South Dakota was the inspiration for the original Little House on the Prairie books, and today much of the state west of the Missouri River is still covered by ranches and homesteads. Just over 880,000 people live in South Dakota, most of them east of the river in only a few cities of any size. Over 16% of South Dakota’s residents are seniors aged 65 and over, and the state can be very affordable for them. South Dakota doesn’t tax regular income from work, and it leaves all forms of retirement income, from Social Security to IRA withdrawals, untouched as well. Public and private pensions are not taxed at the state level, and seniors aged 70 and over can defer the payment of property taxes through South Dakota’s Homestead Exemption until their home has sold.

Seniors in South Dakota can choose from 133 senior living communities and will find  costs for all care types within about $1,000 of the national average, according to the Genworth 2019 Cost of Care Survey. These and other costs can make senior care difficult to manage for some seniors on fixed or limited incomes. The purpose of this guide is to help seniors in South Dakota understand what the likely costs of care can be, as well as to identify the free and low-cost resources available to help them find safe and comfortable senior living in South Dakota.

The Cost of Senior Living in South Dakota

Note: There currently isn’t authoritative data on the average cost of Independent Living Facilities nationwide, so instead, we use the cost of Assisted Living to estimate it. Since the cost of Independent Living is typically 30-40% lower than the cost of Assisted Living, the numbers below were calculated by subtracting 35% from the cost of Assisted Living.

Note: Memory care is typically provided in communities licensed as assisted living facilities, and in general, costs 20-30% more than standard assisted living services. No authoritative cost data is available for this type of care, so we estimated memory care rates by adding 25% to assisted living fees in the Genworth 2021 Cost of Care Survey.

Over time, nearly all seniors develop a need for some type of long-term care support or service. Independent living feels and functions like a private home. Facilities provide minimal assistance, seniors have opportunities to socialize with others in the community. Assisted living communities offer varying levels of help, including memory care for those with cognitive impairments. Nursing homes are one step down from hospital care. It’s generally the most expensive type of long-term care and the most comprehensive.

According to Genworth’s 2021 Cost of Care Survey, assisted living in South Dakota costs $3,350 per month on average. Memory care is around 25% more at $4,188 per month. An independent living community is the least expensive residential care option at $2,178 per month, while seniors who choose a semiprivate room in a nursing home can expect to pay around $7,118.

The Cost of Assisted Living in South Dakota

The exact cost of assisted living varies depending on a number of factors, including the location, size of the facility, amenities and types of care provided. In South Dakota, assisted living communities cost around $3,350 per month. This is less than the national average of $4,500. South Dakota facilities cost less than those in several surrounding states. North Dakota is closest in cost at $3,391 per month. Wyoming and Nebraska seniors pay around $4,169 and $4,076, and those in Minnesota pay around $4,508.

The Cost of Nursing Home Care in South Dakota

In the United States, the average cost of a semiprivate room in a nursing home is $7,908 per month. In South Dakota, the same type of care costs around $7,118. Wyoming is one neighboring state with lower nursing home costs at $6,996 per month. North Dakota has some of the highest rates in the region at $11,978. Minnesota nursing homes average $11,601 per month, and Nebraska’s facilities cost around $7,483.

Can You Use Medicaid to Pay for Senior Living in South Dakota?

South Dakota’s seniors who require long-term care may receive assistance with the payment of some services through the state’s Medicaid program. Medicaid covers most medically necessary services regardless of the residential arrangement; however, it only covers room and board in a nursing home. Assisted living and memory care is partially covered by state waivers, but nursing homes are fully covered provided that these services are recommended by a physician. Because independent living doesn’t cover any medical treatment, it’s typically not covered by any insurance plans.

	Medicaid Coverage Level	Type of Medicaid Coverage	Entitlement? *
Assisted Living	Partial	Waiver	No
Independent Living	None	N/A	N/A
Memory Care	Partial	Waiver	No
Nursing Home Care	Full	Medicaid	Yes

*Note: Entitlement programs mean that everyone who qualifies will receive coverage and be accepted into the programs. If the program is not “entitlement,” then participant caps could be in place, and there may be a waiting list.

Medicaid’s Coverage of Assisted Living & Memory Care in South Dakota

Services in assisted living and memory care facilities in South Dakota are partially covered by the Home- and Community-Based Services HOPE Waiver. The HOPE Waiver is designed to provide services at home or in the community to delay entry into a nursing home.

