Dr. James Borders, a long-time Lexington internist, has often viewed his career in medicine as “a calling” or “a ministry” — never just a job. “I think our greatest calling in life is to take care of each other,” Borders said. He says that no matter how well-intended primary care physicians are in their practices, “they encounter people who can’t come to appointments, or don’t have social support, the right economics, or so many other things that make it difficult for a physician to care for them.”
Dr. James Borders
That is why Borders was attracted to a healthcare program called Bluegrass PACE, or Program of All-Inclusive Care for the Elderly. He even came out of retirement to become its medical director in 2023. PACE’s primary goal is to keep older Kentucky patients who are candidates for skilled nursing facilities out of nursing homes. PACE managers coordinate all aspects of the patient’s care and support, working to help them manage everyday tasks and chronic medical conditions. A PACE physician becomes the patient’s primary care doctor.
The healthcare team develops an individualized plan for each participant. An interdisciplinary team meets daily and consists of a physician, two nurse practitioners, a nurse liaison, a dietician, a social worker, home care coordinator, and an activities coordinator to help fill the days of the patients who come to the day center. Borders emphasizes that the center is not an adult day care facility that warehouses these elderly patients all day, but a busy medical and activity-filled place.
The program is available to Medicare or Medicaid recipients aged 55 or older who qualify for a nursing home level of care and who live in the service area of the PACE organization. The patients must demonstrate that they are able, with strong support from the PACE healthcare community, to live at home and be safe while managing their daily essential activities.
If a PACE patient’s health deteriorates to the point where they need a nursing home, then the patient’s family will receive help in locating an appropriate one. “But PACE does not disappear,” Borders said. “We are still committed to them.”
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The Bluegrass PACE program includes a staffed activity center off Harrodsburg Road in Lexington.
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The Bluegrass PACE day center includes a gym for physical and occupational therapy, as well as a full-service pharmacy.
Bluegrass PACE Care opened in July of 2022 as the first Program of All-Inclusive Care for the Elderly in Kentucky. PACE programs have since expanded to counties throughout the state, each administered by a qualified provider, with Mountain View PACE most recently opening new facilities in Pikeville and Corbin.
Bluegrass PACE also provides an important element of elderly care, namely transportation to and from its center off Harrodsburg Road on Lexington’s west side, and to any authorized medical appointments. There is also an attractive day center where patients spend about two to three days per week, with available activities to keep them engaged and socializing. Breakfast or lunch is provided. There is also a gym for physical and occupational therapy and a full-service pharmacy.
“We try to keep them as independent as possible,” Borders said. “PACE fills in the gaps. When I started practicing medicine in the 1980s, I never thought there would be a model of care that would allow for all of that. Now there is.”
Borders says that on average, a PACE participant is in a hospital roughly half as many days as a comparably aged patient. He says they tend to live longer and have greater satisfaction. “It is a win-win,” he said.
However, Borders believes the American healthcare system is fragmented, expensive, unwieldy, and difficult to navigate with too much emphasis on specialty care. What’s needed, he says, is more of the human touch. “It’s not so much about which medicine you prescribe, or which tests you perform. God put us on earth to look after each other, not just ourselves. This is such a luxurious opportunity for a physician who sees their work this way to have our kind of support to offer that kind of care.”
Dr. Borders is a graduate of the University of Kentucky School of Medicine. He then went to Baylor University Medical Center in Dallas to serve a three-year residency. “I returned to Lexington in 1988 to join my identical twin brother, John, also an internist, in a practice, which we ran for 27 years.” James Borders then joined Baptist Health Lexington as chief medical officer and did that from 2015 to 2022. While there, he was heavily involved in patient care management and co-led the hospital’s ethics committee.
Even then, Borders came to realize that the challenging circumstances facing many patients could be improved with the right services and clinicians. Borders retired from Baptist Health only to return to the profession in a leadership role at Bluegrass PACE.
“Dr. Borders brings many years of experience and expertise to the team,” said Liz Fowler, president and CEO of Bluegrass Care Navigators, which operated in the region for 45 years and until 2017 was known as Hospice of the Bluegrass. The new name better describes the agency’s development of non-hospice service lines. BGCN serves Fayette, Jessamine, Franklin, Anderson, and Woodford Counties. Fowler went on to say that Borders “embraces the mission of Bluegrass Care Navigators to deliver comforting care to all at the right time.”
Turner West, vice president of health policy and strategy for BCNW, agrees. “PACE is a terrific program,” he said. “We are proud that it is available to frail older adults in our community.” West added that it was logical for Hospice of the Bluegrass to go from being an end-of-life resource to supporting the Bluegrass community by becoming the first PACE provider in the state. “When the PACE model is used, we see tremendous improvement in clinical outcomes for the PACE participant so they are more likely to stay independent much longer, have a higher quality of life, and can delay or avoid nursing home placement,” West said.
PACE leaders know about the social factors that exacerbate poor health outcomes. Things like lack of transportation, access to healthy foods, support from a caregiver, or just isolation and loneliness. “I think this is the ultimate concierge medicine,” said Borders, “and one of the best-kept secrets in healthcare.”