Everything in this guide so far has kept two things apart on purpose. Chapter 4 split the account into a rehab side and a long-term side, with their own ad groups, their own pages and their own promises. Chapter 8 wrote different ads for each. That separation is the most important structural decision in a nursing home account.
AI Max is the one Google feature that reads your whole website at once. Turn it on and Google can write new ad text from anything on your domain and send a searcher to whatever page it judges most relevant. On most business websites that's a manageable risk. On a nursing home website, one sentence about Medicare can be true on one side of the building and misleading on the other.
Medicare Covers Up to 100 Days of Rehab and Generally Not a Long-Term Stay
Here's the split every admissions director knows and plenty of families don't. Medicare Part A covers skilled nursing and rehab after a qualifying hospital stay: up to 100 days in each benefit period, with Medicare paying in full for the first 20 days and the patient owing a daily coinsurance from day 21 on. The qualifying stay has its own trap, too. Time spent in the hospital under observation doesn't count toward the three inpatient days. Some Medicare Advantage plans waive that three-day rule, and some add their own approval steps. Coverage for any one patient depends on details an ad can't know.
Long-term care is different. Medicare's own guide to choosing a nursing home says it plainly: Medicare "generally doesn't cover long-term nursing home stays." Most long-term residents pay through Medicaid or their own savings.
Nursing home websites talk about Medicare because families ask about it. Of the 12 local sites we checked in our example market, Pittsburgh, 5 mentioned Medicare on the pages we read. One described its long-term care as "Medicare-certified." One put "Medicare and Medicaid approved" in the footer of every page. One said it accepts Medicare along with a list of private plans. One explained that Medicare pays for skilled nursing only "under very specific circumstances, for a very limited period of time."
All of those statements are true. The problem is where a line like "Medicare Accepted" ends up. Chapter 8 recommended it for rehab ads, where it answers the family's first question. In front of a family searching "long term care facility near me," the same words suggest Medicare will pay for their mother's permanent stay. It usually won't, and the family finds that out after the admission.
AI Max Writes From Your Whole Site and Can Swap the Landing Page
AI Max isn't a separate campaign. It's a bundle of switches inside a Search campaign, and every new Search campaign now starts with the bundle on. Three of its parts matter here:
- Search term matching lets the campaign show on searches beyond your keywords, much like broad match.
- Text customization lets Google write new headlines and descriptions based on your landing page, your site and your existing ads.
- Final URL expansion lets Google send a searcher to a different page on your site than the one you chose.
There's a side effect Google spells out: once the page gets swapped, any headline you pinned drops out, on the theory that it was written for the old page. And the features are linked: Final URL expansion only works with text customization on, so turning off text customization turns off both. And Google is clear that none of this performs without bidding that optimizes for conversions.
Put those together on a nursing home site. A long-term care search matches broadly. Text customization, reading a site that mentions Medicare, writes a headline about it. Final URL expansion decides the rehab page is a better fit. None of that requires a mistake by anyone. It's what the features are built to do, applied to a website that serves two very different families.
AI Max Comes Last, After Exact and Broad Match Have Carried the Account
Our rollout saves AI Max for last. It never goes into Isolation, the exact-match campaign from Chapter 6. The reason is simple. Search term matching behaves like broad match with more automation layered on, and an exact-match campaign exists precisely to keep that kind of reach out.
By the time AI Max makes sense, the account should already have what it needs to use it well: Isolation and Exploration running, Performance Max past its learning period, conversions that include real admissions imported by click ID (Chapter 1), and a long record of search terms that shows what families actually type. Without that history, Smart Bidding has nothing to steer the new reach with, and AI Max is guessing on your behalf.
Since new Search campaigns start with AI Max on, check the setting on every campaign you build and switch it off until it's time (Chapter 9).
Text Guidelines Can Keep "Medicare" Out of the Long-Term Campaign
When AI Max does get its turn, Google gives you a way to fence what it writes. Text guidelines, still labeled a beta, work at the campaign level and apply only to text Google generates, never to the ads you wrote yourself. Each campaign gets two lists.
- Term exclusions: up to 25 words or phrases Google-written text must never use. They aren't case sensitive.
- Messaging restrictions: up to 40 plain-English rules about what the text can't say.
This is where the two-sided account pays off again, with one adjustment. Chapter 4 split rehab and long-term care into separate ad groups, but text guidelines, like URL exclusions, are set per campaign. So before AI Max gets its test, give each side its own campaign. Then each can carry its own guidelines, and a rule written for long-term families never has to bend around a rehab ad.
For the long-term campaign, exclude "covered by Medicare" and "Medicare covers," along with "no cost" and "free care," and add a restriction against any claim about insurance or Medicare coverage. For the rehab campaign the list looks different: keep Medicare available, but restrict anything that promises a specific number of covered days, since coverage depends on the patient meeting Medicare's conditions.
Two limits to know. Term exclusions are language-specific, so an English exclusion won't stop a Spanish ad from saying the same thing. And Google says a dollar sign on the term list won't stop generated text with prices. That takes its own restriction: "Don't generate assets with prices." Any pricing a nursing home shows should come from the admissions office, not an algorithm.
URL Exclusions Keep Each Campaign on Its Own Side of the Building
Text guidelines police the words. For the page, the tool is a list of addresses the campaign may never send a family to. Like text guidelines, they're set per campaign, which is another reason for the split above. On a nursing home site:
- The rehab campaign excludes the long-term care pages, so a family searching after a hip replacement doesn't land on a page about permanent residence.
- The long-term campaign excludes the short-term rehab pages, so a family planning a permanent move doesn't land on a page about Medicare-covered therapy.
- Both exclude the pages written for other audiences, the same list from Chapter 10: hiring, hospice, donations and memorials.
If maintaining that list feels like more work than it's worth, there's a simpler option. Leave text customization off, which turns Final URL expansion off with it, and test search term matching alone. You give up Google-written text and page swapping, and keep the one AI Max feature that can find new searches.
An AI Max Test Is Only as Safe as the Person Reading Its Headlines
Run AI Max as an experiment rather than switching it on across the account. Google offers built-in AI Max experiments, which compare the campaign as it is against the same campaign with AI Max, so the result rests on conversions rather than impressions. Start with one campaign, ideally the rehab side, where the searches are more specific and the Medicare line is at least true.
Then read what it writes. Google tells advertisers to review the Google-optimized text assets in the campaign to confirm the guidelines are working, and that's where the generated lines appear. Check it weekly for the first month and look for three things: any claim about coverage or cost, any line that belongs to the other side of the building, and any searcher who landed on a page you didn't choose. The first time a long-term ad promises Medicare coverage, pause the experiment, tighten the guidelines and start again.
AI Max can find searches a nursing home would never have thought to buy. It can also write the one sentence a family will quote back to your admissions director in an angry phone call. The difference is whether someone at the building reads the ads before the families do.
Next: The Hospital List and the People Who Hand It Out
Chapter 14 turns to the hospital list, the discharge planners who hand it to families, and what Google Ads can and can't do to get a nursing home onto it.
Every chapter, from tracking through the hospital list and hiring, is on the guide's home page.
In the nursing home accounts under our Google Ads management, the long-term campaign's banned-phrase list exists before AI Max gets a single test impression. If you're running your own, open your Search campaigns today and check whether AI Max is already on.
