Forgiveness, Gratitude and Mental Health

Aging inevitably means loss: loss of family members, friends, abilities, familiar things. Of course, aging can also involve gains: new friends, family members, new skills, new experiences. In fact, living inevitably brings loss; it's just that losses accumulate as we get older, and may seem to outnumber the gains. Sometimes losses are welcome (e.g., a bad job, someone who was very difficult to be around), but most often, loss is accompanied by grief, a longing for what was lost. When my partner died, it wasn't just her that I lost, it was a loss of dreams. I could still discover new things about her as I cleaned out her things - but there would be no new stories about us.

I've been influenced by the positive psychology movement championed by Marty Seligman and his colleagues at the University of Pennsylvania. Seligman believes that we have detailed information about psychopathology, but not not enough information about what makes us thrive. 

Seligman found a formula for a happy life: H = S + C + V. 

Happiness (H) is a function of my set points (S) (determined by genetics), my circumstances (C), and factors I can voluntarily control (V). There are fleeting moments of pleasure, and there is enduring happiness. Set points are a general propensities for happiness. I have a genetic predisposition to depression, but also a predisposition for humor. One thing I appreciated about my father was his sense of humor. Seligman calls this a happiness thermostat - even when people experience great fortune, like winning the lottery, they feel momentary happiness, but often drift back to their previous happiness level. The thermostat works the other way, too - people usually recover from major setbacks. 

Circumstances refer to living conditions and events. Most people describe themselves as happy once they reach a minimal level of resources - housing, food, companionship. But beyond that minimal level, more resources (e,.g, money) doesn't necessarily improve happiness. I am lucky - I have a house, and enough money that I haven't had to worry about food in decades.

Factors under voluntary control include our perspectives on the past, present, and future. 

There are several positive emotions about the past: satisfaction, contentment, fulfillment, pride, and serenity. Activities that enhance our perspective on the past are Forgiveness and Gratitude.

I have been lucky in avoiding major trauma. 

Forgiveness for what trauma I have experienced has come easily. Three people broke into my house 40 years ago, stealing food, clothes, games, my first TV. It took me a long time to feel comfortable in my house, but eventually than fear passed. It was easy to forgive the thieves. They lived in the house for the coldest 3 days Kentucky had experienced in a century - I figured they needed the items they took more than I did, and I hoped they could find security. 

My father had trouble with alcohol, and was emotionally abusive. I realized as a young adult that he was a creature of his times, and didn't know better about managing me and his own insecurities. While forgiveness came, repairing the relationship was very difficult - he was deaf, would not seek help for his hearing, and often complained about my failure to "enunciate". I have come to terms with his relationship being a difficult one for me to manage. 

Forgiveness has been much harder for a man that threatened to put me in the ICU because I was transgender. He sent a threatening letter to me, and multiple threatening letters to the superintendent of a neighboring school district. I understand hate exists in the world, and there are people who are dangerous. I was extremely thankful for law enforcement, and a legal system that put restraints on him, and for supportive friends. Sometimes forgiveness isn't possible, but mental health depends on coming to terms with a person's infliction of harm on us (or the threat of harm). We have to have a feeling of safety, and a realization that our fears are justified. 

When I was growing up, the most evil person I could imagine was the dentist who performed a root canal on me. On the first day of Little League practice, I caught a ball in my teeth, breaking one tooth in half, and bruising the incisors above it. Our family dentist referred us to Dr. C. He had me in so much pain I broke the arms off his dental chair, and he threatened to sue my parents. A few years ago, I looked him up on line. He was a professor at Rutgers College of Dentistry, a founder of the Jewish Dental School in Jerusalem, and wrote many articles about effective dental surgery. No doubt he spent many hours contemplating how to make root canal surgery more comfortable, and no doubt many people have less pain and more functional teeth because of him.

This season I am thankful for my wide range of friends at work, in my profession, and my neighbors. I have had friends helping me with a very difficult caseload; another friend who recently moved to Washington and invited my child and I to Thanksgiving. I am thankful for music and good literature. I am thankful for the resources at my fingertips that give me access to everything from recipes to games to current news. I am thankful for all the opportunities I've had, and that are still opening up to me.

Activities like Forgiveness and Gratitude are ongoing - I don't think we reach an endpoint in our relationship with the past. I will talk about activities related to how we build happiness in the present, and in anticipating the future, in later blog posts. 

