A Family Guide from Apex Home Nursing Services
What to Ask Before You Hire Any Home Care Agency
Written by Halston Juracka, RN-BSN, CBIS, Co-Owner of Apex Home Nursing Services · Las Vegas, Nevada · Updated June 2026
Most home care companies sound identical on the phone. Warm voice, reassuring words, "we treat every client like family." Then the caregiver shows up and you discover what you actually bought. This is a plain-language checklist of the questions that separate a premium, nurse-led agency from a staffing service that simply fills a shift. Ask these ten questions of anyone you are considering, including us.
Why the right questions matter so much
Home care is one of the only high-stakes purchases families make where they rarely get to inspect the product first. You are trusting a stranger inside your parent's home, often when that parent is at their most vulnerable. And the quality gap between agencies is enormous, even when the hourly rate looks similar.
Here is a number that should reframe how you shop. According to AARP and the National Alliance for Caregiving's 2025 report, more than half of family caregivers now handle complex medical and nursing tasks, yet only about 1 in 5 has received any formal training for them.1 The same training gap exists across much of the paid home care industry. Many "caregivers" are warm, well-meaning people with almost no clinical oversight standing behind them. The questions below are how you tell the difference before you sign.
~22%
Share of family caregivers who received formal training, even though over half perform medical and nursing tasks. The same oversight gap exists in much of paid home care. Clinical supervision is the thing to screen for.
Source: AARP and National Alliance for Caregiving, Caregiving in the U.S. 20251
What care actually costs in Las Vegas right now
1
Who actually answers the phone when something goes wrong at 7 p.m.?
Care needs do not keep business hours. Ask exactly who you reach after hours and on weekends, and whether it is a real decision-maker or an answering service that takes a message until Monday.
2
Is a registered nurse involved, and what does that nurse actually do?
This is the single most important question. "We have a nurse on staff" can mean a nurse who signed paperwork once. Ask whether an RN builds the care plan, reviews visit documentation, and is clinically accountable for the quality of care. That ongoing nurse oversight is what catches decline early and prevents hospital trips.
3
Will my parent have a dedicated caregiver or a rotating roster of strangers?
Consistency is not a luxury, it is a safety feature. A caregiver who sees the same person every week notices the subtle changes, the slightly worse balance, the quieter mood, the fuller pill bottle. A rotating roster of unfamiliar faces notices nothing, and it is exhausting and frightening for someone with memory loss.
4
How do you screen, background-check, and train your caregivers?
Ask specifically about background investigations, license and registry verification, exclusion checks, tuberculosis screening, and what training is required before a caregiver ever sees a client. A premium agency will have a clear, documented process. A staffing service will get uncomfortable.
5
What happens when the caregiver and my parent are not a good fit?
Sometimes personalities just do not click, and that is normal. The question is whether the agency treats it as a problem to solve quickly or a complaint to manage. Ask what the re-match process looks like and how fast it happens.
6
Are you private pay, and do you bill insurance? Why does that matter?
Sometimes personalities just do not click, and that is normal. The question is whether the agency treats it as a problem to solve quickly or a complaint to manage. Ask what the re-match process looks like and how fast it happens.
7
Will you coordinate with our existing doctors, home health, and hospice?
Good home care does not interfere with the care already in place. It fills the gaps between visits and keeps everyone informed. Ask whether the agency communicates with physicians and works alongside home health and hospice without stepping on them.
8
Who writes the care plan, and who reviews what happened at each visit?
A real care plan is a living clinical document, not a one-page intake form. Ask who creates it, how often it is updated, and crucially, who reads the visit notes afterward. Documentation that nobody reviews is just paperwork. Documentation a nurse reviews is an early-warning system.
9
What is your plan when there is an emergency or a change in condition?
Ask them to walk you through it. What does the caregiver do, who do they call, and how fast does a clinical decision-maker get involved. The quality of this answer tells you whether you are hiring a safety system or just a companion.
10
Can our family see what actually happened at each visit?
You should never have to wonder whether care is being delivered as promised. Ask whether there is a secure way for the family to view visit notes and documentation. Transparency is the hallmark of an agency that has nothing to hide.
If an agency answers most of these the right way, you are likely looking at a premium, clinically-led provider. If they get vague or defensive on the nurse-oversight questions in particular, you have found a staffing service, no matter how warm the phone voice was.
How Apex answers these ten questions, and why we cost more
We wrote this checklist knowing full well you would hold it up to us. Good. Here is where we stand, plainly:
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When something goes wrong after hours, you reach an RN owner, my wife Kayla or me, not a call center.
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When your loved one needs registered-nursing involvement, that nurse is one of us, personally, under our own Nevada licenses, with our name and reputation on the line.
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A nurse reviews the documentation from every visit, hunting for early decline, medication concerns, and safety issues, because documentation nobody reads is just paper.
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We build around one consistent, dedicated caregiver, never a rotating roster of strangers.
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We are private pay, with transparent pricing, and we work alongside your existing doctors, home health, and hospice without interfering.
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You get a secure family portal where you can see what happened at every visit, any time.
And yes, we cost more than the staffing service down the street. Our personal care is $65 an hour and our registered nursing is $200 an hour. Here is exactly what that buys. Caregivers we recruit from the best in the state and pay roughly 50 percent above market, so they actually stay and actually know your loved one. A client list we keep deliberately small, so nobody ever gets a fraction of our attention. And two owner-nurses who will get on the phone and argue with the hospitalist, the discharge planner, the facility, and the hospice team like family, then translate every order and every change into plain English so you are never lost in the medical machine.
I am a Certified Brain Injury Specialist with a focus on stroke and brain-injury recovery and a nurse educator. Kayla holds our clinical and compliance side to the same standard. We designed Apex so the answer to every question above is the premium one by default, because we built it as nurses, for the care we would demand for our own parents.
The cheap agency gives you a warm voice and a rotating stranger. We give you a team of professionals who function like family, a nurse, an advocate, and an elite caregiver, all personally invested in your loved one. With your parent's safety, that difference is the entire ballgame.
Put us to the test
Bring this checklist to a conversation with one of the RN owners and ask us anything on it. If we are not the right fit, we will tell you honestly.
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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
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AARP and National Alliance for Caregiving. Caregiving in the U.S. 2025, 2025. aarp.org
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AARP. New Report Reveals Crisis Point for America's 63 Million Family Caregivers, July 2025. aarp.org
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AARP. 2024 Home and Community Preferences Survey. aarp.org
This guide is general educational information, not medical, legal, or financial advice. 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.