When the United States Constitution was signed, people were expected to live only 35 to 40 years.

Then came clean water, better hygiene, vaccination, reduced childhood mortality, antibiotics. More recently, breakthroughs in gene therapy and a surge in technology that can spot diseases faster than a trained eye. Americans today are living 30 years longer on average.

As Maine’s population ails and ages, experts say there is a grave need for more workers and better infrastructure to take care of them. But much like assistive technology or mobile healthcare, some have pointed to older people as the key to combatting workforce shortages.

Maine needs to prevent them from getting sick, said Jess Maurer, executive director of the Maine Council on Aging.

“We have to be thinking totally differently about how we address the workforce shortage,” Maurer said. “We have to reduce the demand by keeping people healthy, really rethink flexibility within the healthcare workforce. We have to deliver healthcare in a very different way, and that includes through community paramedicine, community health workers and community nursing.”

Some of those initiatives have already taken off in central Maine. In other ways, rural communities are decades behind. What should residents know about the healthcare changes that could shape their lives?

Maurer outlined how Maine is setting up for the future.

What’s the problem with aging in America?

The human lifespan has grown by 30 years, but among 204 countries, the United States ranks 49th on longevity. It’s expected to drop to 66th by 2050.

Maurer said the problem is a wide gap between the American healthspan — the number of years spent in good health — and lifespan.

“I am going to live, right now, 12 unhealthier years than people in Japan,” Maurer said, “because we have not invested in the health and well-being of older people.

“We have been sold a bill of goods that aging is going to be about disease, decline and disability. People are so afraid of what’s going to happen that it actually creates anxiety and depression. So when it gets bad, you don’t do anything about it, because you just think it’s normal. And when the system doesn’t work for you, you don’t complain.

“There’s research that says if you live with an age-positive view, you live seven and a half years longer with fewer chronic conditions, less anxiety and depression, better brain health, and you actually heal faster than people who have a negative outlook.

“We have to make a ginormous shift in public health. Keeping people healthy and well is the only way that we’re going to change the drastic challenges we’re having right now with the rural healthcare workforce.”

What are our workforce challenges?

An estimated 30,000 hours of home care go undelivered each week in Maine, according to an analysis of MaineCare data by Maurer and the Maine Center for Economic Policy. About 200 Mainers a day are stuck in hospitals when they could be discharged to nursing homes. Maine needs at least 2,300 more direct support workers to address the existing need for care.

With the share of Mainers aged 65 or older projected to grow to 29% by 2050, that demand will only increase. Maurer said we can’t bank on more workers coming in.

She said Maine has to focus on keeping people healthy.

“If we didn’t have unhealthy people, we wouldn’t need so many home care workers,” Maurer said. “We have CFOs and HR directors and frontline tourism staff, all leaving their jobs, about 10,000 a year, to take care of older people. We have to understand that we do not have an unlimited supply of workers.

“Who we have are older people.

“For more than a decade, the Maine Development Foundation and Maine Chamber of Commerce has been saying that the best solution to our workforce shortage is putting people who are 65 and older who are not currently working back to work. There are 186,000 people between the ages of 65 and 74, and only 50,000 of them are working.

“Purpose is the No. 1 key driver to good health. It actually isn’t good for anyone to retire at 65 and do nothing for 30 years. Our purposeful engagement in the world is important to our emotional stability, and when that big thing goes away, we don’t replace it with something.

“Nobody is saying you’ve got to quit a 40-hour-week job and go work somewhere else for 40 hours a week. You could work 20 hours a week, 15 hours a week. If you did, you’d really help the economy, you’d actually be making a little bit more money, and it’s good for you.

“We’ve got to help employers understand how to build flexibility in. Skilled nurses want to continue to work, skilled healthcare professionals want to continue to work, but they want to work with more flexibility.”

Could Maine’s government play a role?

It has to, Maurer said.

Projecting that Maine could lose 65,000 workers by 2030 if nothing changed, Maine’s Economic Development Strategy aimed to expand infrastructure, entrepreneurship, education, child care and mental health support to keep people in Maine.

Maurer said older people need to be a bigger part of policy conversations.

“There are there 33 states that have formally included older people intentionally in their Rural Health Transformation Program, and Maine is not one of them — despite the fact that the initial draft had older people as a priority,” Maurer said.

“Our government officials have to understand these population shifts, and they have to understand that they have a direct impact on the health of older people. We have an incredible opportunity to keep people healthy and out of hospitals.”

What about technology?

Technology and telehealth are promising solutions to Maine’s care gaps. But Maurer is also seeing a return to the old school: home visits.

“We’re seeing more and more mobile health units and home visiting with a care provider, an (occupational therapist) or a social worker,” Maurer said. “We have this huge problem in healthcare that is coupled with transportation: 72% of older people live in a community that doesn’t have a fixed or flex transportation system.

“It just doesn’t work for people if it’s not door-to-door, on-demand. We have something like 1,500 people getting no care or partial care who are nursing home-eligible. So why aren’t we in their homes, doing an in-home assessment? We don’t have somebody who’s going to give you a shower — what technology could we put in to make it safer for you?”

“We need a technology care plan in this state,” Maurer said.