Family structure and transitions into and out of homeboundness: Evidence from the National Health and Aging Trends Study, 2011–2024

Objectives Homebound status refers to needing assistance or an assistive device to leave home, being normally unable to leave home, or experiencing leaving home as a major effort. This study examines transitions into and out of homeboundness and whether family structure is associated with these transitions, with attention to gender differences. Methods Using National Health and Aging Trends Study data from 2011–2024, transition probabilities across four states—independent, homebound, nursing home residence, and deceased—were estimated using an unadjusted continuous-time homogeneous Markov model. Multinomial logistic regression models then assessed associations between family structure and subsequent transitions, including gender interactions. Results Among respondents who were independent, 84.6% remained independent, and 12.2% became homebound by the next wave. Among those who were homebound, 23.6% returned to independence, 60.1% remained homebound, 2.4% entered nursing home residence, and 13.9% died. Unpartnered older adults had higher risks of transitioning from independence to nursing home (RRR = 1.752, p <.01) and death (RRR = 1.265, p <.01). Parents had lower risks than childless older adults of transitioning from independence to nursing home (RRR = 0.523, p <.01) and death (RRR = 0.735, p <.01), and from homeboundness to nursing home (RRR = 0.574, p <.001). The association between being unpartnered and becoming homebound was significantly stronger among men than women. Discussion : Homeboundness as a dynamic and socially structured process. Family structure may shape pathways into homeboundness, institutional care, and death, with implications for aging in place.