HOPE Waiver

The HOPE Waiver provides services to seniors who require nursing home care. The waiver pays for homemaker support, delivered meals, personal care assistance and home safety modifications. The waiver allows seniors to choose their own caregivers and even hire family members to provide support.

Seniors who are eligible for Medicaid also qualify for the HOPE Waiver. To apply, contact the South Dakota Department of Human Services Long Services and Supports division at (605) 773-5483.

Medicaid’s Coverage of Nursing Home Care in South Dakota

Medicaid covers the cost of a nursing home in South Dakota for seniors who meet the income and asset limits for this program. Medicaid covers everything from room and board to personal care services, including grooming, medication management, bathing, transportation and meals. It also pays for physical and speech therapy and skilled nursing. Facilities are typically reimbursed at a fixed daily rate. Those who qualify for Medicaid receive nursing home benefits when this level of care is needed. No additional application is required.

Eligibility for Medicaid in South Dakota

South Dakota residents qualify for Medicaid if they meet income and asset limits for the year. In 2022, these limits include an income of no more than $30,276 per year and assets of no more than $2,000 for a single applicant. In a two-person household, the income limit is $30,276 per applicant. When only one spouse applies, the asset limit is $2,000 for the applicant and $137,400 for the nonapplicant. This allows the individual to remain in the home while avoiding poverty. The asset limit in a two-person household where both seniors apply is $3,000.

2022 South Dakota Medicaid Income Limits

	Yearly Income Limits	Asset Limits
Single Person	$30,276	$2,000
Two-Person Household (Only One Applicant)	$30,276 for applicant	$2,000 for applicant $137,400 for nonapplicant
Two-Person Household (Two Applicants)	$30,276 per applicant	$3,000

Aside from income and asset limits, there are other eligibility requirements for Medicaid to consider. Applicants must:

• Be 65 years of age or older.
• Be a citizen of South Dakota.
• Be a permanent resident of the United States.
• Require nursing home care.

Applying for Medicaid in South Dakota

Seniors can apply for South Dakota Medicaid online through the South Dakota Department of Social Services website or by calling (800) 305-3064. Applicants may also submit a paper application by downloading the form, completing it and mailing it to the Department of Social Services, Division of Economic Assistance, 700 Governors Drive, Pierre, SD 57501.

Before You Apply

Before applying for Medicaid, South Dakota seniors should gather important information to prove their eligibility. This includes:

• Copy of a birth certificate
• Proof of citizenship or legal alien status
• Government-issued ID
• Social Security number
• Copies of bank statements for the past 60 days
• Copies of income from all sources for the past 60 days
• Copies of award letters for veterans’ benefits, retirement accounts and Social Security
• Documents proving property ownership
• Additional documentation to prove eligibility

How to Get Help

Seniors in South Dakota who need help applying for Medicaid can contact one of the following resources for answers to popular questions. These agencies cover everything from eligibility to changing the information on existing accounts.

	Contact	What You Should Know
Medicaid.gov	(800) 633-4227	Medicaid.gov is the starting point for questions concerning Medicaid and the application process. This federal website provides trained professionals who can give details on eligibility, plan options and coverage amounts.
South Dakota Medicaid	(605) 773-3165	South Dakota’s Medicaid website allows seniors to apply for coverage, check the status of their application, make changes to their account and apply for supplemental insurance.
Healthcare.gov	(866) 689-8675	Healthcare.gov is a one-stop shop for information about Medicaid, CHIP and Marketplace coverage available through the Affordable Care Act. Agents can describe Medicaid expansion rules and help seniors determine if they’re eligible for coverage.

Can You Use Medicare to Pay for Senior Living in South Dakota?

Unfortunately, Medicare does not cover the cost of assisted living, independent living, or memory care. Unlike nursing homes, these care types are not considered to be “clinical settings” and so are not eligible for Medicare coverage. That being said, those who live in these communities can still use Medicare to cover the cost of approved medications, doctor visits, medical equipment, etc.

When it comes to nursing home care, it gets much more complicated. Medicare does provide limited coverage for a qualified stay in a nursing home,but there are strict rules and requirements of which you should be aware. This benefit is available to seniors who have been hospitalized for at least three days, excluding the date of discharge.

