TX HHS Form 3650. Assisted Living Facility Memory Care Disclosure Statement

The TX HHS Form 3650, Assisted Living Facility Memory Care Disclosure Statement, is a crucial document that helps solve the problem of ensuring transparency in memory care services provided by assisted living facilities. This form is typically used when an assisted living facility advertises or promotes its provision of memory care services to residents with Alzheimer's disease or related disorders.

The form requires facilities to provide specific information about their memory care services, including the types of assistance offered, such as bladder and bowel incontinence care, medication injections, and behavior management. Facilities must also indicate what is involved in their pre-admission process, which may include facility tours, family interviews, medical records assessments, and home assessments.

Key features of this form include the requirement for facilities to provide copies of the disclosure statement to anyone requesting information about memory care services and to post it along with their facility license. Facilities must also complete the Alzheimer's Assisted Living Disclosure Statement (HHSC Form 3641) if they are certified to provide care to residents with Alzheimer's disease and related disorders. By using this form, assisted living facilities can demonstrate their commitment to transparency and accountability in providing memory care services.

• This form is used by assisted living facilities that advertise or promote memory care services to residents with Alzheimer's disease or related disorders.
• The form requires facilities to provide specific information about their memory care services, including the types of assistance offered and the pre-admission process.
• Facilities must complete this form if they are certified to provide care to residents with Alzheimer's disease and related disorders.