healthcare spending on nonfatal older-adult falls reached about $80 billion a year and is projected to top $101 billion by 2030.

1 in 4

Older adults who fall each year. Roughly half who fall will fall again, and a single bad fall frequently begins the slide into rehab, then assisted living, then skilled nursing.

Source: CDC Older Adult Fall Prevention

The hidden math: the crisis you are paying to prevent

Here is the calculation almost no family makes until it is too late. A fall is rarely a single bill. It is a cascade.

It starts with the ambulance and the emergency room. Then the hospital admission. Then the rehab stay, because she is now weaker than before. Then, very often, the family decides home no longer feels safe, and a memory care or assisted living placement follows at $4,500 to $6,000 or more every month, indefinitely. Layer in the adult child who burns vacation days, then unpaid leave, then watches their own job and health suffer while they try to hold it together.

Now compare that to the alternative. A few hours a week of skilled, supervised in-home support at around $33 an hour is a few hundred dollars a week. The entire point of that support is to catch the weakness, the medication mix-up, the unsafe rug, the missed meal, the early urinary tract infection, before any of it becomes the fall that triggers the cascade. You are not spending money. You are buying down a much larger, much more painful expense that has not happened yet.

And there is the part the spreadsheets miss entirely: 75 percent of adults over 50 say they want to stay in their own home as they age. The cost of waiting is not only financial. It is the loss of the exact outcome your loved one wants most.

Why early in-home support changes the trajectory

The reason early support works is not the caregiver alone. It is the clinical eyes on the situation. Decline in older adults almost never announces itself. It whispers. A little less appetite. A slightly unsteady walk to the bathroom. A pill bottle that is too full because doses are being missed. A quieter voice on the phone. Individually, each is easy to rationalize. Together, they are the early chapters of the crisis story.

When someone with clinical training is reviewing what is actually happening in the home, week over week, those whispers get heard. That is the difference between a phone call that says "we noticed Mom's balance is off, let us adjust things now" and a phone call from an emergency room at 2 a.m. The first call costs almost nothing. The second one can cost a hundred thousand dollars and a year of everyone's life.

Why Apex costs more than the agency down the street, and why that is the point

Let me be blunt, because your family deserves bluntness instead of a sales pitch. Apex is not the cheapest home care in Las Vegas, and we are not trying to be. Our personal care runs $65 an hour, our registered nursing care runs $200 an hour, and our membership tiers build real nurse involvement into the price. The company advertising $28 an hour is selling a different product that happens to share a name.

That price difference is not markup. It is the three things that decide whether your loved one is genuinely safe or merely supervised.
 

1. The nurse fighting for your family is an owner, not an employee

When an Apex client needs registered-nursing involvement, the nurse is my wife Kayla or me, personally, working under our own Nevada RN licenses. Not a nurse who signed a care plan once and vanished. Not a name on a roster who rotates out next month. An owner of this company, with our name and our reputation on the line for your mother exactly the way they would be for ours. When we say we will fight for your family, we mean it literally. We get on the phone with the hospitalist, the discharge planner, the facility, and the hospice team, and we advocate with clinical authority until your loved one gets what they actually need. We translate every order, every medication change, and every frightening word out of a doctor's mouth into plain English you can act on. And we stand beside you through every hard decision as the situation shifts, because no family should have to navigate the medical system alone and afraid.
 

2. Our caregivers are the best we can find, and we pay to keep them

Turnover is the silent killer of care quality. A caregiver who quits in three weeks never learns your mother's routine, never notices the subtle change in her walk, and never becomes someone she trusts. So we do the thing most agencies refuse to do: we recruit the best caregivers in the state, and we pay them roughly 50 percent above the going rate to stay. What you get is a caregiver who shows up, who knows your loved one cold, who is genuinely excellent at this work, and who is invested because we invested in them first. You do not get that for $28 an hour. Nobody does.

3. We keep our client list small on purpose

This is the part that sounds like a business mistake and is actually the entire strategy. We deliberately keep our roster exclusive and small, because a caregiver or an owner stretched across forty families gives every one of them a sliver of their attention. We would rather serve a few families ferociously than many families adequately. When you join Apex, you are not account number 312. You are one of a small group of people we have personally committed to protect, and our caregivers and we as owners pour our best into you every single day.

Anything less than this gets you worse results. That is not marketing, it is arithmetic. Rotating strangers miss the early signs. Underpaid caregivers churn out before they ever learn your loved one. Agencies with no real nurse behind them cannot catch the medication error or the early infection, so it becomes the ER trip, the rehab stay, the placement, the precise crisis you were paying to avoid. With a parent's safety, the cheap option is almost always the expensive option. You simply pay for it later, in dollars and in regret.

Why Apex costs more than the agency down the street, and why that is the point

Let me be blunt, because your family deserves bluntness instead of a sales pitch. Apex is not the cheapest home care in Las Vegas, and we are not trying to be. Our personal care runs $65 an hour, our registered nursing care runs $200 an hour, and our membership tiers build real nurse involvement into the price. The company advertising $28 an hour is selling a different product that happens to share a name.

