There is limited understanding about the continuity of grandmothers' roles in families, especially their caregiving to grandchildren. Identifying and understanding patterns of caregiving stability and change has important health implications for grandmothers and their families. Grandmothers were categorized as providing one of three types of caregiving to grandchildren: grandmothers raising grandchildren, grandmothers in multi-generational homes, and grandmothers who are do not reside with or provide care to grandchildren. Grandmother participants responded to three mailed questionnaires, one year apart, about the effects of caregiving on grandmothers' health, well-being, and family functioning. The sample included 486 Ohio grandmothers in year one, 440 in year two, and 431 in year three.  Sixty-five grandmothers reported a change in caregiving status between the first two waves, 47 reported changes between the second and third waves, and 19 reported changes at both time intervals. Results: The most frequent caregiving change was from a caregiver role to a non-caregiver role. Grandmothers who experienced changes to their caregiver status were likely to have more depressive symptoms than grandmothers who maintained their caregiver status; they also reported a decrease in intra-family strain, which remained higher than that of other grandmothers. Open-ended responses in the questionnaire and qualitative interviews reveal that the reasons for caregiver status changes usually revolve around the circumstances of the adult children. Grandmothers who entered into a multigenerational arrangement often did so because of the work demands and/or changes in marital status of their adult children. Some grandmothers, even those whose caregiving status remained stable, report multiple transitions of family members in and out of the grandmother's home in the year between data points. These less visible changes in caregiving responsibilities may substantially impact the grandmothers' lives and those of their family members, and have under-recognized implications for the well-being of grandmothers and others.