Income Streams

Much of my anxiety about retirement is financial - it feels a bit like walking off the edge of a cliff. Can I have enough money to live on, and still fulfill some of my dreams?

I will have four income streams, and my expenses will be changing.

I have modeled a budget in Excel.

The first income stream is Social Security. Given my birth year, I can fully retire at age 70. That means I will be at my maximum Social Security payment level, and if I earn extra money, I can keep it without affecting my Social Security amount. My Social Security payment will replace 35% of my current paycheck. That amount is fixed, with an annual cost-of-living adjustment.

The second income stream is from my pension. I participate in the Washington State Teacher Retirement System's Plan 3, which is a hybrid defined benefit/investment system. My defined benefit will be 33% of my current paycheck. 

The investment part of TRS Plan 3 is a third income stream. I can choose not to withdraw any of it, but IRS rules require minimum withdrawals starting at age 72. Given the withdrawal rate that will keep some money in the account to age 100, my withdrawals could replace 33% of my current paycheck. Of course the amount actually in this account fluctuates with the markets

With these three income streams, I can have the same amount of monthly income as I do now. 

A fourth income stream is jobs that I do. There is high demand for school psychology services and related skills. It's possible I could continue to do the work I do now, but there are strict retirement system rules that limit me to working 900 hours/year for a district - I am not sure yet whether that limit applies to a single district, or multiple districts in a year. I also get asked to do related jobs. This summer, I worked for two testing companies, each with a project that could be completed in under five hours, and each paid me $1,000 per job. Those two jobs involved work on the internet - I could have completed them from anywhere. The retirement of baby boomers has created a huge staffing shortage, one that won't go away in my lifetime. Covid created a necessity for online assessment technology, and there are school psychologists working from remote locations. That all sounds like a lot of work,  but I would still get to choose the hours I work. 

I have often thought of volunteer work I would like to do on projects that are important but not expected as part of my current job. This might include things like a research and program evaluation focused on reasons for non-attendance among our secondary students. I've often thought I would like to tutor students. My boss pointed out that I could be paid for such work. 

A fifth income stream I might have had is personal savings. Some people are very good at socking away money aside from retirement accounts. I have not been good. I have been able to keep one paycheck away from living paycheck to paycheck, and probably should be saving more, but it will never be a source of long-term income for me. Our District provides a pre-tax annuity savings plan which would be quite useful.

A sixth income stream is not really income, but reductions in expenses. I will go from regular to a retired member of my union (NKEA/WEA/NEA) and professional associations (NASP/APA) - this will cut annual expenses of $2,000.  I will no longer be paying into the retirement system, and my contribution to the WA Cares long-term care insurance will go away. Our current president-elect has promised to eliminate income taxes on Social Security, but I think that is unlikely (and foolish)

So it looks like I won't have to worry much about surviving financially.  

A Healthy Lifespan

Writing about the health insurance decision made me think about the most important insurance decisions - how to stay healthy during an extended lifespan. When I was born, I could expect to live 66.7 years. I've already beaten that by 3 years. A male born today can expect to live to 73.5, a female, 79.3.  Health changes in the last 69 years means people are likely to live almost 7 years longer.  The hardest year for survival before the elder years is the first year - having made it to 69, I can expect to live another 14.3 years (age 83), if I am like most males (my birth gender). I am transgender, and have been on female hormones - had I been born female, I could expect another 16.7 years (85). But I am not typical: I am white, English speaking, native-born, highly educated, have a well-paying job with good health care, and I have never smoked. Having those characteristics, I have a 50% chance of living to 93. 

What will my life be like at 93? About 11% of the younger adult population (age 21 to 64), and about a quarter (24.3%) of people in my age cohort (65 to 74) have disabilities. But this rate nearly doubles among those over 74 (45.9%). I sometimes describe myself as "temporarily able" - someday the slings and arrows of life are likely to catch up to me. 

What can I do to keep disability and illness at bay for the longest possible time? They say you can't change your genetics, but genetics can warn you of possible illnesses that can be prevented. If I'm alive in 3 years I will have outlived both of my parents. I've outlived both of my maternal grandparents. My paternal grandparents lived well into their 70s. The family curses on my mother's side appear to be diabetes and heart disease, on my dad's side, depression and alcohol abuse. 