Once you’ve met the hospitalization requirement, Medicare will pay for up to 100 days in a skilled nursing facility (per benefit period). While the first 20 days are covered in full, there is a daily coinsurance rate that must be paid starting on day 21. After day 100, seniors are responsible for the entire cost.

	Medicare Coverage	Medicare Coverage Duration	Coinsurance Requirement?
Assisted Living	None	N/A	N/A
Independent Living	None	N/A	N/A
Memory Care	None	N/A	N/A
Nursing Home Care	Limited	100 Days Per Benefit Period	Yes – After 20 Days

What Nursing Home Care Services Does Medicare Cover?

Medicare covers a number of specific services, including:

• Meals
• A semiprivate room
• Medications
• Skilled nursing services
• Physical therapy
• Occupational therapy
• Speech therapy
• Audiologist care
• Medical supplies
• Medical social services
• Nutritional counseling
• Ambulance transportation

What Nursing Home Care Services Aren’t Covered by Medicare?

Medicare does not cover long-term custodial care that addresses seniors’ day-to-day needs. This includes help with daily activities, such as bathing, dressing and using medical equipment.

Medicare applications can be challenging for seniors to understand, but there are several organizations that provide assistance throughout the entire process. Many of these resources provide additional assistance with supplemental insurance and making changes to existing accounts.

	Contact	What You Should Know
South Dakota Department of Social Services	(800) 772-1213	The South Dakota Department of Social Services has trained counselors who provide general information on the programs and services offered by state and federal government, including Medicare. The department offers details on eligibility, searches for providers who accept Medicare and helps seniors understand their rights and responsibilities.
South Dakota Senior Health Information and insurance Education (SHIINE)	(800) 536-8197	SHIINE helps seniors in South Dakota understand available insurance options and answers questions concerning enrollment in Medicare and various Medicare supplements. The organization can also help explain benefits, billing, Medigap and prescription drug coverage, and it makes unbiased recommendations regarding the type of insurance best suited for the individual’s needs.
Benefits.gov	(877) 999-5612	Benefits.gov is the federal website for information involving state and federal benefit programs. The site offers a general explanation of Medicare, including eligibility requirements, contact information and application details.

Are There Other Financial Assistance Options for Senior Living in South Dakota?

Depending on your unique situation, there may be other financial assistance options to partially or fully cover the cost of senior living in South Dakota. Below, we cover some of the common ways that seniors can make senior living options such as assisted living or memory care more affordable.

	How to Get Started	What You Should Know
Aid and Attendance	Apply online at va.gov.	If you are a veteran and you receive a VA pension, you may also be eligible for the Aid and Attendance benefit. This benefit takes the form of a monthly cash allowance that you receive in addition to your standard pension. This benefit is used by veterans who need long-term care services, including care received at an assisted living facility.
Reverse Mortgages	Research and learn about the different types at ftc.gov.	If you own a home, you may be able to use a reverse mortgage to access some of the equity in your home. Like traditional loans, reverse mortgages do need to be repaid with interest, typically within 12 months, so seniors should carefully weigh this option alongside other financing methods.
Long-Term Care (LTC) Insurance	Learn about how to receive LTC insurance benefits at acl.gov.	While those who currently need assisted living will typically not be eligible, if you purchased an LTC insurance policy in the past, you may be able to use it to help pay for assisted living. While most policies cover at least a portion of the cost, you still need to check the specific terms of your policy.

Free Senior Living Resources for Seniors in South Dakota

South Dakota has programs and services to address the needs of seniors within the state. These resources are provided by both state and private agencies and are designed to enhance the quality of life of older adults in the area.

	Contact	What You Should Know
South Dakota Department of Human Services	(605) 773-5990	The South Dakota Department of Human Services operates the Division of Long-Term Services and Supports (LTSS), which enables older adults to live independently for as long as possible with the assistance of home- and community-based services. These services include meals, transportation, publications, case management and referrals.
Dakota at Home	(833) 663-9673	Dakota at Home is a free information and referral service that helps seniors identify available public and private long-term services and supports. These resources cover everything from insurance options to caregiver training and relief.
South Dakota Ombudsman Program	(866) 854-5465	The South Dakota Long-Term Care Ombudsman Program investigates and works to resolve complaints on behalf of older adults in long-term care communities. The ombudsman empowers residents by informing them of their rights, makes recommendations for protecting the interests of residents in long-term care facilities, partners with care providers to improve seniors’ quality of life and works with families to address concerns.
Senior Companions	(605) 312-6700	Senior Companions is a nonprofit organization that provides in-home assistance and respite care to seniors within the state and those with disabilities. Services include companionship, transportation, meal planning and preparation, light housekeeping and health checks.
Coalition on Aging	(844) 395-4592	The South Dakota Coalition on Aging connects the aging population with professionals who provide education and forums. The coalition can assist with senior planning, housing and home- and community-based services as well as information about hospice, legal assistance, case management, companionship and health and fitness.

