TX HHS Form 3651. Memory Care Disclosure Statement for Nursing Facilities

The Memory Care Disclosure Statement for Nursing Facilities (Form 3651) helps families make informed decisions about care by providing standardized information about the services offered by nursing facilities that advertise or promote memory care. This form is typically completed by nursing facility administrators to describe the specialized dementia care provided, including any designated units or secured areas.

The statement requires facilities to provide specific information about their services, including whether they have a specialized unit for residents with dementia and if they are certified to provide care to residents with Alzheimer's disease or related disorders. Facilities must also post this disclosure statement along with their facility license and provide copies to anyone requesting information about memory care services.

This form is essential for nursing facilities that advertise or promote memory care services, as it empowers consumers to make informed decisions about care. By completing the disclosure statement, facilities can demonstrate their commitment to providing high-quality dementia care and help families choose the best facility for their loved ones. Key points to note include:

• Nursing facilities must complete this form if they advertise or promote memory care services.
• The form requires specific information about a facility's services, including designated units or secured areas.
• Facilities must post the disclosure statement along with their facility license and provide copies to interested parties.