A daughter types "home health care near me" from a hospital waiting room. Her father is being discharged on Friday with a wound that needs a nurse. Your ad appears, she taps it, and the page that opens talks about companionship, light housekeeping and help with errands. She goes back to the results and taps the next agency.
You paid for that click, and the page didn't answer her question. Google grades ads and pages on exactly that kind of fit, and in our experience an account that keeps sending families to the wrong page pays more for lower spots over time. This chapter explains how Google weighs your ad and page before it takes your money, and why an agency that sells both home care and home health needs to treat them as two different offers.
Google Weighs Your Ad and Page Against What the Family Typed, Not Just Your Bid
Every time someone searches, Google runs a quick auction to decide which ads show and in what order. Google calls the outcome Ad Rank. Its help page names six ingredients, and a home care agency controls more of them than it thinks:
- Your bid: your ceiling for one family's click.
- How good the ad and the landing page are, judged at the moment of the search.
- Quality thresholds: a floor your ad must get over, or it doesn't appear for that family at all.
- How close the competition is among the ads in that auction.
- The searcher's context: where they are, what device they're on, when they're searching and what they typed.
- What your extras add, such as a phone number, location or sitelinks on the ad.
How the six are weighed against each other is Google's secret; there is no published equation to reverse-engineer. What it does say is that better-quality ads often pay less per click. For a home care agency, that is the whole point of this chapter: the ad and page that fit the family's search can win a higher spot for less money than a bigger bid on a page that doesn't.
Quality Score Grades Three Things and Never Enters the Auction
Quality Score is the number most people point to when they talk about quality, and it is widely misunderstood. Google describes it as a diagnostic, a way for you to see how your ads are doing for a keyword, and says plainly that it is not itself fed into the auction. It runs from 1 to 10, for each keyword, and it grades three things:
- Expected clickthrough rate: how likely people are to click your ad when it shows for that keyword.
- Ad relevance: whether your ad speaks to the service the family asked for.
- Landing page experience: whether the page the family lands on answers their question and is easy to use.
For each part, Google tells you whether you trail, match or beat the other agencies bidding on that search, judged across the past three months.
One detail trips people up. Google measures expected clickthrough rate as if position and ad extras didn't exist; its definition says the measure is taken regardless of where the ad appeared or what assets it carried. So a bigger bid that pushes your ad to the top of the page does not improve that grade. The only way to raise it is an ad that more families actually want to click.
Keyword Planner Pools Home Care and Home Health. Relevance Doesn't.
Here is where home care agencies get into trouble. When we pulled searches for our example market, Chicago, Keyword Planner returned "home care services" and "home health care services" as a single line, the same 9,900 searches a month and the same bid range. "Home care agency" and "home health care agencies" came back pooled the same way.
It is tempting to build one ad group from a pooled list: one set of keywords, one ad, one page. The trouble is that the people typing those searches often want different things. The family looking for a companion for Mom four afternoons a week and the family looking for a nurse to change a surgical dressing both see the same ad and land on the same page.
Our reading of what happens next: the ad answers the wrong question for one of them, the page answers the wrong question for one of them, and ad relevance and landing page experience both suffer for the keywords where the fit is worst. You end up paying more for weaker spots on searches you could have won.
The fix is structural. Split ad groups by service, and give each one its own page:
- Companion and personal care
- Dementia and Alzheimer's care
- 24-hour and live-in care
- Respite care
- Skilled nursing at home
- Physical, occupational and speech therapy at home
Each ad group gets a handful of closely related searches, an ad written for that service and a page that answers that family's first question. Chapter 5 builds the keyword lists that fill these groups.
Several Example Agencies Already Built One Page per Service
This isn't a theoretical ideal. Among the 12 agencies we profiled in our example market, several already have the pages.
- Assisting Hands (Orland Park) gives each service its own page on the office's site: Alzheimer's and dementia care, Parkinson's care, stroke care, orthopedic care, transitional care and hospice support, among others.
