Sometime in the first few months of a nursing home account, Google will start recommending Performance Max. It'll show up as a suggestion in the account, in an email, maybe in a call from a Google rep. The pitch is simple: one campaign, every Google channel, and AI that finds the families for you.
For a nursing home, Performance Max starts with two handicaps nobody mentions in that pitch. It can't learn from the audiences it usually depends on, because Google's own health rules keep them out. And it chooses which page of your site to send people to, on a site that was never built only for families. So it has to wait until your Search campaigns have given it something better to learn from, and it needs a fence around your website when it starts.
A Nursing Home's Admissions Records Can't Train Performance Max
Performance Max is a single campaign that buys ad space across Google Search, YouTube, Display, Discover, Gmail and Maps at once. In most industries, the advertiser gives it a head start: a customer list to find more people like, and a list of recent website visitors to show ads to again.
A nursing home can't hand over either one. Google's rules for health-related ads divide audiences into two kinds. Audiences Google builds itself, like people it judges to be in the market for senior care, are allowed. Audiences the advertiser supplies are not: no customer lists, no lists built from your own website data, no lookalike audiences built from either. Google's health rules cover chronic conditions that need long-term care and ads aimed at caregivers, which by our reading is exactly what a nursing home ad is. It's the same reason Chapter 2 took remarketing off the table.
That leaves Performance Max with less to go on than it gets almost anywhere else. What it can learn from is your conversions, meaning the calls, tour requests and admissions Chapter 1 set up to report back. That's why the timing in this chapter matters more than the settings. A Performance Max campaign with thin conversion data and no audience lists is guessing across six channels at once.
Performance Max Chooses Where Families Land. Every Nursing Home Site Has Pages They Shouldn't See.
A nursing home website serves several audiences at once. Families looking for care are one. Job seekers, donors, hospice families and residents' relatives looking up a memorial service are others. Of the 12 nursing home websites we studied in our example market, Pittsburgh, every one linked to a hiring page, for example. None of that is a problem until a campaign starts choosing pages on its own.
Performance Max has a setting called Final URL expansion that lets it replace the page you chose with whatever page on your site it judges more relevant to the search. It comes switched on. Google's help page admits the swap can misfire, landing a click somewhere nobody planned, and puts the burden of fencing it on you.
On a nursing home site, the pages that go on the exclusion list are predictable:
- Careers and job listings. A daughter searching for a rehab bed shouldn't land on a CNA opening.
- Hospice and end-of-life pages, unless hospice is what the campaign is selling.
- Donate, giving and memorial pages.
- Any level of care you don't provide. If the campus site describes assisted living you don't run from this building, keep the ads off it.
One quirk: the page you enter as the campaign's own landing page can't be excluded, so make sure it's the right one. The other option is to switch Final URL expansion off entirely, and for a first Performance Max campaign that's a reasonable choice. Turn off text customization while you're there. When it's on, Google can write new headlines and pull images from those same pages.
Then keep checking. Once the campaign is running, open the landing pages report every couple of weeks and read down the list of pages that actually received clicks. A page you didn't expect is a page to add to the exclusions, and on a nursing home site there's usually one more than you thought.
Performance Max Waits Until Search Has Proven What an Admission Inquiry Looks Like
Performance Max comes third, after the exact-match Isolation campaign and the broad-match Exploration campaign from Chapter 6. The gate is volume, not the calendar. It opens once the two Search campaigns together are producing 30 or more quality conversions a month and holding there. For most nursing homes that's around six or seven months in. A building with a bigger budget and more searches in its market can get there sooner.
When it opens, set it up plainly:
- Goal: conversions. Not conversion value, because a nursing home can't report a reliable dollar value for an inquiry on day one.
- Bidding: no target cost per conversion at launch. Give it several weeks of unrestricted learning, and only then set a target, drawn from its own track record.
- Location: Presence, the same as the Search campaigns (Chapter 9).
- New customer settings: skip them. Every family calling a nursing home is new anyway.
One more reason to fund Search first. When a family's search matches one of your exact-match Search keywords word for word, Google hands that search to the Search campaign first. The exception is money: a Search campaign that has spent its daily budget steps aside, and Performance Max can take the search it would have won. Keep Isolation funded, and the searches you've proven stay in the campaign you control.
Brand Exclusions Stop Performance Max From Claiming Families Who Already Typed Your Name
Nothing stops Performance Max, out of the box, from buying the searches for your own building's name. Those families already know you. They were going to find you through the brand campaign from Chapter 2, or through the free listing right under the ad. When Performance Max takes those searches, its results look great and teach you nothing.
Google lets you add brand exclusions to Performance Max, so the campaign won't serve on searches tied to the brands you list. Add your facility's name, your campus name, and the name of the parent organization if families search it. That forces Performance Max to earn its conversions from families who didn't already know you, which is the only reason to run it.
Search Themes and Custom Segments Point It at Families, With a Health Caveat
Since it can't start from your lists, give Performance Max direction another way.
Search themes are short phrases that tell Google what kinds of searches you want. In Google's pecking order they rank alongside phrase and broad keywords. Use the searches that have proven themselves in Isolation and Exploration: "short term rehab," "skilled nursing facility," "nursing homes that accept medicare." If Google flags a health-related theme, like a "near me" phrase tied to a condition, drop it rather than fight it.
Custom segments describe the kind of person you want in terms Google understands: people who've searched certain phrases, or people who visit certain websites. Build them before you build the campaign. A segment of people searching the long-tail phrases from Chapter 6, and one of people browsing competitor nursing home websites, give Performance Max a sketch of a family looking for care. It's profiling by behavior, not a list of your own residents, which is why it's allowed. Google treats these as hints, and says Performance Max may still show ads to people outside them if it thinks they'll convert.
Now the caveat. Google's health rules include a footnote saying campaigns that use custom segments with sensitive ads or landing pages won't be eligible to serve, apart from some Display placements. Google doesn't say whether a custom segment used as a Performance Max hint counts. So check the campaign's status a few days after launch. If it shows as limited or not serving, remove the custom segment and let the conversions do the steering.
Google's Generated Images Can't Show Your Therapy Gym. Your Own Photos Can.
Six channels means six kinds of ad, and each one needs pictures, footage and words to fill it. If you don't supply enough, Google will make its own from your site and its AI tools. For a nursing home, that's how a family ends up judging your building by images you didn't pick.
- Photos: real ones, of your building. The therapy gym, a resident room, the dining room, the entrance, the garden. A family comparing buildings can tell a real room from a stock photo, and they're looking for the real one.
- Video: supply at least one short, real video. If you don't, Google can generate video from your images, and a slideshow of stills won't show a family the building the way a real walk-through does.
- Headlines: move over the best performers from your Search ads (Chapter 8), the ones built from your reviews.
- AI asset generation: skip it at launch. It's a shortcut to exactly the generic copy Chapter 8 warned against.
One legal line. A photo or story of a real resident is protected health information for a nursing home. In 2025, federal regulators settled with Cadia Healthcare Facilities, a group of Delaware rehab and skilled nursing centers, for $182,000 after a complaint about a patient's name, photo and recovery story posted as a "success story" on the company's website. If you want a resident in an ad, get written HIPAA authorization first.
Next: Demand Gen, the Campaign That Needs a Face
Chapter 11 covers Demand Gen, Google's campaign for YouTube and the feeds, and what a nursing home can realistically do there under the same health rules.
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, Performance Max opens only after Search has done the heavy lifting for months, and the pages meant for other audiences are fenced off on day one. If you already run Performance Max, open its landing page report today and look for any page you didn't choose.
