Two searches hit Google in the same hour. A daughter at her father's hospital bedside types "short term rehab near me." A son who has been caring for his mother at home for a year types "nursing homes near me." Both see an ad for your building, and both land on the same page, titled "Skilled Nursing," that tries to talk to both of them at once.
Neither of them gets what they came for, and Google notices. The way your ads are grouped and the page each one lands on decide where your ad shows and how much each click costs, often more than your bid does. For a nursing home, the most important split in the whole account is the one between rehab and long-term care.
Google Ranks Your Ad on Six Things, and Your Bid Is Only One of Them
Picture the instant a daughter types "short term rehab near me" into her phone. Before the results appear, Google weighs every nursing home ad that could show and ranks them, and that rank decides who appears and in what order. The first spots get the most clicks. Google's help center lists six, and every one has a nursing home version:
- Your bid. The top price you'd pay for her click. The real charge often lands lower.
- Your ad and the page behind it. Whether a rehab ad leads to a page about rehab, and whether that page makes sense to a worried family on a small screen.
- A quality floor. Below it, no amount of money puts a rehab ad on her screen.
- The other nursing homes in the auction. When your score sits close to a competitor's, you trade places often; pull further ahead and you're more likely to hold the spot, sometimes paying more for that certainty.
- Her situation. Where she is, the phone in her hand, the hour, and the exact words she typed.
- Your extras. The call button, a link straight to the rehab page, the 24-hour admissions line, weighed by how much Google thinks each will lift clicks.
There's no published equation behind those six, so don't trust anyone who shows you one. What Google does say is that a better ad can often win the same spot for less per click. That's the lever a nursing home can pull today without raising a bid: make the ad and the page answer the search.
In Reviews, Rehab Families Talk About Therapy. Long-Term Families Talk About the Staff.
The rehab search and the long-term search come from different people with different worries, and you can see it in how they write.
We read and coded hundreds of Google reviews of nursing homes in our example market, Pittsburgh: 163 written about short-term rehab stays and 69 about long-term care. The words barely overlap.
Rehab families write about therapy, walking again and getting home. "They build up my strength and stability so that I could go home safely," one patient wrote about Greenery Center for Rehab And Nursing. Long-term families write about the people who know their mother, whether anyone calls them back, and whether the place feels like a home. "The staff treat residents like family, not like a checklist," one wrote about Ivy Park Post Acute.
Google has a name for how well your ad matches what the searcher meant: ad relevance. It's one of the three grades inside Quality Score, and it's the easiest one to move, because it's decided almost entirely by how you organize the account.
The fix is to split the account by type of stay, with small, tight ad groups of five or six keywords each:
- A rehab ad group for searches like "short term rehab near me" and "skilled nursing rehab," with ads that talk about therapy and going home. (Chapter 5 covers why the word "rehab" needs careful handling in your keywords.)
- A long-term care ad group for searches like "nursing homes near me" and "long term care facility near me," with ads that talk about the staff, the building and daily life.
Two ad groups only stay two if each one keeps the other's searches out. Once broad match arrives later in the rollout, a long-term ad group will start catching rehab searches and the reverse. Add the rehab words ("rehab," "short term," "after surgery") as negative keywords in the long-term group, and the long-term words ("long term," "memory care," "medicaid") as negatives in the rehab group, so each search reaches the ad written for it. In an exact-match launch this matters less; it matters a lot later.
Other kinds of stays follow the same rule. If your building runs a secured memory care unit, offers respite stays or provides hospice care on site, each one earns its own ad group only when it has its own page to land on. In our example market, hospice or end-of-life care showed up on 6 of the 12 sites and respite in the nursing setting on 3. A service mentioned in one line of a combined page isn't ready for its own ads yet.
A single ad that promises "Rehab, Long-Term Care, Respite and Hospice" matches everyone a little and no one well. Two ads, each written in one family's words, match their own searches closely.
Only Four of Twelve Nursing Home Websites Give Rehab and Long-Term Families Different Pages
The ad is half the match. The page it lands on is the other half, and it's where most nursing homes fall short.
Back in Pittsburgh, our example market, we opened the home page of each of the twelve nursing homes and campuses buying Search ads and followed its links to the care pages. Four give rehab and long-term care separate pages. Four put both on a single "skilled nursing" page. Two link only to a rehab page, and two link to neither from the home page. Your own market will be different, but a combined page is common enough that it's worth checking yours today.
Landing page experience, the third Quality Score grade, asks one thing of the page: does it give this family what the ad just promised them? A rehab page should answer the rehab family's questions first: what therapy looks like and how often, how long a typical stay runs, how discharge planning works, and how fast you can admit. A long-term care page should answer different ones: what a day looks like, who the staff are, how you keep families informed, how visiting works and which payers you accept.
A quick way to test a page is to read only what shows on a phone before scrolling. On a rehab page, the family should see the word rehab or recovery, something about therapy, and a phone number that reaches admissions. On a long-term page, they should see the word home or residents, a line about daily life, and the same fast way to call. If the first screen is a welcome message from the CEO, the page is answering a question nobody asked.
Families notice when the two get blended in the building itself, not just on the website. A handful of rehab patients in our review sample complained about being roomed with long-term residents. "The two types of patient should not be mixed," one knee replacement patient wrote. A website that blurs the two sends the same signal before the family ever visits.
One more thing about the page: most of these families are on a phone, often in a hospital hallway. Paste each page's address into PageSpeed Insights, Google's free speed checker, and fix whatever keeps the admissions number from appearing quickly. Speed won't rescue a page that answers the wrong question, but a slow page can bury a good one.
Quality Score Is a Diagnostic, Not a Price Tag
Inside your account, each keyword carries a number from 1 to 10 called Quality Score. Behind that number sit three grades, and Google marks each one with a simple label, from above average down to below average:
- Expected click-through rate. How likely is a family typing that phrase to tap your ad?
- Ad relevance. Does the ad speak to what that family meant, rehab or long-term care?
- Landing page experience. Once they tap, does the page give them what they came for?
The number itself doesn't go into the auction. Google calls it a diagnostic, and that's the right way to use it: it tells you which of the three is letting a keyword down.
One common myth to drop: bidding higher does not raise your expected click-through rate. Google says that grade is measured with the influence of ad position and assets taken out. You can't buy your way to a better one. You earn it by writing an ad the searcher actually wants to click.
Give it time before you read it. A brand-new keyword shows a dash instead of a number until it has collected enough searches to grade, and a small nursing home's long-tail keywords can take weeks to get there. Judge the keywords that get real traffic first.
In practice, the grades point straight at the problem. If your long-term keywords show below-average ad relevance, the ad is probably still talking about therapy. If your rehab keywords show below-average landing page experience, they're probably landing on the combined page. The split this chapter describes is usually the fix for both.
Next: Build the Keyword List Without Buying Someone Else's Rehab
Two ad groups need two keyword lists, and the rehab list has a trap in it. Chapter 5 shows how Keyword Planner mixes nursing home rehab with drug and alcohol rehab, and how to keep the expensive half out.
Every chapter, from tracking through the hospital list, Medicare and hiring, is on the guide's home page.
When we set up Google Ads management for a nursing home, the rehab and long-term split is the first structural decision, before a single keyword goes live. If you're doing it yourself, click your own rehab ad and your own long-term ad today and see whether they land on two different pages.
