South Dakota is an ideal retirement choice for seniors on a budget. The cost of living is well below the national average and there are no state income taxes, so seniors have more money in the budget to enjoy their golden years. More than 17% of the state’s 895,000 residents are aged 65 and older, and this population has access to quality health services from facilities such as Avera McKennan Hospital and University Health Center. Although winters are cold, summers are comfortable and may tempt seniors into enjoying South Dakota’s scenic vistas. 

In-home care in South Dakota costs an average of $5,911 per month and offers assistance with daily activities such as grooming and meals. Home health care also averages $5,911 monthly and provides medical help such as skilled nursing. Both of these services can help seniors who wish to remain living at home. 

This guide has an overview of the costs for in-home care and other senior living options in South Dakota. It also covers programs that can help you finance in-home care and resources available in the state to help you age in place.

The Cost of In-Home Care in South Dakota

According to the Genworth 2021 Cost of Care Survey, the average monthly cost of in-home care in South Dakota is $5,911. This is high compared to the national average of $4,957 and the region. At $5,148 per month, Nebraska has the most affordable in-home care in the surrounding states. In Wyoming and Iowa, the average price is $5,529, while seniors in North Dakota pay $5,689. Minnesota is the only one of South Dakota’s neighbors with higher costs. Seniors there pay $6,673 per month or $762 more than those in South Dakota.


South Dakota


The United States


North Dakota









South Dakota’s two major cities, Rapid City and Sioux Falls, have average in-home care costs of $6,101. This is slightly higher than the state average. Close to the South Dakotan border, Sioux City, Iowa, is significantly cheaper at $5,539. Omaha, Nebraska, and Casper, Wyoming, are also more affordable than South Dakota’s cities, with costs of $5,529 and $5,720 respectively. North in Bismarck, North Dakota, cost is significantly higher at $7,823 per month. 


Rapid City


Sioux Falls


Omaha, NE


Bismarck, ND


Casper, WY


Sioux City, IA

Older adults in South Dakota have a range of senior living options to suit their needs. Adult day health care is the most affordable at $2,600 per month. Assisted living is also an affordable option in South Dakota, with an average cost of $3,350. Like in-home care, home health care costs $5,911 monthly. At $7,118, nursing home care is the most expensive option, reflecting the higher level of care provided.


In-Home Care


Home Health Care


Adult Day Health Care


Assisted Living


Nursing Home Care

Does Medicaid Cover Home Care in South Dakota?

Medicaid in South Dakota covers home care directly and through waiver programs. The Personal Care Services program offers limited home care through Medicaid. The waiver program is known as the Home and Community-Based Options and Person Centered Excellence (HOPE) program. The benefits available through the programs are similar and designed to prevent or delay nursing home entry. Services include assistance with activities of daily living, shopping and cleaning. However, the Personal Care Services program only provides services for a limited number of hours each year. 

Home Care Waiver Programs in South Dakota

Home and Community-Based Options and Person Centered Excellence (HOPE)

The HOPE Waiver is also known as the Elderly Waiver or HCBS Waiver. Unlike the Personal Care Services Program, HOPE waiting lists may apply. Also, residents aren’t able to receive benefits from HOPE and Personal Care Services at the same time. 

HOPE is available to people aged 65 and over who require a nursing home level of care. Adults under 65 are also eligible if they have been assessed as disabled by the Social Security Administration. Applicants must also meet the income and asset limits of the program. The cost of care provided for individuals in the program can’t exceed 85% of the cost of the same care in a nursing home. 

HOPE is available to people in a number of different living situations including the home, assisted living facilities and community living homes. Note that not all benefits are available in all living situations. Recipients can receive assistance with activities of daily living, such as grooming, mobility and dressing. Other benefits include companionship, homemaker support, delivered meals, respite care and private duty nursing. In addition, seniors may be able to get funding to help with home modifications, medical equipment and emergency response systems through the waiver. 

Seniors interested in the program can contact their local Department of Social Services office or the Aging and Disability Resource Center in their area. 

How to Know if You’re Eligible for Medicaid in South Dakota

Seniors must first meet the financial criteria to be eligible for Medicaid. In South Dakota, singles must have an income of less than $10,092 and assets of less than $2,000. In two-person households, the income limit is $15,132 and the asset limit is $3,000.

Not all assets are counted when calculating eligibility for Medicaid. Personal belongings, an automobile and certain prepaid funeral contracts are exempt. Your home is also exempt if you still live there and the equity interest is less than the state limit. 

2022 Medicaid Income Limits for Seniors in South Dakota

Income Limits*
Asset Limits

Single Person



Two-Person Household



*Per year

In addition to meeting financial criteria, seniors must be:

  • A resident of South Dakota
  • A U.S. citizen, resident or legal immigrant

Applicants may also need to meet functional eligibility criteria to qualify for certain programs and benefits.

How to Apply for Medicaid in South Dakota

You can apply for Medicaid by filling in an application and returning it in person or by mail or fax to your local Department of Social Services office. Forms can be downloaded from the website or you can call (800) 305-3064 to request one. There is not currently an online application option for long-term care-related programs.

