When it comes to caring for the chronically ill elderly, New Jersey comes in close to the bottom, ranking 50th of 53 states, including Washington D.C., Puerto Rico and the Virgin Islands.

That's according to a survey by East Brunswick-based Healthcare Quality Strategies which finds that one in five Medicare patients discharged from the hospital in New Jersey return within 30 days.

"New Jersey is a very densely populated state and hospitals are easier to access. It may have something to do with the fact that it's relatively easy in a place like New Jersey if someone calls the doctor for the doctor to tell them to go over to the emergency room," said Dr. Andrew Miller, medical director of Healthcare Quality Strategies. "If someone lives 70 miles from the nearest hospital, that's a harder thing to do. There might be more efforts going on in places like that to keep people from having to go into the emergency room."

"There is also capacity in the system to take care of people. We have hospital beds that are empty. I'm not saying that hospitals are trying to fill beds that shouldn't be, but it's easier to admit someone when there's an empty bed there and if there's a doubt, why not admit the patient when they can get good care?" said Miller.

Another problem is when it comes to the coordination of care after a person is discharged and the communication between different providers.

"Once people leave the hospital, the hospital is no longer taking care of them. People who are chronically ill have things that need to be addressed on an on-going basis. They aren't coming into the hospital, getting cured and going home. They're coming in, getting their medical condition under control and going home. But, it can very easily go back out of control. So, having nurses go into the home and provide care for them is important as is educating people on how they can manage their own chronic diseases," said Miller. "There are people who are aware of the patient's condition and that information needs to be communicated to those who are going to be caring for the patient upon leaving the hospital."

"All licensed health care facilities now have to fill out a universal transfer form in New Jersey to make sure key information is transmitted when a patient moves from one health care setting to another because that's the kind of thing that doesn't always happen. If someone goes to the hospital and is admitted through the emergency room and is cared for at the hospital, their doctor may not even know they were in the hospital in the first place. We need to set up a system where their primary care doctor is notified," said Miller. "The system is not currently set up to address this issue."

Among the counties in New Jersey, Hudson and Essex counties saw the highest percentage of people return to the hospital, with 24.6 and 24.1 percent re-admissions, respectively. The statewide average was 20 percent and only Hunterdon and Morris counties were below the state average.