A daughter in Phoenix types "home care chicago" into Google at nine at night. Her mother fell last week, the hospital discharge is Friday, and she is the one who has to find help. She has a credit card, a deadline and every reason to call tonight. On most agency accounts built the careful way, she never sees an ad.
That isn't a budget problem or a bidding problem. It comes from one location setting, the same setting that keeps a home care account's leads local and clean. This chapter shows how to keep that protection on your main campaigns and still reach the family member searching from another state, with one small campaign built only for them.
Google's Default Reaches Anyone Interested in Your City. Our Method Starts With Presence.
Every Google Ads campaign has two location options, and the choice sits under a small "Location options" link that most people never open.
- Presence or interest is the one Google recommends and preselects. It counts a searcher in Ohio who types your city's name the same as a neighbor down the street.
- Presence counts only where the searcher is, or regularly spends time. The searcher in Ohio drops out.
Google recommends the wider option, yet its own help page lists "a sensitive vertical with strict targeting limitations" as a reason to choose Presence. Care for older and disabled adults is that kind of business, and our method sets every main campaign to Presence. The reason is practical: "Presence or interest" also picks up people planning a move, researching a job, or reading about a city they will never hire in, and in a small account those clicks drain the budget before the real leads arrive.
Presence has a cost, though, and in home care it's a big one. It hides your ad from the adult child who lives somewhere else and searches for care in your city by name.
A Third of the Searches for "Home Care Chicago" Come From Out of Town
We compared Keyword Planner's national volumes with its volumes for our example market's metro area, Chicago. The difference is searches made from outside the metro area:
- "home care chicago": 590 searches a month nationally, 390 from inside the metro, so about a third from outside
- "caregiver chicago": 210 nationally, 140 inside, again about a third outside
- "home care agencies chicago": 880 nationally, 720 inside, about one in five outside
- "home health agency chicago": 480 nationally, 170 inside, nearly two thirds outside
- "home care naperville": 390 nationally, 140 inside the metro
Keyword Planner rounds its numbers and pools close variants, so read these as a pattern, not a count. The pattern is consistent: a meaningful share of the searches that name your city come from people who aren't in it.
Who are those searchers? Some are hospital case managers and discharge planners, and some are the adult children who run a parent's care from a distance. National research points to the second group. In AARP's 2025 caregiving study, 39% of family caregivers who live apart from the person they care for use paid help, compared with 22% of those who live together, and more than 10% of caregivers live an hour or more away.
The families say it in their reviews too. "I live in California, my Mom lives in Chicago," one wrote. "We live in another state and needed to set up a care company for my sister in Chicago," wrote another. A caregiver on Reddit put it in four words: "I'm 2,500 miles away."
Those are buyers, not browsers. They can't drop by the office or interview caregivers in person, so they hire the agency to be their eyes. If the main campaigns are the only ones running, your ad never reaches them.
One Small Out-of-Area Campaign Wins Back the Family Searching From Another State
The fix isn't to switch your main campaigns back to Google's default. It's one separate campaign, built only for the searcher who names your area from outside it. Our recipe:
- Location: the whole United States, on Presence, with your own service area added as an excluded location. Local searchers stay in your main campaigns, where they belong, and this campaign only ever reaches people outside your area.
- Keywords: exact and phrase match only, and every keyword names a place you serve: "home care chicago," "in home care evanston," "home health agency naperville." Without the city, a searcher in Phoenix is looking for care in Phoenix.
- No "near me" searches. "Home care near me" means near the searcher, which for this campaign is always somewhere you don't serve.
- Its own small budget, so it can't take money from the main campaigns and you can read its cost per lead on its own.
- Ads written for the family far away. Chapter 8 built a headline for exactly this reader, "Updates for Family Far Away." Add the proof they need: a named care manager, updates after every visit, a video call with Mom.
- Its own landing page, answering the questions a long-distance family asks first: who will call me, how often, what happens if something goes wrong, and how I pay from another state.
Watch the search terms report for this campaign closely in the first weeks. Out-of-area searches include job seekers ("home care chicago jobs") and people comparing cities before a move, and they belong on the negative keyword list from Chapter 6.