I am living in a miraculous time. I have been on statin drugs for the last 30 years to keep high cholesterol at bay, and I try to follow a Mediterranean diet. I take an ACE-inhibitor for high blood pressure, and Xarelto to prevent blood clots. I use a CPAP machine to help with sleep apnea, a condition which untreated creates a high risk of stroke. Most of these prevention tools did not exist in my grandparents' time. 

Some of these conditions are likely due to my weight. I am about 40 pounds over what is "normal weight" for my height. I love food - but I eat too much and I'm too sedentary. 

My job involves a lot of sitting - a lot of typing reports. I've had leg pains from time to time, starting 30 years ago, but worsening last year when I had what my doctor called "sciatica". After six weeks and intense pain making walking difficult  I now have a set of physical therapy exercises which take about 20 minutes in the morning and 10 minutes at night.  And I have been pain-free for the last six months. 

I know evidence is limited on whether mental games can prevent dementia, but I play games every day: the Times mini crossword, Wordle, Connections, Spelling Bee, and Apple News’ Quartiles.  I do these because they are fun. They only exercise one specific ability: crystallized, or verbal ability, the one ability that grows in later life.  I need to do more visual-spatial games, more fluid reasoning problem solving games, and games that stretch my working memory  

(Note to self: If I want to go on photographic walking tours of Paris next October, I need to keep up my PT, keep on walking daily, eat smart portions of healthy food, and keep thinking how great the future can be.)

 

Don't Retire: Rewire! A list of things that energize me

I've joined a retirement group with the National Association of School Psychologists. We're meeting monthly via Zoom and at the Association's annual convention. These are school psychologists who have retired or are nearing retirement - we have had similar jobs and skill sets, and similar financial profiles - so it is reassuring and educational to participate in these meetings and hear how people are doing. At the first meeting I attended, my friend Michelle Malbey recommended a book by Jeri Sedlar and Rick Miners called "Don't retire: Rewire! Five steps to fulfilling work that fuels you passion, suits your personaility, and fills your pocket" (Third Edition, 2018, Alpha/Penguin Books). 

Every summer for me is like a trial run for retirement. I can set my own schedule and participate in whatever activities I want to do. But after a few weeks, I realize I need some discipline. I can't sleep til noon every day, and I can't play video games all day. My life needs to have a purpose or purposes. In fact my life has had purpose, and those purposes can continue. It's just that in retirement, I get to choose how I meet those purposes. I can choose what activities to be involved in without worrying where my next paycheck is coming from. 

The concept of "rewiring" is understanding the drivers that have propelled my work over the years; linking those drivers to activities, creating a rewired version of those activities, and creating an action plan to make it happen.

Sedlar and Miners take you through a series of exercises to identify your drivers. My drivers include:

1. Adventure (local and distant)
2. Friendship
3. Experiences
4. Mentoring
5. Having a Global perspective
6. Making a difference

My values include;

1. Adventure
2. Autonomy
3. Beauty
4. Calmness
5. Community
6. Curiosity
7. Compassion
8. Friendships
9. Justice
10. Comedy

Then, there are dream projects/activities

1. Travel around France and Spain blogging about food and experiences
2. Photography
3. Learning keyboard and fiddle
4. Comedy clubs
5. Music clubs
6. Sailing
7. Theater - acting? managing?being in the audience?
8. Driving the Trans Canada highway
9. Driving a US loop
10. Museums 
11. Mentoring
12. Creating an ADHD assessment manual for my district
13. Helping my district to earn an Exceptional Psychological Services designation from NASP

Some of these are reminders to revisit things that give me joy (I haven't picked up my fiddle since before Covid). Some are things I haven't attempted yet (I've been on sailboats - but my only experience sailing was my uncle handing me the tiller of his boat in the Gulf). Some straddle the line between being an active driver of the activity vs spectator, and for some activities, being a spectator will be just fine. 

Rewiring is a process of scheduling activities that scratch those itches. Some things can be easily scheduled short term. Others are long-term projects, and I can't do them all. I will document progress here. 

 

Health Care Decisions: Traditional Medicare vs Medicare Advantage

One of the first decisions I need to make is health care. 

I must have health insurance. I have health insurance coverage through my employer currently. That will go away after I retire in June. 