- Broad Street Home Care runs a private skilled nursing page and a stroke recovery page, and each one carries its own phone number, which also tells the office which page a call came from.
- Renewal Memory Partners has separate Chicago pages for in-home memory care and for home health care services.
- Amedisys, at its Lake Zurich branch, lists nursing, physical therapy, occupational and speech therapy, wound care and condition programs for heart failure, COPD and fall reduction.
The weaker pattern shows up too, and it is common: every ad pointing to the homepage, where the family has to find their own answer. A homepage is written for everyone, which makes it the right answer for almost no search.
A Home Health Page Has to Answer Questions a Companion Care Page Never Gets
The two services draw different questions, and a good page answers the ones its family is actually asking.
A family arriving from a home health search wants to know whether Medicare covers it, whether their parent has to be homebound, whether they need a doctor's order, which nurses and therapists will come, and how the agency rates. That last one has a public answer. Medicare's Care Compare site rates home health agencies on a five-star scale built from seven quality measures, and according to the Centers for Medicare & Medicaid Services, which runs it, most agencies land in the middle at three stars. If yours rates well, the page should say so.
A family arriving from a companion or personal care search asks different things: which tasks your caregivers handle, whether there is a minimum number of hours, whether Mom will see the same caregiver each visit, whether you take long-term care insurance, and how fast care can start.
An agency that offers both still needs both pages, and the ad for each service should send families to the right one. Chapter 15 adds a third dimension, the payer, and shows how private pay, Medicaid and Medicare families each get their own path.
Page Speed Won't Set Your Quality Score. It Decides Whether the Family Waits.
Page speed comes up in every Quality Score conversation, so it is worth being precise. When Google explains landing page experience, it talks about whether the page is relevant, useful and simple to navigate. It also tells advertisers to check mobile load speed. They don't name load time as one of the things that set your Ad Rank.
That doesn't make speed optional. It matters for a simpler reason: the family is often searching on a phone, in a hospital hallway or a parking lot, and a page that takes too long to load loses them before they read a word.
How fast are home care pages on a phone? Our test: Google's free PageSpeed Insights, mobile mode, run three times on every example agency's page, with the median kept. It is a lab test on a simulated slow phone connection, not a record of real visits, but it is a fair comparison. The middle score across the 12 was 56 out of 100, and 4 of the 12 scored under 50. Two were fast by any standard: Help at Home's Chicago page scored 100 and the Home Care Powered by AUAF homepage scored 91. Both keep their pages simple.
Run the same free test on the pages your ads point to. If a service page scores far below the rest, fix it before you raise a bid to send more families there.
Fix the Lowest of the Three Statuses First
Once your campaigns have run for a few weeks, open the Keywords report and add the three Quality Score columns. Next to every keyword you'll see a grade for each of the three parts. Start with whichever is lowest.
- Expected clickthrough rate below average: the ad isn't earning the click. Rewrite it in the words families use, which is what Chapter 8 does with family reviews.
- Ad relevance below average: the keyword and the ad don't match. Tighten the ad group so every keyword in it belongs with that ad, the work Chapter 5 starts.
- Landing page experience below average: the page isn't answering the search. Send the ad to the matching service page, or build one.
Change one thing at a time and give it a few weeks. The grades look back three months, so a new page or a new ad needs time before it shows up in them.
Next: Your Keyword List Will Fill Up With Nursing Homes and Job Seekers
Separate ad groups need separate keyword lists, and a home care keyword list collects a lot of searches you don't want: nursing homes, assisted living, caregiver jobs and competitor names. Chapter 5 builds the list from real competitors' sites and cuts those searches before they cost you anything.
If you're starting here, Chapter 3 prices what a click is worth by payer, and Chapter 2 maps which searches to buy first. The guide home lists all fifteen chapters.
Separate service pages are one of the first things we ask a home care agency for under our Google Ads management, because no bid makes up for a page that answers the wrong question.