Google Switches On Six Settings a New Home Care Campaign Should Launch Without
A new Search campaign arrives with several settings already on, and most of them reach further than a new home care account should. Our method switches them off at launch and turns some back on later, once conversion tracking has enough data to judge them:
- Search partners: off. Partner sites add traffic you can't see clearly, and our method holds them back until the account has reliable conversions to test them against.
- Display Network: off. A Search campaign can place ads on websites too. Keep search and display in separate campaigns so each one's results are readable.
- Automatically created assets: off. These are lines Google drafts from your website. A home care site mixes client pages with caregiver job pages, so a drafted line can pitch a job to a family, or promise Medicare coverage without the conditions Chapter 8 said it needs.
- AI Max: off. It now arrives switched on in every freshly built Search campaign and stretches each keyword to searches you never chose. Chapter 13 covers when it's worth a test.
- Broad match: off during Isolation. Chapter 6 explains when it earns a place.
- Dynamic search ads: off. They pick search terms and write headlines from your pages, the opposite of the control you're building.
Three things go on:
- Ad rotation on "Optimize," the option that favors your stronger ads.
- Auto-tagging, which stamps each click so a form fill or phone call can be traced back to it (Chapter 1).
- Call reporting, which counts calls from your ads and records how long each one lasted, so a two-minute intake call isn't scored the same as a hang-up.
Searches for your agency's own name get a campaign of their own as well. A family that already knows you converts cheaply, and mixed in with everyone else it hides how much a stranger's call really costs.
Target the Area Your Caregivers Can Drive To, in the Languages They Speak
For the main campaigns, draw the service area around where you can staff a case, not a round radius around the office. A 25-mile circle looks tidy, but it can take in suburbs with no caregivers nearby and cut through neighborhoods you serve every day. Google Ads lets you target by county, city and ZIP code, so build the list from where your caregivers actually live and drive. When a new county fills up with caregivers, add it; when one keeps producing clients you can't staff, take it out.
(Job ads follow different rules. Google doesn't let US employment ads target by ZIP code, which matters for the recruiting campaigns in Chapter 10.)
Language is the other half of the area, and Google changed how it works this month. Starting in September 2026, Search campaigns lose their language setting. Google now matches ads by the language they're written in, judging a searcher's language from the search itself, their language settings and their preferences. The practical rule is simpler than before: to reach families who search in Spanish, write ads in Spanish, in their own ad group, pointing to a page in Spanish.
It's worth doing when your team can deliver it. Families notice. One wrote that a home health nurse "speaks English and Spanish which made it easier for my father to ask questions in Spanish." Another thanked a coordinator who "went as far as finding someone who speaks Tagalog." If your caregivers speak a language your market searches in, give it an ad group of its own, and don't run ads in a language your office can't answer the phone in.
A Week on a Small Budget Tells You What Your Market's Clicks Cost
Start every new campaign, the out-of-area one included, with a small daily budget. The first week isn't for leads. It's for reading the bid estimates and impression share Google shows next to each keyword, which tell you what the first page and the top of the page cost in your market.
A small budget won't choke a strong Monday, either: on a heavy day, Google is allowed to run past the daily figure, up to double, and balance it out across the month. After a week, you know which ad groups can win auctions at a price you can afford (Chapter 3 set that ceiling). Raise the budget on those, leave the rest alone, and let the out-of-area campaign prove its cost per lead before it gets more.
Next: Performance Max Can Send Your Ads to the Careers Page
Search campaigns give you this much control. Performance Max gives most of it to Google, and in home care, where caregiver job searches use many of the same words as family searches, that can mean paying for applicants with your client budget. Chapter 10 shows how to keep Performance Max pointed at families.
If you're starting here, Chapter 1 sets up the tracking these settings depend on, Chapter 6 covers broad match and negatives, and Chapter 8 writes the ads for the family far away. The guide home lists all fifteen chapters.
In the home care accounts we run through our Google Ads management, the out-of-area campaign launches alongside the local ones.
