Rural-Urban Differences in Homebound Status by Health and Functional Limitations
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.
Key Findings:
- Rural and urban Medicare beneficiaries age 65 and older reported similar rates of being homebound (5.7% and 6.1%).
- Rural older adults in very good health (on a scale from poor to excellent) were less likely than their urban counterparts to be homebound (0.4% vs. 2.1%). However, rural older adults in poor health were more likely to be homebound than urban older adults in poor health, although the difference was not statistically significant (35.7% vs. 27.1%).
- Among both rural and urban older adults, the highest rates of being homebound were among people with diagnoses of dementia (26.6% and 26.2%, respectively) and stroke (24.0% and 13.3%).