Maine is the oldest state in the country, followed closely by Vermont and New Hampshire. This says something about hearty Yankees, perhaps, but the reality includes a unique set of both challenges and opportunities for our healthcare expectations. The aging cohort is a vital and active component of our society, our economy and our future, and, overwhelmingly, members of the oldest demographic have reaffirmed their intention to remain in their own homes and own communities for as long as they possibly can.

Although healthier than previous generations, seniors over the age of 65 remain the biggest consumers of healthcare services and products. In order to fulfill their desire to remain contributors to their communities, they’re going to need a little help from the rest of us. And they’re getting it, although not without some difficulties.

One of the least celebrated elements of the healthcare system in this country is the extent to which unpaid family caregivers are an essential part of making that system work for everyone. Most unpaid caregivers don’t even recognize that that’s what they’re doing. Typically, they’ll say something like, “Oh, that’s my mom! Of course I look out for her.”

But the economic impact of the services provided by family members, nationwide, is about $450 billion per year, equivalent to the total sales of Wal-mart, Toyota, Ford and Daimler-Chrysler, combined. That includes $2.3 billion right here in Maine (all numbers courtesy of the AARP Policy Center).

They help prepare meals, manage finances; they provide transportation – especially critical in the most rural state in the East, and one with so few public transportation options – grocery shopping, and lately: snow removal.

But nearly half of all family caregivers also perform various forms of medical or nursing tasks, like complex medication management, wound care, and injections. Most family caregivers also work full or part time, while being essentially on-call 24/7 in support of their loved ones. It’s a challenging agenda for everyone, further complicated by the fact that a lot of intrepid Yankees still have trouble asking for – or accepting – help.

Complicated and expensive though it is, homecare is vastly more efficient, less costly, and more closely aligned with the preferences of our aging population than the alternative of institutionalization. Per capita costs for all forms of long-term care in Maine are higher than national averages, partly because we are such a rural area.

Home health costs here are about 11 percent greater than average, according to Genworth Financial, but the costs of an assisted living facility here are 41 percent higher than national averages. The cost of a semi-private room in a nursing home in Maine could be nearly double that of the cost of homecare services, but the state devotes a much higher percentage of its healthcare support to institutional care than to the less expensive and more desirable alternatives.

Those circumstances are changing, though, as Maine towns and cities are considering ways to become more supportive of their aging populations, and as more resources are becoming more easily available to more households. Some of this easier access is a function of social media and other electronic connections, but the bigger part is a function of new sensitivities on the part of the agencies that support aging in place.

There is legislation pending at the legislature that will facilitate transfer of care to either professional or family caregivers for seniors being discharged from medical facilities (the CARE act).

Speaker of the House Mark Eves has introduced a measure to significantly increase the supply of affordable housing for seniors (Keep ME Home).

And a broad range of advice and support for seniors and families is available from a growing list of agencies that are aligned with the Maine Council on Aging, including AARP-Maine (http://states.aarp.org/category/maine), Maine’s Area Agencies on Aging (http://www.maine4a.org/), The Home Care and Hospice Alliance of Maine (http://homecarealliance.org/), and from the Council, at http://www.mainecouncilonaging.org/.

More than two-thirds of Mainers over age 50 either currently provide some form of family healthcare support, have done so, or expect to do so. The result is that more of us will stay in our homes longer, will continue to be significant contributors to the Maine economy, to our communities and to the philanthropic network of the state (the Boomer generation — those born between 1946 and 1964 — alone constitutes more than 52 percent of the total economy of Maine) far longer than would be possible otherwise.

But just as each of us has a responsibility to engage in our own healthcare, so we are responsible to access the array of resources available to help. Fortunately, as the number of older Mainers continue to grow, access to resources is getting easier, too.