Nursing homes nationwide will likely experience a dip in scorecard ranking of quality care this year due to the federal government increasing the standards it uses to assess 16,000 institutions listed on the Nursing Home Compare website.

About three in 10 homes are likely to lose one star based on the five-star ranking system established by the Centers for Medicare and Medicaid (CMS), due to program changes.

The quality ranking program reviews everything from staffing levels to the number of falls at a nursing home to pain reports by patients.

This year's scorecard was expanded to add categories relating to the use of anti-psychotic drugs for restraining patients. The government has also increased the number of points needed to earn a rating of two or more stars and changed the scoring method for the staffing star rating.

Nursing homes must now earn a four-star rating on either the RN or total staffing rating to attain an overall staffing rating of four stars.

Due to the changes, the government notes on its website that consumers should not compare a facility's quality measure ratings in February to those that appeared in earlier months as these wouldn't be "appropriate."

The ranking system features pros and cons, acknowledges Medicare, and it even outlines strengths and limitations on health inspections, staffing and quality measures.

On the plus side, the ranking data is information gleamed from onsite visits by trained inspectors. Federal quality checks are also in place, such as checking on state inspectors' efforts to track nursing homes.

It also makes clear that differences between state Medicaid programs can impact the scorecard results since states conduct their own types of inspections and even have different Medicaid program licensing requirements.

"The best comparisons are made by looking at nursing homes within the same state. You should be careful if you are trying to compare a nursing home in one state with a nursing home in another state," notes the Nursing Home Compare website.

The scorecard, while lauded by many as a good initiative for giving consumers and families guidance on available nursing home options and evaluative data, isn't perfect, says an industry executive who believes further improvements can be made.

For one thing the numbers sometimes don't tell the whole story, believes John Quintier, executive director of Emerald Ridge Rehabilitation Care Center in North Carolina.

"I'd like to see customer satisfaction surveys included from families and residents. To really measure the care of the facility, you need to talk to family and residents,"