Most senior care owners assume the whole category is expensive. Assisted living operators talk about $20 clicks, memory care advertisers talk about more, and a nursing home administrator who hears those numbers tends to budget timidly or skip Google Ads entirely.
The numbers say the opposite. The search a family types most often when a parent needs a nursing home is one of the cheapest high-intent clicks in all of senior care. That changes the goal. A nursing home shouldn't be trying to squeeze onto the page at the lowest price it can get away with. It should be buying the top of the page on the handful of searches that bring families, and proving every week that it's still there.
"Nursing Homes Near Me" Tops Out at $9 While Assisted Living Runs Past $18
Keyword Planner estimates what advertisers pay for an ad at the top of the page, as a low and a high. Here are the national ranges for the searches families type when they're looking for care:
"Nursing homes near me" runs $2.33 to $9.03, on 201,000 searches a month. "Assisted living near me" runs $3.79 to $18.40 on 165,000. At the top of each range, the nursing home search costs less than half as much. Our example market, Pittsburgh, shows the same gap: $2.09 to $10.11 for "nursing homes near me," against $5.70 to $23.00 for assisted living.
Two cautions. These are estimates based on broad match, so treat any figure as a range of about 30% either way, and your market will land somewhere different. And the low end of each range is closer than the high end. The gap is widest where it matters most, at the top of the page.
There's a plain reason for the difference. An assisted living resident usually pays privately, month after month, and operators bid to match. Most long-term nursing home residents are on Medicaid, which pays a set daily rate, and the advertisers bidding for them bid like it. Chapter 3 worked out what an admission is worth by payer. The point here is simpler: on the search that matters most, a nursing home is shopping in the cheap aisle.
Six of Ten Local Operators With a Nursing Floor Advertised Everything Else
Price isn't the only thing working in a nursing home's favor. The competition is thinner than it looks.
Google keeps a public library of every advertiser's ads, the Ads Transparency Center. We searched it for each example-market operator with a nursing home, keeping the ones with Search ads live since the end of June. Ten qualified. Here's what their readable ads were selling:
Four ran ads for nursing or rehab care. The other six had a nursing floor and advertised something else. Two continuing care campuses advertised only their independent or assisted living apartments. One advertised senior living and dementia care. Two regional chains ran ads naming their communities in other states. One ran nothing but nurse hiring ads.
Whatever each operator's reasons, the result is the same. Their budgets go to apartments, other markets and hiring, which leaves the nursing searches in that market with fewer serious bidders than the search volume suggests.
One limit on this: the Transparency Center doesn't show where an ad was aimed, and some ads can't be read, so an operator could be running a nursing ad we didn't see. Run the same check on your own market before you set a budget. It takes an afternoon, and it tells you whether the top spot on "nursing homes near me" is contested or waiting for someone to take it.
With No Conversion History, Smart Bidding Guesses. Manual Bids Buy the Spot.
Google's automated bidding learns from conversions. A brand-new nursing home account has none, so handing it the bids on day one means letting it guess with your money.
So Isolation, the exact-match campaign from Chapter 6, starts on manual bids. You set a maximum cost per click for each ad group: one bid for the rehab group, another for long-term care. You decide what a click from a family typing "short term rehab near me" is worth, and you raise or lower it based on what you see.
Manual bidding sounds riskier than it is, because the maximum isn't what you pay. Google says the actual cost per click is often less than your maximum, because you only pay what's needed to clear its quality thresholds and beat the ad ranked just below yours. A $12 maximum on "nursing homes near me" might cost $6 or $7 a click in practice.
Bid firmly in the first weeks. A new account has no Quality Score history, and a cautious bid can leave you off the page entirely, where you learn nothing. As the account builds a record and the scores come in, step the bids down.
Top Impression Share Is the Number That Proves You Own "Nursing Homes Near Me"
Winning a click tells you almost nothing about where you're showing. The columns that do are hidden by default. Add these at the keyword level:
- Search top impression share. The share of eligible showings where your ad landed in the block of ads above the results. On the searches that bring families, aim for 75% to 90%. Much below that and a neighbor's ad is taking your calls.
- Search absolute top impression share. The share where yours sat in the first slot, above every other ad. Only one advertiser gets that spot in each auction, so this number will be lower, and that's fine. Watch it on your two or three most important searches.
- Search lost impression share due to rank. How often you missed a showing because your ad rank was too low. Ad rank combines your bid and your quality, so this number rising means a bid is too low, or an ad and page don't match the search well enough.
- Quality Score. Google's 1-to-10 rating for each keyword. It shows a dash until there's enough data, so give a new keyword a few weeks. Chapter 4 covered why an ad that matches its search earns a better score.
Read those together. Top impression share slipping while lost to rank climbs means a competitor is outbidding you or out-matching you. Top share slipping while lost to rank stays flat usually points to budget. Most nursing homes only need this discipline on a short list: "nursing homes near me," "short term rehab near me," "skilled nursing facilities near me" and your own name.
Auction Insights Shows Which Rivals Push a Search Past What an Admission Is Worth
The auction insights report shows who else showed up in the same auctions as you. Each rival gets a row of six numbers: how often it showed (impression share), how often it showed alongside you (overlap rate), how often you beat it (outranking share), how often it sat above you (position above rate), and how often it reached the top block (top of page rate) or the first slot (absolute top of the page rate). The report stays blank when your impression share is under 10%, so a brand-new or underfunded account may have nothing to read yet.
For a nursing home, two of the six matter most:
- Overlap rate tells you how often a rival's ad showed alongside yours. A hospital system's rehab unit or a large chain that overlaps you on half your auctions is your real competition, whatever the rest of the market is doing.
- Outranking share tells you how often you showed above that rival, or showed when they didn't. If it drops week after week, someone is bidding up your searches.
That's when the decision gets real. Chapter 3 put a value on a rehab admission and a long-term one, then walked the math from a click to what an admission costs. If a rival pushes a search's price past that line, stop matching them. Drop that keyword's bid or pause it, and spend the difference on searches where the top spot still pencils out. A nursing home doesn't need to win every auction. It needs to win the ones that turn into admissions at a cost that makes sense.
What a Family's Call Really Cost in Your First Campaign Caps What Broad Match May Spend
Once the first campaign reaches roughly 30 quality conversions a month, the second one opens: Exploration, broad match with automated bidding (Chapter 6). In Google's menus the bidding is Maximize Conversions with a target cost per action, and that target is the most important number you'll set.
Take it from what Isolation actually paid. If the exact-match campaign spent $2,400 last month and produced 30 real inquiries, the target starts at $80. Not the number you wish it were, and not a number from another industry. A target set too low starves broad match of room to learn. One set too high lets it spend freely on anything.
The catch is the word "real." A 30-second call counts as a conversion, and plenty of those aren't families. Vendors, job seekers and wrong numbers all ring the admissions line. Before you trust Isolation's cost per inquiry, check which calls were families.
Google won't help with recordings here. It keeps call recording off for businesses it identifies as healthcare. So the check comes from your side: the admissions director's call log, matched against the calls from ads, or a call tracking service that signs a Business Associate Agreement and records on your behalf. Pull the calls that weren't families out of the count, recompute the cost per inquiry, and set Exploration's target from that number.
Next: Write the Ad the Family Actually Reads
Chapter 8 moves from the bid to the words: what families judge a nursing home on, and how to get it into an ad before a competitor does.
Every chapter, from tracking through the hospital list and hiring, is on the guide's home page.
On the nursing home accounts we run in Google Ads management, top impression share on "nursing homes near me" is the first number we check every week. If you're running your own, add that column today and see how often you're actually at the top.
