Role Reversal vs Role Expansion

By January 12, 2015Senior Care News

Role Reversal vs Role Expansion


I had a “light bulb” moment thought recently- perhaps how we were parented as children will dictate our approach to the family caregiver dynamic when we get older.  

I have spent most of my adult life interacting with caregivers both on professional and personal levels. During this time, I have witnessed various approaches to family care giving, and throughout these years,  I have been puzzled by many decisions made by children, who seek to find what is in the best interest of  their parents.

A recent meeting with  a family triggered this line of thinking. Mother is in her eighties, highly independent, lives alone, was diagnosed with a couple chronic illnesses but has a wonderful support system in place. On meeting with the family, I was immediately convinced that she poses a fall risk. She walked with an unsteady gait, was weak, and moved a bit too fast without her walker.  The hope was to have someone with her to make sure she is on time with meals and medication, to help around the home, and provide some amount of companionship. My recommendations were in line with what the children envisioned as a reasonable solution, for now. As we sat and discussed these options, I noticed through her body language and her occasional  protests that, mother was having no part of it.

After a couple of visits from the caregiver, services were cancelled because mother refused to have help. She explained to the children that she had made it thus far without help and would be fine without it. During the meetings, I observed mom’s dominant role and how the children took on a more submissive stance. They deferred to mom often and were very careful to avoid upsetting her. 

This was not the first time I witnessed children who had a very hard time with taking on what is considered by some, a form of role reversal. Conversely, there are many adult children who have not only embraced the role of advisor and decision maker..they are quite adept at it. Typically, those children already have a plan in place and are ready to go at the time of our meeting. The question is, does parenting style impact how children confront their inevitable role as caregiver?  And, how do we help family caregivers move beyond what is a role crisis, to a place where making the “right” decisions are easier?

My firm belief is that we start by not using the term role reversal. A huge misconception is that as we age, we become the parent and our parents become like our children, often referred to as role reversal. I don’t believe this is a reasonable approach. As healthcare professionals, we have a responsibility to educate our clients that what they are experiencing is not a role reversal, but a role expansion.

A role expansion for adult children translates to- the ability to view the aging process in a practical and expansive way. My parents will always be my parents,  but now I need to help them with sorting bills, transport to appointments, help with planning,  and helping to make wise decisions-Decisions that lend to quality of life.  

Role reversal used in the context of any parental style,  may invoke a complexity of emotions that could complicate what is an already complicated situation. Therefore, it’s not worth using.

Role expansion- the preferred reference, requires the ability to navigate and negotiate regardless of how we were parented. Within this definition, it calls for caregivers to:

·         Involve parents in the decision making process


·         Engage family members and share in the responsibilities


·         Provide informative content that helps with decision making


·         Create rules and guidelines for communicating-effectively


·         Communicate concerns to aging parents so there is honest dialogue


·         Negotiate what is a reasonable solution that creates peace of mind


·         Discuss how to navigate insurance, hospital, legal, and financial avenues

From this perspective, all situations may not end perfectly.  We will continue to encounter the resistant parent and the submissive children. However, if we as health professionals can help families embrace their respective roles in a healthy manner, perhaps what we will encounter less, is failure to provide a safe environment for seniors, who end up falling with irreversible consequences.  I hope when I am old and set in my ways, my children will approach me, not as my parents, but as my children who love and care for me. That approach comes with great benefits…ones I hope I will be able to appreciate.  


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