Depressive symptoms are highly prevalent among medically ill homebound elderly and are associated with significant functional decline, lower quality of life, and increased health care utilization. Despite this, depression is generally underdiagnosed and undertreated among medically ill homebound older adults. The objective of this study was to determine the validity of a brief depression measure (CES-D) and examine the nature of depressive symptoms reported by the older sample. Using confirmatory factor and rating scale analysis, the factor structure of responses in a cross-sectional home care sample (n=618) was examined with a further analysis of item responses from identified urban and rural subsamples. Radloff's (1977) four-factor depression model fit the data well. Some symptom items were expressed differently and this offers an opportunity to understand the unique clinical aspects of depression in homebound older adults.