A home care owner opens the Google Ads account for the first time in a month, sees a $14 click on "in home care," and does the math against a first visit: four hours at $35 is $140. Ten clicks like that and the ad has eaten the whole first visit. It looks like a bad deal.
It is the wrong comparison. The family that booked four hours on a Tuesday may be booking forty a week by spring. This chapter builds the math the right way around: what a click costs, what a lead costs, what a client costs, and what that client is worth to your agency, paid privately, through Medicaid or through Medicare.
A First Week of Care Is the Wrong Yardstick for a $16 Click
Start with the two prices that matter. On the revenue side, the national median rate for non-medical home care was $35 an hour in the 2025 Cost of Care Survey from CareScout, the long-running survey formerly published with Genworth. In Illinois, our example state, it was $36.
On the cost side, advertisers in our example market, Chicago, should expect to pay somewhere between $4.20 and $16.20 to reach the top of the page for "in home care," going by Keyword Planner. Your market's range will differ, but the shape won't: a single click can cost more than a lot of people expect.
Hold those two numbers next to each other and a $16 click against a four-hour first visit looks painful. Hold the click against the client, the months and the hours that follow, and it looks cheap. What follows is that comparison, built so you can drop in your own numbers.
An $8 Click Becomes a $500 Client in Three Steps
Our method prices a client through a chain. Each link is a number your account and your client records can give you, once Chapter 1's tracking is in place. Nobody publishes reliable conversion or close rates for home care, so two of the links below are illustrations. Replace them with your own as soon as you have a month of data.
- Price per click: $8. Inside the example market's range for "in home care."
- Share of clicks that become a call or form: 8%. An illustration. That makes each lead cost $100.
- Share of leads that become a client: 1 in 5. Also an illustration. That makes each new client cost $500.
For scale, Activated Insights, a firm that benchmarks home care agencies each year, reported that the cost to win a client reached $800 in 2023, across every channel agencies use. Your Google Ads cost per client might land above or below that. The point of the chain is that you'll know which, and why.
The Agency That Calls Back First Pays Less for Every Client
The last link in the chain, leads to clients, is the one most agencies can move fastest, and it has nothing to do with bids. Families shop by phone. One forum post about finding a second agency after the first closed: "We found the 2nd one by calling around." Another family, in a Google review: "Home Instead was the first to respond to the all the numerous calls I made to help my parents and I'm so glad they did."
Speed wins the family. Run the same chain with a faster callback: if 1 in 4 leads becomes a client instead of 1 in 5, the same $100 leads now cost $400 per client instead of $500. Same budget, same ads, same bids, and 25% more clients.
Activated Insights also reports that agencies which track every inquiry had median revenue of $3.15 million, against $1.40 million for agencies that didn't, in its 2025 data. That is a correlation, not proof that tracking alone doubles revenue. But it describes the kind of agency that knows where each lead went, and that agency can answer the question this chapter asks.
Hours Grow, and So Does What a Private-Pay Client Is Worth
Private-pay clients rarely stay at their first schedule. In the 719 family and patient reviews we read from agencies in our example market, 24 described hours going up, some to around-the-clock care, and 25 described a relationship of a year or more. One family wrote: "At first it was for just one day for 8 hours. Over time as more and more care was needed Companion's for Seniors always came through as our need grew to 24 hours/day for 5 days/week."
Our arithmetic at the $35 national median:
- 12 hours a week is about $420 a week, or about $1,820 a month.
- 40 hours a week is about $1,400 a week, or about $6,070 a month.
Not every client grows, and not every client stays. The industry's own figures are sobering: Activated Insights reported that agencies lost 45.5% of their clients during 2024, and its 2023 report, on 2022 data as summarized by Homecare CEO, put the average client's lifetime value at $14,830. That figure is dated and secondhand, but it is a useful floor. Your client records can tell you your own: average months of service times average monthly billing.
Two more things belong in that number. It is revenue, not profit: the median companion and personal care aide earned $17 an hour in the 2026 Activated Insights data reported by HHAeXchange, which leaves about $18 of a $35 hour for payroll taxes, insurance, training, the office and profit. (That is our arithmetic across two different surveys, so treat it as a rough shape, not a margin.) And it leaves out the referrals a happy family sends you, which no tracking will ever fully count.