That price difference is not markup. It is the three things that decide whether your loved one is genuinely safe or merely supervised.
 

1. The nurse fighting for your family is an owner, not an employee

When an Apex client needs registered-nursing involvement, the nurse is my wife Kayla or me, personally, working under our own Nevada RN licenses. Not a nurse who signed a care plan once and vanished. Not a name on a roster who rotates out next month. An owner of this company, with our name and our reputation on the line for your mother exactly the way they would be for ours. When we say we will fight for your family, we mean it literally. We get on the phone with the hospitalist, the discharge planner, the facility, and the hospice team, and we advocate with clinical authority until your loved one gets what they actually need. We translate every order, every medication change, and every frightening word out of a doctor's mouth into plain English you can act on. And we stand beside you through every hard decision as the situation shifts, because no family should have to navigate the medical system alone and afraid.
 

2. Our caregivers are the best we can find, and we pay to keep them

Turnover is the silent killer of care quality. A caregiver who quits in three weeks never learns your mother's routine, never notices the subtle change in her walk, and never becomes someone she trusts. So we do the thing most agencies refuse to do: we recruit the best caregivers in the state, and we pay them roughly 50 percent above the going rate to stay. What you get is a caregiver who shows up, who knows your loved one cold, who is genuinely excellent at this work, and who is invested because we invested in them first. You do not get that for $28 an hour. Nobody does.

3. We keep our client list small on purpose

This is the part that sounds like a business mistake and is actually the entire strategy. We deliberately keep our roster exclusive and small, because a caregiver or an owner stretched across forty families gives every one of them a sliver of their attention. We would rather serve a few families ferociously than many families adequately. When you join Apex, you are not account number 312. You are one of a small group of people we have personally committed to protect, and our caregivers and we as owners pour our best into you every single day.

Anything less than this gets you worse results. That is not marketing, it is arithmetic. Rotating strangers miss the early signs. Underpaid caregivers churn out before they ever learn your loved one. Agencies with no real nurse behind them cannot catch the medication error or the early infection, so it becomes the ER trip, the rehab stay, the placement, the precise crisis you were paying to avoid. With a parent's safety, the cheap option is almost always the expensive option. You simply pay for it later, in dollars and in regret.

What you are actually buying

Strip everything else away and here is what Apex really is. My wife Kayla and I are both registered nurses, and we built this company to be the care we would demand for our own parents and refuse to accept anything less.

You get a personal nurse who is an owner, not an employee, who will argue with the hospital, decode every order, and stand with you through every impossible decision. You get a caregiver who is among the best in the state and who actually stays long enough to matter. And you get the two of us, personally invested in your loved one's safety and in our own reputation, treating your family like ours because honestly it is the only way we know how to do this work. It is basically having a team of professionals in the family: a nurse, an advocate, and an elite caregiver who come to love your people the way you do.
 

That is what more money buys at Apex. Not more hours. Better outcomes. The highest chance your loved one stays safe and at home, and the smallest possible weight on your shoulders. We will fight for your family like they are our own, because to us, that is exactly what they become.

Find out what the right level of support looks like for your family

Talk it through with one of the RN owners. No pressure, no sales script, just a clear, honest read on where your loved one stands and what would actually help.

BOOK YOUR 15-MINUTE NURSE CALL FOR MORE INFORMATION

Or call or text us directly: (702) 843-7402

Frequently asked questions

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HJ
About the author

Halston Juracka, RN-BSN, CBIS is a registered nurse, Certified Brain Injury Specialist, nurse educator, and co-owner of Apex Home Nursing Services in Las Vegas. He co-founded Apex with his wife and fellow registered nurse, Kayla Juracka, RN-BSN, to bring genuine nurse-led oversight to private-pay home care for families in Summerlin, Henderson, and the greater Las Vegas valley.

References
  1. CareScout. Cost of Care Survey and long-term care statistics. carescout.com/cost-of-care

  2. Paying for Senior Care. Nevada Assisted Living and Home Care Costs (Genworth 2024 data). payingforseniorcare.com/nevada

  3. Genworth and CareScout. 2024 Cost of Care Survey Results, 2025. investor.genworth.com

  4. CareScout. 2025 Cost of Care Survey Results, 2026. investor.genworth.com

  5. U.S. Centers for Disease Control and Prevention. Facts About Falls, Older Adult Fall Prevention, 2026. cdc.gov/falls

  6. National Safety Council. Older Adult Falls, Injury Facts, 2026. injuryfacts.nsc.org

  7. National Council on Aging. Get the Facts on Falls Prevention. ncoa.org

  8. AARP. 2024 Home and Community Preferences Survey. aarp.org

This guide is general educational information, not medical, legal, or financial advice, and does not replace guidance from a treating provider. Apex Home Nursing Services is an RN-owned, private-pay personal care agency in Las Vegas, Nevada. Registered nursing services, where applicable, are provided by the RN owners under their own Nevada licenses, coordinated by, not provided by, the agency. Cost figures are medians and will vary by provider and individual need.

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