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Guide to Senior Living in South Dakota

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.

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

The following rules and guidelines were obtained from the South Dakota Department of Health website, as well as other state-level government sites. Among others, these rules apply to long term care (LTC) including nursing homes (NH) and assisted living centers (ALC).

This data has been most recently updated on 7/13/20, but keep in mind that COVID-19 is a rapidly evolving crisis, so all of the below information can change at any time. For additional questions and up-to-date information, you can contact your loved one’s senior living facility or your local Area Agency on Aging.

Visiting Loved Ones

Can I visit my relative in person if he/she wants emotional support from me?Yes, outdoors (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?NA
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, but it is strongly discouraged
Are residents of senior living facilities who leave and return required to self-quarantine?NA
Are senior living facilities required to cancel all group outings?Yes
Are residents still eating together in the dining hall?Yes, with social distancing
Are facilities still allowed to host group activities within the community?Yes, with social distancing

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
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

Paying for Senior Living in South Dakota

Assisted living is one of South Dakota’s most affordable options for senior care. At $3,500 a month, the average cost of assisted living is well below the average cost for in-home care and home health services, which both cost $5,339 a month, on average. Semiprivate rooms in the state’s nursing homes cost an average of $6,844, while adult day care costs can average $2,427 a month.


Assisted Living


In-Home Care


Home Health Care


Adult Day Care


Nursing Home Care

The Cost of Assisted Living in South Dakota

Assisted living in South Dakota is relatively affordable compared with the national average and nearby states. Seniors in South Dakota pay an average of $3,500 a month for assisted living, while the average national cost is $4,051 for similar services. Nearby states tend to be more expensive than South Dakota. Montana, Wyoming and Minnesota all have costs close to each other, at $3,820, $3,780 and $3,800, respectively. Among states adjacent to South Dakota, only North Dakota averages lower assisted living costs, at $3,405 a month.


South Dakota


United States






North Dakota



The Cost of In-Home Care in South Dakota

At a price of $5,339 a month, the cost of in-home care in South Dakota is equal to Wyoming, and comparable to both North Dakota ($5,148) and Minnesota ($5,529). Only Montana reports lower costs for in-home care with an average monthly rate of $4,576. Unfortunately, all of these prices are above the national average of $4,290. 


South Dakota


United States






North Dakota



The Cost of Nursing Home Care in South Dakota

Nursing home care offers seniors both extensive medical assistance as well as daily supervision. In the U.S., the average cost for this type of care is $7,513 per month, but seniors in South Dakota pay less than that at $6,844 monthly. Care in the state is also  significantly cheaper than all neighboring states. Seniors in Montana, Wyoming, North Dakota and Minnesota will pay on average $500 – $5,031 more for nursing home care than seniors in South Dakota. 


South Dakota


United States






North Dakota



Financial Assistance for Senior Living in South Dakota

HOPE Waiver

The HOPE waiver is South Dakota’s Home and Community-Based Services Medicaid waiver for seniors who need help paying for the cost of senior living. HOPE waivers pay for many senior care expenses, such as the monthly cost of residence in a senior living facility. Other services paid for under the HOPE program, such as home modifications and in-home care, are not available to seniors who opt for residential senior living in a facility.

Seniors in South Dakota may qualify for a HOPE waiver if they’re enrolled in Medicaid and have a physician’s referral to a nursing home level of care. The waiver program pays for the less expensive senior living service for seniors who meet all program participation criteria. These are:

  • U.S. citizen or permanent legal resident
  • Aged 65 and over
  • Enrolled in Medicaid
  • Have a qualifying disability
  • Participate in a needs assessment for placement in the program

The HOPE waiver program imposes relatively strict financial limitations on applicants’ eligibility. In 2020, seniors applying for a HOPE waiver must earn less than $2,349 a month and have less than $2,000 in countable assets. HOPE intake workers can look back over a five-year history for asset transfers and large financial transactions, which are then factored into the eligibility calculation prior to approval.

Contact: Seniors can call (605) 773-3656 to contact DHS staff about the HOPE waiver. Eligible seniors can also visit a local Department of Social Service office.

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.

South Dakota Senior Living Free Resources

South Dakota Agencies

South Dakota Medicaid

Medicaid is a joint federal-state entitlement program that provides basic health insurance to seniors and people with low income. Covered benefits include preventive health screenings and care, needed diagnostic and treatment options and some prescription medications. Medicaid can also help pay for some mobility devices and durable and disposable medical supplies for many seniors.

To enroll in South Dakota’s Medicaid program, seniors must earn less than $783 a month and have $2,000 or less in countable assets over a five-year look-back period. Married couples applying together, or married seniors applying alone, may earn up to $1,700 a month and keep up to $3,000 in countable assets. South Dakota’s Medicaid program doesn’t offer medical need or hardship exemptions to the financial standards for enrollment.

Contact: Seniors can call 1-800-305-3064 to apply for Medicaid over the phone with a state DHS rep. Seniors can also apply in person at a local Department of Social Services office.

Area Agencies on Aging in South Dakota

South Dakota has seven Area Agencies on Aging, whose offices are located around the state. Adults aged 60 and over can visit these offices for help getting access to senior-specific programs, such as caregiver assistance and community outreach programs. AAAs also periodically organize social gatherings for local seniors at a community or senior center, which can help prevent social isolation and bring local seniors together.

Veterans Affairs Offices in South Dakota

The South Dakota Department of Veterans Affairs operates several regional offices in the state where honorably discharged veterans can get help with senior living issues. Staff at the VA offer referrals for counseling and medical care, including preadmission health screenings for senior living. The VA can also provide expert case manager support for senior veterans and their qualifying spouses, who may need assistance locating and applying for the various social services they are eligible for.

Military & Veterans Affairs Office425 E Capitol Ave
Pierre, SD 57501
(605) 773-3269
VA Sioux Falls Regional Benefit Office2501 W 22nd St, Bldg 38
Sioux Falls, SD 57105
(800) 827-1000
Sioux Falls Vet Center3200 W 49th St
Sioux Falls, SD 57106
(605) 330-4552

Social Security Offices in South Dakota

Seniors can visit a local Social Security office for help signing up for the various programs the SSA offers. These include Social Security pensions, the federal Medicare health program and SSI/SSDI. In addition to these services, many SSA offices can help seniors sign up for nutrition support and various other benefits.

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.

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.

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