Two families click the same ad on the same afternoon, and Google charges you the same for each click. One is a daughter whose father needs three weeks of therapy after a hip replacement. The other is a son whose mother can't live alone anymore and has almost no savings left. The first admission will be paid mostly by Medicare. The second will be paid by Medicaid, for as long as she lives there.
Those two clicks cost the same. They are not worth the same. A nursing home that sets its Google Ads budget without knowing the difference is guessing, and guessing is an expensive way to fill beds.
A Medicare Rehab Stay Brings In About $20,700. A Medicaid Month Brings In About $6,100.
Start with what each payer actually sends a nursing home, using national figures.
Medicare short-term rehab. In 2024, fee-for-service Medicare and its beneficiaries spent about $31 billion on 1.5 million covered skilled nursing stays, according to MedPAC, Medicare's independent payment advisory commission. That works out to about $20,700 per stay (our math), and the average covered stay ran 30.7 days, so roughly $673 a day. That figure includes what patients pay themselves: Medicare covers the first 20 days in full, and from day 21 the patient or a supplemental plan owes a daily coinsurance, $217 a day in 2026. Medicare Advantage plans pay on their own terms, and we found no national figure for them.
Medicaid long-term care. The latest national figure comes from MACPAC, the federal commission that studies Medicaid payment: an average base payment of $200.39 a day in 2019. That's about $6,100 a month. It varies a lot by state, from 62% to 182% of the national average after adjusting for wages and resident needs, so look up your own state's rate before you use this one. The same report put the average cost of caring for a Medicaid resident at $238.94 a day, above the payment.
Private pay. CareScout's 2025 survey puts the national median at $315 a day for a semi-private room, or $9,581 a month, and $355 a day for a private room.
Now weigh those against who actually lives in the building. Medicaid is the main payer for 63% of nursing home residents, Medicare for 14%, and everyone else, mostly private pay, 23% (KFF, 2025).
One more thing blurs the line between the two families: some rehab stays don't end at home. MedPAC reports that the median nursing home discharged a risk-adjusted 51.3% of its Medicare patients back to the community in 2023 and 2024. The rest went back to the hospital, moved elsewhere, died, or stayed on as long-term residents, and Medicare doesn't break out how many did each. Families describe that last path in plain words: "My mom has been here multiple times and now on a more permanent basis," one daughter wrote about Peters Township Post Acute. A rehab admission can be the first chapter of a long-term one, which is one more reason not to value it by the Medicare stay alone.
Notice what's missing: a lifetime value. Other industries multiply a monthly payment by a customer's average tenure and get a big, satisfying number. For long-term nursing home residents, we couldn't find a trustworthy national figure for how long a stay lasts, so we won't make one up. Use your own census records. If your average long-term resident stays 18 months, a Medicaid admission is worth about 18 of those months to you. If it's eight, it's eight.
Revenue Isn't Margin. Medicare Days Carry It, and Everything Else Runs Near Zero.
Revenue tells you what comes in. It doesn't tell you what's left, and for nursing homes that gap is the whole story.
MedPAC reports that freestanding nursing homes earned a 24% margin on fee-for-service Medicare patients in 2024. On everything else combined, including Medicaid, private pay and Medicare Advantage, the average margin was negative 2.3%. Add it all together and the typical facility's total margin was 2.1%.
That doesn't mean a nursing home should chase only Medicare rehab and ignore long-term care. Long-term residents keep beds filled every night of the year, and a building with empty beds loses money on all of them. It means the budget math for the two lines is different, and pretending otherwise leaves money on the table in one of them.
A $6.30 Click Becomes a $458 Admission Only If One Inquiry in Four Moves In
Here's the chain every Google Ads budget sits on, with numbers from this industry.
Cost per click. LocaliQ, a digital advertising company, publishes Google search benchmarks from more than 3,500 healthcare campaigns. Its category for assisted living, elder and home care services averaged $6.30 a click in its January 2026 report. That category lumps nursing homes in with assisted living and home care, so treat it as a starting point. For a local check, Keyword Planner quotes $2.09 to $10.11 per click for the top spots on the family phrase in Pittsburgh, our example market.