I needed to sign up for Medicare Part A (Hospital) when I was within three months before or after I turned 65. Part A pays for inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care. Because I've paid at least 10 years Medicare taxes, I don't have to pay a premium for Part A. Had I not enrolled during the enrollment window (a seven month period around my 65 birthday), I would have a 10% surcharge on the Part A portion of my premium for Original Medicare or Medicare Advantage.

To avoid a tax penalty, I must stop any deposits in my Health Savings Account (HSA) at least 6 months prior to my retirement date. My employer makes a single annual deposit into my HSA in October - that money can be used past my retirement date. 

Because I have health care coverage through my employer, and that policy (with Kaiser-Permanente) covers hospitalization, Part A has been painless for me - no monthly premium. But that coverage will go away when I retire, which will either be June 30 or August 31 2025.

And that presents a choice: Within three months of my retirement date, I must choose either Original Medicare or Medicare Advantage. Both have a monthly premium and deductible costs. 

Original Medicare includes Parts A and B. Part B covers doctor visits, outpatient care, durable medical equipment, and preventive health care. I would pay a monthly premium ($174.70) for Part B. These are for services you likely have through your employer. You must be in the US to have Medicare pay for Part A or Part B services. Part B only covers 80% of outpatient costs.

Original Medicare does not cover: Eye exams (for prescription eyeglasses), long-term care; massage therapy; routine physical exams; hearing aids or their fitting; services from providers opting out of Medicare; and most dental care. People on Original Medicare can get Supplemental plans ("Medigap" plans) to cover services that Parts A and B do not cover.  These include Part D plans which cover the cost of medications. Medigap plans applicable to my age and coverage date are Part G plans (confused yet?) Part G plans will cover Part A and B co-insurance and co-pays; they can cover up to 80% of emergency health care out of the US. But there is no cap on out-of-pocket expenses.

Alternatively, instead of Part D & G, I could get a Part C plan (Medicare Advantage).  Kaiser offers several. For Medicare Advantage, there is a cap on out-of-pocket expenses. They can include vision, dental, and hearing services  

Medicare Advantage plans are offered by private insurance companies, who usually require prior authorization for any service outside their network. Original Medicare is provided by any provider who accepts Medicare. Both plans are funded in part by the federal government  

The New York Times reviewed some of the choices here. They also discuss this meta-analysis by KFF of consumer experience. Most respondents reported high satisfaction with their choice.  Advantage clients had procedures turned down more often, but those denials were approved 83% on appeal. However, very few people appealed denials.  Advantage clients also tend to wait longer for procedures because of the approval process. Providers providing complex care are less available to Advantage clients. Medications are included in most Advantage plans, but companies choose which medications they cover.

You can change plans during open enrollment periods. That’s relatively easy between Advantage plans, but not easy if you go from an advantage plan to Original Medicare - Medigap plans can deny coverage based on pre-existing conditions. 

My takeaway if which plan is better depends a lot on whether you have chronic, high cost conditions. If so, it seems Original Medicare is better. If you don’t have such a condition (yet), perhaps Advantage is better because of the cap on out-of-pocket expenses and availability of dental, vision, and hearing services. But this is gambling with your future.  In other words, your mileage may vary widely. 

First Things First - what is retirement?

So, you're reaching a certain age.  You've realized that maybe your retirement system will allow you to quit work, and maybe survive financially. Or, your partner is retiring and wants you to have freedom to travel when they want. Or, you're just done with it.

I am 69 years old. I've been a school psychologist for the last 45 years. Even before that, I worked doing mental health and education related jobs since I was 15. Most of my social contacts have been school psychologists and other school staff. 

I've reached an age when I can retire at the end of this school year (June 2025), take my full social security and pension amount, and could work and keep income with no penalty on my social security and pension amount.  Working can be on my terms. I can work if I want, on what I want, for whom I want, when I want, without worrying about income (I think). That tentativeness is because there are complications I am still trying to figure out.  My dream is to travel in the fall of each year, work on professional projects in the spring. I know I can't just play video games all day; staying health is going to mean doing things that interest me, connecting with interesting people, and keeping active. 

Thus this blog. I will write about things I learn about and choices I am making. You can come along on this adventure - I am hoping you share your ideas with me as I go.