A health facility that provides or offers Alzheimer's and dementia special care shall prepare a written disclosure in a form provided by the division that has been developed in conjunction with the long term care ombudsman's office and that contains the following information:

1. (1) The health facility's mission or philosophy statement concerning the needs of residents with Alzheimer's disease, a related disorder, or dementia.
2. (2) The process and criteria the health facility uses to determine placement, transfer, or discharge from Alzheimer's and dementia special care.
3. (3) The process for the assessment, establishment, and implementation of a plan of Alzheimer's and dementia special care, including how and when changes are made to a plan of care.

4. (4) The following information concerning the staff of the Alzheimer's and dementia special care unit:

   1. (A) The staff-to-patient ratio for each shift.
   2. (B) The positions and classifications of staff.
   3. (C) The initial training or special education requirements of the staff.
   4. (D) The qualities and amount of continuing education and in-service training required for staff.
5. (5) A description of the Alzheimer's and dementia special care unit and the unit's design features.
6. (6) The frequency and types of activities for the residents of the facility who have Alzheimer's disease, a related disorder, or dementia.
7. (7) The extent that the health facility's Alzheimer's and dementia special care unit and program offers family support programs and solicits input from family members.
8. (8) Guidelines for using physical and chemical restraints in providing Alzheimer's and dementia special care.
9. (9) An itemization of the health facility's charges and fees for Alzheimer's and dementia special care and related services.
10. (10) Any other features, services, or characteristics that the health facility believes distinguishes the health facility from Alzheimer's and dementia special care offered by other facilities.

As added by P.L.106-1997, SEC.4.