At first you get phone calls that seem kind of strange. Mom is quitting her quilting club because “They are talking about me.” Later she mentions that an old boyfriend from college is coming to take her to dinner. Then the police call from her house. “Your mom thinks there is someone hiding in her closet.”

The forgetfulness, the fantasies, the hallucinations are symptoms of dementia, probably Alzheimer’s type. This is the story of millions of Americans caring for elderly parents and maneuvering in the murky world of laws, guilt, fear and family dynamics.

A USA Today/ ABC News Gallop Poll of baby boomers found that 41 percent who have a living parent are caring for them, financially and/or personal care; eight percent have parents moving in with them. It’s estimated that 34 million Americans serve as unpaid caregivers for older adults, usually relatives, and they spend 21 hours a week helping out, spending $350 billion in “free” care, according to an AARP survey in 2006.

The AARP survey also found that the typical unpaid caregiver is a 46-year-old woman, who works outside the home. A more recent report from the Alzheimer’s Association and the National Alliance for Caregiving found men make up 40 percent of family care providers, up from 19 percent in 1996. The NAC estimates that $659,000 per person is lost in pensions, Social Security benefits, and wages as adult children.

The physical toll can be severe too. Caregivers reported having one or more chronic conditions, 91 percent reported depression. Caring for elderly parents can threaten the health of the whole family. Being a ‘parent of a parent’ can unlock a family’s hidden dysfunctions and reopen old sibling rivalries. Elder care can exhaust and sometimes demoralize the caregiver. This can frighten and confuse elderly parents. What can a “sandwiched” child do?

• Keep regular contact. Write or call your parents at least once a week at regularly scheduled times.

• Assign family roles. If you have siblings, share responsibilities for financial, legal, medical, and other issues.

• Help your parents stay socially connected. Arrange for a friend, neighbor or family member to visit at least once a week.

• Provide entertainment opportunities. Subscribe to the hometown newspaper. Buy tickets and transportation as birthday gifts for movies, concerts, and sporting events.

• Help manage routine tasks. Arrange for regular grocery and meal deliveries from a local restaurant or senior service programs. Contract for professional lawn care, snow removal, and a regular cleaning service.

• Conduct safety inventories. Take an inventory of what could be a threat to their health and safety (frayed electrical cords, slippery floors, loose handrails, or rugs).

One of the hardest parts of trying to assist aging parent from a distance is monitoring their health. Since many parents don’t want to complain, their children may never know that health problems exist. It is not uncommon for parents not to even tell their children if they are hospitalized. Some warning signs are:

• Changes in daily routines. Getting up later, taking more naps, going to bed early, skipping meals, foregoing routines like reading, writing letters, or taking walks.

• Change in hygiene habits. Skipping showers, wearing the same clothes several days in a row.

• Unexplained mood swings.

• Expressions of hopelessness and depression.

• Displays of fearfulness and anxiety. Afraid to stay by themselves at night. Doesn’t want to leave home for fear that something will happen.