The financial woes of the Otago District Health Board, as anyone who takes the slightest bit of interest must know, are acute and on-going.
The board and staff are under constant pressure to restrict spending and limit the "deficit".
That leaves no area sacrosanct, including disability services to among the most vulnerable, the "disabled" over 65s.
But the latest plan to use telephone interviews to reassess needs and slash costs for household help is a step too far.
The health board nearly a year ago warned that community services for the elderly were "overdelivered" by $10 million (from spending of $79.4 million) when compared with national averages. Targets were set to reduce, over three years, housework assistance and personal care given to people in their homes.
The price paid for the services was already relatively low - home carers and helpers earn close to the minimum wage - so the only option was to cut the services themselves.
Needs assessors would be set targets, and strategies would make it harder to get services and lower service levels.
What emerged last week, though, was news that insufficient savings were being achieved.
Therefore, planning was under way for telephone reassessments of about 2400 Otago elderly who at present receive up to two hours' help a week.
Predictably, board members and community organisations have raised concerns at this blunt instrument.
Many elderly come from more stoic and accepting-of-authority generations who might well agree to inappropriate cuts because they do not want to make a fuss. Others might struggle with "cognitive issues", not understanding properly what is being proposed.
Whatever the benefits of promised extra "needs assessor" training and claims of telephone assessments working elsewhere, those in real need cannot over the telephone be fairly or effectively separated from the others.
The process is just too hit and miss.
There is a danger, too, that saving a few dollars to reduce help with the vacuuming or cleaning the bathroom and kitchen could lead to much greater costs in falls and accidents.
Often, it is just that little bit of help that makes the difference between staying at home and shifting to a rest-home, an option that costs hundreds of dollars a week more.
Yet, the board has been, with some success, trying to encourage the elderly to stay at home because of these very savings. While supplying household assistance on occasions might create an unnecessary culture of dependency and, in some instances, will not be essential, often it is vital.
This is especially so in an era when aid from family members is frequently not available or possible.
The board and its staff have no option but to withhold, withdraw and reduce household help but to do so largely using face-to-face assessment.
The needs assessors, the front-line of the process, in particular, have the unenviable task of being tough but fair.
They are under ever-mounting pressure to shrink costs while battling with their sense of wanting to support their "clients" in every way possible.
Not infrequently and not surprisingly, many families push for everything they can procure for their relatives, and resisting forceful advocates will be difficult.
Sometimes the elderly will put on a show and falsely demonstrate how well they can cope.
Others will perform for the opposite effect.
It is hard enough for skilled and experienced assessors and medical staff to judge what is needed while observing in a person's home, let alone down a telephone line.
What the assessors now have to do, nevertheless, like the board itself, is balance compassion and cost.
They have an important job helping to keep society's disabled elderly in their homes as long as possible, as cheaply as possible, and in ways that do not compromise their wellbeing or their safety.
