TX HHS Form 3641-A. Alzheimer's Disclosure Statement for Nursing Facilities

The TX HHS Form 3641-A, Alzheimer's Disclosure Statement for Nursing Facilities, helps solve the problem of providing transparent information about dementia care services to residents. This form is used by nursing facilities that advertise or promote specialized services for individuals with Alzheimer's disease or related disorders. The administrator of the facility typically completes this form.

The form requires the facility to provide specific information about its services and how they target the special needs of residents with dementia. Key features include providing copies of the disclosure statement to anyone requesting information on Alzheimer's or related dementia care, posting it along with the facility license, and completing sections that apply to the facility's services.

The purpose of this form is twofold: to empower consumers by providing consistent categories of information about facilities and services, and to help facilities develop and define their philosophy, care, and services specifically targeting residents with dementia. This promotes autonomy, innovation, and competition at the facility level. Key points:

• This form is required for all nursing facilities that advertise or promote specialized services for individuals with Alzheimer's disease or related disorders.
• The administrator of the facility typically completes this form.
• The form requires providing specific information about the facility's services and how they target the special needs of residents with dementia.