Case studies / Healthcare
Franchise PPC · Home care · Since 2016Ten years of negative keywords. $750 a month.
Our other home care accounts produce four or five caregiver enquiries for every family. This one doesn't. It runs on the smallest budget in our portfolio. The difference isn't money. It's a decade of search term data on the same account.
A franchise home care account running since 2016.
ComForCare provides in-home care for seniors and people with disabilities or chronic conditions. This engagement covers multiple territories across New York City's five boroughs plus Nassau, Suffolk and Westchester counties.
Eight territories, one franchise brand, and a monthly media budget of $750, the smallest in our portfolio, running longer than any other account we manage.
The caregiver problem isn't inevitable. It's a data problem.
Across two other home care accounts we've published, four to five out of every six enquiries were caregivers looking for work rather than families looking for care. It reads like a structural feature of the category. This account suggests it's actually a function of how much the campaign has learned, and learning takes years, not budget.
Bigger budget, worse mix.
Our Ideal Home Health account ran at three times this budget for a year and produced roughly four caregivers for every family enquiry. Today's Home Care ran at 5.3 to one. Both were properly structured. Neither had a decade of exclusions behind it.
- Monthly budget $1,500+
- Account age Under 12 months
- Negative keyword depth Built from scratch
- Caregiver share High
Smaller budget, cleaner traffic.
A decade of search terms reviewed, excluded and refined on the same account, plus a deliberate focus on private-pay language rather than general home care terms. Caregivers still come through. Materially fewer of them.
- Monthly budget $750
- Account age 10 years
- Negative keyword depth A decade deep
- Caregiver share Materially lower
Eight territories, one franchise brand, $750 a month.
ComForCare provides in-home care for seniors and people with disabilities or chronic conditions. This engagement covers multiple territories across New York City's five boroughs plus Nassau, Suffolk and Westchester counties.
Franchise paid search has constraints that independent agencies don't, and four of them shaped this account.
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Franchise brand terms are contested from inside
A national franchise brand is searched by name, and the traffic is valuable, but in a system with many independently owned locations, bidding on the brand name has to be coordinated. Uncoordinated, franchisees raise each other's costs to buy traffic the brand had already earned.
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Territory lines don't match how people search
Someone in an overlapping part of Queens or western Nassau searches once. The territory boundary is a contractual fact, not a search behaviour, so geographic targeting has to be built deliberately rather than drawn on a map.
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$750 a month across eight territories is nothing
That's roughly $94 per territory per month in one of the most expensive media markets in the country. Nothing about this account works unless the targeting is extremely precise.
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The category attracts the workforce, not just the customer
Home care and caregiver-job searches share most of their vocabulary. At this budget, every click spent on someone looking for work is a click not spent on a family.
Four decisions, then ten years of maintenance.
The setup took weeks. The thing that makes the account work took a decade.
Hold the brand terms deliberately
Brand campaigns run for the territories under management, structured so the franchise name captures searchers who already know ComForCare and are looking for their local provider. Brand traffic is the cheapest in any account. In a franchise system the question isn't whether to bid on it but who does, for which geography.
The brand name working for the right territories.
Target private-pay language, not general home care
Campaigns built around private home care terminology rather than broad home care or Medicaid-adjacent language. Private-pay families search differently from Medicaid-eligible families, and, importantly, differently from caregivers looking for work. The vocabulary itself does much of the filtering.
Traffic skewed toward families who buy rather than families who qualify.
Geography built around service, not territory maps
Targeting set to the areas each territory can genuinely staff and serve, with overlaps handled deliberately rather than left to compete. At $750 a month across eight territories, two campaigns bidding on the same suburb is budget spent twice on one enquiry.
Eight territories covered without internal competition.
Review search terms. Every month. For ten years.
The unglamorous part, and the whole reason the account performs. Every month's search terms reviewed, irrelevant queries excluded, and the negative list extended. Job-seeking language, training and certification queries, agency-comparison research, and the long tail of terms that look relevant and never convert.
A decade of accumulated exclusions no new account can replicate.
A negative keyword list is an asset that compounds.
Most of what an agency builds can be rebuilt. Campaign structure, ad copy, bidding, landing pages: a competent team reproduces all of it in a few weeks.
A negative keyword list built from ten years of real search terms on one account in one market cannot be reproduced at any speed. It exists because somebody looked at what people actually typed, every month, for a decade, and removed what didn't work.
It's why this account runs on $750 a month and still performs, while newer home care accounts need several times the budget to produce a worse mix of enquiries. The budget isn't the advantage. The exclusions are.
What that means if you're switching agencies
When an account moves to a new agency and performance drops for six months, this is usually why. The new team rebuilds the structure quickly and then spends half a year rediscovering exclusions the previous account already knew.
If you change agencies, export your search terms report and your negative keyword lists first. They're yours, they're the most valuable thing in the account, and most handovers lose them.
And what we're not claiming
We're not publishing lead volume or cost per lead for this account, because we don't have figures we're confident enough to state. The caregiver comparison is directional, this account produces materially fewer than our other home care campaigns, but we haven't classified every call here the way we did on Today's Home Care, so no ratio is claimed.
What we can state plainly: a client on a $750 monthly budget has kept the same agency since 2016.
Four things for franchises and long-running accounts.
Coordinate brand bidding across territories
In a franchise, uncoordinated brand campaigns mean locations bidding against each other for traffic the brand already earned. Decide who bids where before anyone launches.
Vocabulary filters better than targeting
Private-pay families, Medicaid families and job seekers use different words. Choosing which vocabulary to target does more filtering than any audience setting.
Search term review is the whole job
It's unglamorous, it never finishes, and it's the difference between an account that improves for a decade and one that plateaus in month three.
Take your negative lists with you
If you change agencies, export the search terms report and negative keyword lists first. They are the most valuable thing in the account and the easiest to lose.
What went into it.
Six of our services, running since 2016.
The other home care accounts.
How long is your negative keyword list?
It's a strange question and it's the fastest way to tell whether an account has been managed or just maintained. Give us read-only access and we'll show you what your search terms report contains that your negatives don't, and, for franchises, whether your locations are bidding against each other. Findings are yours to keep either way.
Read-only access · No obligation · You keep your accounts