COVID-19 Rules and Restrictions for South Dakota Senior Living Facilities

The following information is based on research done on several government websites, including doh.sd.gov. These rules apply to nursing homes and other types of senior living facilities. We’ve most recently updated this data on 2/13/2022, but since COVID-19 is a rapidly evolving pandemic, contact your local senior living facility or Area Agency on Aging for more specific and up-to-date information.

Visiting Loved Ones

Can I visit my relative in person if he/she wants emotional support from me?	Yes (Conditions Apply)
Can I visit my relative in person for end-of-life compassion care?	Yes
Will my loved one be required to self-quarantine after I visit him or her?	No
Do I need to wear PPE and/or a cloth mask if I do visit my relative in person?	Yes
Are Hairdressers and other non-medical contractors still allowed in senior living facilities?	Yes
Does the state recommend or require that senior living facilities assist families with setting up virtual visit alternatives?	Yes
Are visitors being screened for elevated temperatures?	Yes
Are visitors being asked questions about health, travel, and potential virus contact?	Yes

Outings and Group Activities

Are residents allowed to leave the facility for non-medical reasons?	Yes
Are residents of senior living facilities who leave and return required to self-quarantine?	No (Conditions Apply)
Are senior living facilities required to cancel all group outings?	No
Are residents still eating together in the dining hall?	Yes (Conditions Apply)
Are facilities still allowed to host group activities within the community?	Yes (Conditions Apply)

Safety Measures for Staff & Contractors

Are staff members and contractors being screened for elevated temperatures?	Yes
Are staff members and contractors being tested for Coronavirus?	Yes (Conditions Apply)
Are staff members and contractors being asked questions about health, travel, and potential virus contact?	Yes

Safety Measures for Residents

Are staff members required to regularly screen residents for coronavirus symptoms?	Yes
Are residents relied on to screen themselves and self-report potential coronavirus symptoms?	No
Are staff members required to take residents’ temperatures?	Yes
Are residents being tested for coronavirus?	Yes (Conditions Apply)

Senior Living Laws and Regulations in South Dakota

Note: All these rules typically apply to non-clinical senior living facilities, such as independent living, assisted living, and memory care facilities. Nursing homes and other senior living facilities with a clinical setting may have additional or slightly different requirements and regulations.

Senior living in South Dakota is regulated by the Department of Health. The Department formulates regulations and policy goals, sets living standards and licenses facilities throughout the state. Licensed senior living facilities must submit to inspections by the Department, which may be either scheduled or unscheduled. The Department also sets rules for how senior living facilities in South Dakota must operate, specifically in the areas of new resident admissions, memory care and Alzheimer’s treatment, medication management, and staff training and minimum standards.

Admission Requirements

Prior to admission at a licensed senior living facility, all seniors must undergo a medical and mental health screening that includes a significant needs assessment component. During this examination, a doctor must take the senior’s health history, evaluate their physical, psychological and social needs and draft a plan of care. This care plan must indicate that the specific senior living facility being considered is capable of meeting all of the new resident’s needs within its licensed scope of care. Care plans are to be kept available in residents’ files and are accessible to Department inspectors and designated decision makers acting on behalf of the resident. A revised care plan must be submitted with every change in the senior resident’s condition or ongoing care needs.

Facilities licensed to offer senior living in South Dakota are not permitted to admit residents whose medical needs are greater than what the facility is capable of meeting. Facilities aren’t to admit residents who need continuous IV drip medications, extensive therapy services, such as wound care, or other needs equivalent to skilled nursing care. An exception may be made for seniors who are transitioning into hospice at a facility where they already reside. In that case, a visiting hospice nurse may provide comfort care measures within a designated scope of care.

