On Saturday, the Otago Daily Times reported level six of the inpatient building could be scrapped, along with mental health beds for elderly people earmarked for the floor.
The options were presented to HNZ last week after consultants and Australian construction giant CPB completed a cost-saving exercise triggered in July, when an initial price for the then 11-floor inpatient building came in significantly over budget.
"Our parents and grandparents, and we ourselves when we age — we will be paying a heavy price for this kind of ageism."
Assoc Prof Barak, who spoke to the ODT between ward rounds at Dunedin Hospital, said rest-homes were already referring people with dementia to the Emergency Department and not accepting them back to the rest-home due to their unsafe or inappropriate behaviour.
If the proposed cut went ahead, there would be a range of negative outcomes for the community — "beginning with potentially increased rates of death by suicide", he said.
A "complex, vicious cycle" would form — rest-homes would have nowhere to refer patients with behaviour disturbances, while those receiving acute care would have longer recovery times.
"What would the ED consultant do when they're faced with an 82-year-old man or woman who's been sent by ambulance from a rest-home because they have become suspicious, violent, unsafe?
"They will have to admit them — there will be no psychotherapeutic beds — they will be admitted to a general medical bed."
Otago and Southland had a population ageing at an accelerated rate compared with other parts of the country and psychogeriatric care in the area needed investment, not cuts.
"Thinking that we can reduce this further in Southland and Otago is a terribly uninformed and unintelligent decision," he said.
"Burying your [head] in the sand and thinking that community service or NGOs can take the place of the acute inpatient services — that is not a policy."
Over the weekend, he had spoken to members of the old age psychiatry faculty in the Royal Australian New Zealand College of Psychiatry.
"Every single member was outraged and disappointed by this terribly, terribly unintelligent decision."
The proposed policy suggested to Assoc Prof Barak there was prejudice against older people by those proposing the cuts.
Relatively young people who believed they would "stay young forever" were making policies decisions, he said.
"When they make policy decisions with this kind of ageistic attitude, we end up with a terrible, terrible disservice to our older adults in our communities."
Fellow consultant psychiatrist Esther Abeln shared Assoc Prof Barak’s concerns.
She said an acute psychogeriatric hospital ward provided treatment a rest-home could not.
Hospital patients had severe suicidal risk, life threatening depressive illness or severe behavioural disturbance often due to psychosis, bipolar disorder or advanced dementia.
"These are not patients that can be looked after in rest-homes, similarly as you would not expect a rest-home to manage a patient with a heart attack or appendicitis," she said.
Health New Zealand Te Whatu Ora (HNZ) head of infrastructure delivery Blake Lepper said work was ongoing to identify the right options to deliver health facilities before they were presented to ministers.
"Health NZ has been instructed to work urgently to develop options that can be achieved within the budget and deliver modern, fit-for-purpose health facilities that will enhance clinical safety and enable new models of care."
The project steering group had been presented with several interim design options to consider to address the hospital’s "budget challenges".
"The option to exclude one of the floors was one of the many options presented. None of the options were endorsed.
"No options have been presented to the government, and this will happen in due course."
Health Minister Shane Reti was unable to answer questions as he was travelling.
