Publication Date: January 12th, 2026
Publication Type: Policy Brief
Topic(s): Aging, Chronic Diseases and Conditions, Disabilities, Healthcare Access, Home Health
Author(s): Henning-Smith C, Bailey D, Lahr M, and Rydberg K
The U.S. population is aging, especially in rural areas, and most older adults would prefer to age at home rather than move to a new home, community, or institutional setting. However, age is sometimes accompanied by changes in mobility and physical and mental functioning, which can make it challenging for older adults to leave their homes and engage in their communities. In some cases, such functional limitations cause an older adult to be classified as “homebound”; that is, not able to leave their home without help, or at all. While many older adults with such high levels of functional limitations receive care in institutional settings (e.g., nursing homes and assisted living facilities), not all do. Without access to adequate institutional or home and community-based care, older adults may become homebound, a state that is associated with poorer health outcomes, higher rates of hospitalization and emergency department use, and greater risk of social isolation, functional decline, and mortality.
Overall, however, the prevalence of and risk factors for being homebound remain understudied, especially among rural older adults. Rural-urban differences in the health status and socio-demographic characteristics of older adults, combined with rural-urban differences in informal caregiving and access to institutional-level care, require a more nuanced understanding of rural-specific risks associated with being homebound. In particular, rural older adults are older, are in poorer health, have higher rates of disability, and have fewer economic resources than urban older adults. Altogether, this may put rural older adults at higher risk of being homebound than their urban counterparts, but more research is needed to confirm this and to identify which rural older adults are at greatest risk.