Conversion rate. The same LocaliQ category converted 5.51% of clicks into leads. At $6.30 a click, that's about $114 per inquiry (our math; the averaged figure LocaliQ reports is $74.44).
Inquiry to admission. This is the number nobody publishes for nursing homes, and the one that decides everything. So here are two scenarios, and you should replace them with your own:
- If one inquiry in four becomes an admission, each admission costs about $458 in ad spend.
- If one in eight does, each admission costs about $916.
Value. Now set that cost against the payer. Even at one in eight, $916 is a small share of a $20,700 Medicare stay, and a Medicaid admission pays it back in the first month of revenue. That's why "is Google Ads too expensive for a nursing home?" is usually the wrong question. The right one is how many admissions you want, and what you'll pay for each.
Turning that into a budget is simple multiplication. Say you want five more admissions a month and your inquiries admit at one in four. Five times $458 is about $2,290 a month, or about $75 a day on average. Don't panic at a $140 Tuesday. Google is allowed to double the daily average when searches spike, then evens it out over the month.
Chapter 1's tracking is what replaces these scenarios with your real numbers. After a month or two of counted calls and tours, with admissions sent back to Google by click ID, you'll know your conversion rate and your inquiry-to-admission rate. That's when the budget stops being an estimate.
The Nursing Home That Answers the Admissions Phone First Gets the Bed
Of all the links in that chain, the inquiry-to-admission rate is the one a nursing home controls most, and speed moves it more than anything.
For rehab, the competition is literal. WellSky, a software company that handles hospital discharge referrals, reports that hospitals sent each patient's referral to an average of 6.6 facilities in 2024, and 32% of referrals were accepted. Your admissions team is racing half a dozen other buildings for the same patient, often on a Friday afternoon. Of the twelve nursing home websites we looked at in our example market, one advertised a 24/7 admissions line.
Families notice who moved fast. In the Google reviews we read, rehab families singled out the admissions person again and again: "The admissions coordinator was able to admit me right away after my 1st surgery," one patient wrote about The Rehabilitation and Nursing Center at Greater Pittsburgh. Another family praised the staffer who "pulled together such a clutch turnaround" before the hospital discharge.
Speed on the phone changes the cost per admission more than any bid change will. If a faster callback moves you from one in eight to one in four, every admission costs half as much, and you didn't touch the ads.
Reviews and word of mouth work the same way. A family who picks you because a friend's mother had a good stay, or because your Google rating is strong, still counts in your ad math if they clicked your ad on the way to calling. The ad gets the credit for an admission your reputation mostly earned. That's fine, as long as you remember it when you're deciding what a click is worth.
One "Our Services" Page Hides Which Payer Your Ad Money Found
If rehab and long-term care are worth different amounts, they need to be measured separately, and that starts with where the ad sends people.
A rehab search should land on a page about short-term rehab: therapy, going home, the Medicare days. A long-term search should land on a page about living there. When both kinds of searches land on one "our services" page, you can't tell which line produced which inquiry, and you can't give either line the budget it earns. Chapter 4 builds those pages and the ad groups that point to them, because Google's quality ratings reward the same separation.
Once each line has its own page and its own conversions, the budget can follow the value. Later in the rollout, when broad match comes in, each line can get its own target cost per admission, set from the real numbers above rather than one blended average.
Next: Make Google See the Difference Too
Chapter 4 shows why Google rewards a rehab ad that lands on a rehab page, and why that separation is worth more than any bid you'll ever raise.
Every chapter, from tracking through the hospital list and hiring, is on the guide's home page.
Before we set a single bid for a nursing home in Google Ads management, we build this payer math with the administrator, because the right budget for a rehab unit and for a long-term wing is never the same number. If you're doing it yourself, pull last quarter's admissions, count how many came from inquiries, and put your real ratio in place of our one in four.