Memory Care Regulation

Senior living facilities in South Dakota are free to admit or deny admission to seniors with impaired cognition, such as results from Alzheimer’s disease and other forms of dementia. Regardless of the facility’s admission policy, each facility is required to use a validated screening tool to monitor each resident’s level of cognition. Screenings must be performed on admission, annually and after an observed change of condition.

Facilities that admit seniors with Alzheimer’s disease or other cognitive impairment must first be evaluated by the resident’s doctor, physician’s assistant or nurse practitioner to verify that all of the resident’s needs can be met by the facility. Residents with dementia are to be provided with the opportunity to participate in daily therapy and social activities that are mentally engaging. Facilities offering memory care services must be equipped with a functioning set of exit alarms to prevent residents from wandering.

Medication Management

All senior living facilities must develop a written policy for medication management that adheres to state standards. Residents who can understand instructions and self-administer medications may do so, though staff must reevaluate the resident’s level of cognition every three months. A physician’s statement is required that certifies a resident is capable of safely keeping and managing their own medications.

Schedule I drugs are not permitted on the grounds of any senior living facility in South Dakota. Schedule II narcotics may be securely kept in compliance with controlled substances rules for the state. All controlled medications must be secured in a locking container with access limited to authorized staff members. Nursing staff and medication aides may dispense medication only within their scope of practice. Noncertified staff, including personal caregivers, may not administer medication at all. Caregivers are allowed to prompt residents to take medication, assist with minor preparation of a dose and log the resident’s consumption of the medicine.

Staffing Requirements

Senior living facilities in South Dakota are required to appoint an administrator who can act in a management role for the rest of the staff. Administrators must be licensed health professionals, health care or health administration majors with a four-year degree or successfully complete a state-approved course of training for senior living administration. Staff members who provide hands-on care for residents must pass a background and health care worker screening prior to employment. No specific training is required under state law, though facilities must conduct orientation for new employees. South Dakota doesn’t impose a minimum staff ratio, but it does require sufficient staff on duty at all times to care for each resident and manage emergency evacuations.

Frequently Asked Questions

How much does assisted living cost in South Dakota?

Assisted living in South Dakota averages $3,500 a month for many seniors. This is less than the $4,051 seniors pay nationwide, and it’s also less than the monthly cost for many other types of senior care in South Dakota.

Does South Dakota Medicaid pay for assisted living?

Medicaid in South Dakota doesn’t pay for the monthly costs of assisted living. Because board and care are not strictly medical expenses, the low-income health insurance program cannot directly pay for the ongoing monthly cost of care in an assisted living facility. The state does offer some seniors an assisted living waiver, which diverts eligible seniors from nursing care and into assisted living. Seniors can speak with a Medicaid caseworker or admissions rep at a participating assisted living facility for information about the waiver program.

Does Medicare pay for assisted living?

Medicare doesn’t directly pay for the costs associated with assisted living. Original Medicare Parts A and B provide limited inpatient and outpatient services for most beneficiaries, but the nonmedical nature of assisted living excludes it from both types of coverage. Some seniors in South Dakota participate in a Medicare Advantage, or Part C, plan, which can vary somewhat in the extra benefits offered. They can speak with a plan representative to know for sure what a given plan pays for.

What are “activities of daily living”?

Activities of daily living are the regular tasks many seniors need help to complete. These include bathing and personal hygiene, getting dressed, shopping and preparing meals, and, sometimes, light housekeeping. Personal caregivers can assist with these activities, and seniors who need help with two or more of them may qualify for an assisted living waiver in South Dakota.

What is the difference between assisted living and nursing homes?

Assisted living communities provide long-term seniors care in something close to an apartment or private home setting. Nursing care facilities tend to care for residents on shorter timescales and in a more clinical environment. Nursing homes offer skilled nursing care for residents who need post-acute rehab services and help managing chronic illnesses, while assisted living facilities  have a less medically intensive, more independent environment for seniors who could use help with normal activities of daily living.

Learn More About Senior Living in South Dakota

For more information about specific types of senior living in South Dakota read our Guide to Assisted Living and Independent Living.

The Top Cities for Senior Living in South Dakota

Learn more about the cost of senior living in the top South Dakota cities. Additionally, find reviews and information about assisted living facilities and other senior living communities across the state.