Medicaid Pays a State Rate. Medicare Pays by the 30-Day Period.
Private pay is only one of the ways an agency gets paid, and each payer changes what a client is worth.
Medicaid. A health policy research group, KFF, found in its survey of state programs that the median Medicaid rate paid to personal care agencies was $26 an hour. Rates are set by each state. Illinois, our example state, pays $30.80 an hour in its Community Care Program and, by law, requires agencies to pay the worker at least $18.75 an hour, which leaves about $12 for everything else (our arithmetic). Families also wait to qualify. One wrote: "it's probably going to take 9 months to a year to get her on Medicaid or state assistance for any type of in-home care."
Medicare home health. Medicare pays home health agencies by the 30-day period of care, not by the hour. The 2026 national standardized payment is $2,038.22 per period, adjusted for each patient's needs and location. A period with only a handful of visits is paid per visit instead. And more than half of eligible Medicare beneficiaries, 55% in 2025 according to Congress's Medicare advisory commission, are in Medicare Advantage plans that pay under their own contracts. Home health relationships are shorter but repeat. One patient wrote: "I have used Center of Illinois Home Health several times over the last 2 1/2 years."
The practical rule: every payer gets its own ceiling on what a client can cost. A Medicaid lead and a private-pay lead from the same search are not worth the same bid. Chapter 7 sets separate bidding targets, and Chapter 15 builds separate campaigns and pages for each payer.
Pay Google for the Click, Not a Referral Site for the Family
Home care has another way to buy leads, and it is worth comparing. The referral sites that advertise on the same searches sell families to agencies. A Place for Mom says plainly: "We are paid by home care agencies each time we refer a family to them." Caring.com says some providers pay it "a referral fee when a family hires them," while others pay per contact or by subscription. Neither publishes its prices.
For Medicare and Medicaid clients, how you pay matters. The anti-kickback law makes it a felony to pay for referrals of people covered by federal health programs. The HHS Office of Inspector General has said that pay-per-patient arrangements are "particularly problematic," and in a 2021 opinion about a per-click directory for home health and home care providers it declined to impose sanctions, largely because the fee was charged whether or not the person became a patient. Our reading: paying Google for a click is the low-risk way to buy those leads, and a per-admission deal with a lead seller needs a lawyer's review first. (This isn't legal advice.)
Private-pay clients sit outside that federal law, but the math still favors the click. A referral fee is set by the seller. A cost per client from Google Ads is set by your own tracking, your own ads and how fast your office calls back.
The Budget Is the Clients You Want Times What Each Can Cost
Now the budget almost writes itself. Pick a monthly target for new clients from Google Ads. Then multiply it by the most you can pay to win one.
Using the illustration: four new private-pay clients a month at $500 each is a budget of about $2,000 a month. If your records say an average private-pay client is worth several thousand dollars in margin over their time with you, $500 is an easy trade. If they say much less, the ceiling comes down.
Three rules keep the first month honest:
- Start lower than the math allows. Launch with a modest daily budget and read Keyword Planner's bid estimates before raising it.
- Keep payers apart. Set one allowable cost per client for private pay, another for Medicaid, another for Medicare home health.
- Replace the illustrations fast. After a month of what our method calls an Isolation campaign (exact match, manual bids, only the searches most likely to become clients), your own cost per lead and your own close rate replace every assumption above.
Next: A Home Health Search Needs a Home Health Page
Once you know what a click can cost, the next question is how to pay less for the same one. Part of a click's price is set by how closely your ad and landing page fit what the family typed. A home health search that lands on a companion care page pays a price for that mismatch, and Chapter 4 shows how to fix it.
If you skipped ahead, Chapter 1 sets up the tracking this chapter's numbers come from, and Chapter 2 maps which searches to buy first. The guide home lists all fifteen chapters.
Pricing each payer separately is the first spreadsheet we build for a new home care account under our Google Ads management.