What Information You Will Need  

In order to assess your application, the Department of Social Services asks for proof of:

  • Identity and date of birth
  • Citizenship or residency status
  • Income
  • Assets
  • Housing costs
  • Existing health insurance

How to Get Help Applying for Medicaid 

Area Served
Services Provided

(605) 773-4678

Entire State

Medicaid applications are processed by local Department of Social Services offices. Staff at these offices can answer questions about applying and help you complete applications. You can also request an interview to assist you with the application process.


Entire state

The department’s website has detailed information on the application process, information required and your benefits and responsibilities. The site’s frequently asked questions can also help you determine your eligibility.

Local numbers are available online

Entire state

SHINE is designed to help seniors navigate the Medicare system by providing counseling and education. Counselors are also knowledgeable about other health insurance options, including Medicaid.

Does Medicare Cover In-Home Care in South Dakota?

In general, Medicare does not cover the cost of non-medical home care. That being said, there are situations in which Medicare provides some coverage for medical home care, referred to as “Home Healthcare.” There are several eligibility restrictions for coverage, including that individuals must be homebound and have a referral from their doctor specifically for home healthcare services.

Below is an overview of some of the skilled medical professionals whose in-home services are typically covered by Medicare – for more in-depth information, refer to our Guide to Home Healthcare.

  • Physical Therapists: Physical therapy is used to help patients recover from injuries (broken bones, knee injuries, etc.), treat ongoing conditions such as arthritis, and assist in recovery from surgeries and procedures such as a knee or hip replacement.
  • Visiting Nurses: Licensed nurses can provide a number of medical services for those who don’t need to stay in the hospital, but do need regular medical services such as wound care, changing feeding tubes, etc.
  • Occupational Therapists: Occupational therapists help seniors regain or maintain the ability to accomplish normal, daily tasks, such as bathing, dressing, eating, and other daily activities.
  • Speech Therapists: Speech therapists help seniors who are struggling to adequately communicate due to a stroke, dementia, or any other cause regain the ability to functionally communicate using a variety of means. Additionally, speech therapists help to keep seniors independent by modifying diets, teaching special techniques to swallow safely, and retraining associated muscles.

As mentioned above, in-home care is distinctly different from home healthcare. But, there can be some overlap in services between the two types of care. So, while Medicare doesn’t cover non-medical in-home care, there are in-home care services that may be covered in special circumstances when they’re provided in conjunction with home healthcare (such as an occupational therapist helping with eating or dressing)

Other Financial Assistance Options for In-Home Care in South Dakota

While the above programs help many people finance in-home care, they will not cover all costs for everyone. There are other ways to pay for in-home care, including out-of-pocket arrangements with siblings, annuities, reverse mortgages, private insurance and more. Read’s Guide to In-Home Care Costs to learn more about these alternative payment options.

Free and Low-Cost Resources for Seniors in South Dakota

South Dakota has a range of free and low-cost resources that can help seniors access assistance, stretch their budget and live independently. Government and nonprofit organizations across the state offer meals, care planning, legal services and more.

Area Served
Services Provided

(833) 663-9673

Entire state

Dakota at Home is the Aging and Disability Resource Center for the state. It provides free information and referral services to help people locate resources in the community. Seniors can also access options planning to guide decisions about their future.

(605) 773-3181

Entire state

CHIP provides low-interest loans to low-income homeowners to help repair or improve homes. Accessibility modifications are eligible improvements through the program. Seniors can also use a CHIP loan for weatherization improvements or to make repairs that enhance safety.

(605) 773-3165

Entire state

LIEAP helps low-income households pay for heating costs. Eligibility is based on your household size and income, with payments made directly to energy suppliers. The state also has the Energy Crisis Intervention Program for people at risk of losing their heating.

Local numbers available online

Entire state

The Nutrition Program works with 20 nonprofit organizations across the state to provide hot meals to people aged 60 and over. Meals may be provided in a group setting or delivered to those who are homebound. The programs also offer opportunities for social contact.

(855) 287-3510

Entire state

Access to Justice is a project of the State Bar of South Dakota. It helps connect eligible South Dakotans, including low-income seniors, with pro bono legal services. 


Entire state

South Dakota has a number of tax relief programs that can assist older residents. Seniors can receive a sales and property tax refund each year. There is also municipal property tax reductions, a homestead exemption and an assessment freeze on property for older adults.

COVID-19 Rules for In-Home Care Providers in South Dakota

As of April 2022, all Medicare and Medicaid certified home providers must be vaccinated against the virus that causes COVID-19. This is true of both in-home care providers and home health care providers. However, federal and state rules can change rapidly. If you’re concerned about the vaccination status of your care providers, check with the local area agency on aging for up-to-date information. 

It’s also possible for your home care agency to have more stringent rules regarding vaccinations and PPE usage. A representative of the agency can answer any questions you have regarding the policies and procedures your caregiver is operating under.

In-Home Care Laws and Regulations in South Dakota

Although in-home, non-medical care services are unlicensed in South Dakota, there are several laws and regulations that apply to home care providers and homemaker agencies to protect seniors from abuse, fraud and exploitation. Several guidelines apply to in-home care providers covered under South Dakota Medicaid programs, and the following table highlights those guidelines.

In-Home Care Laws and Regulations in South Dakota
Scope of Care
Home care providers may deliver non-medical personal care and assistance, such as help with bathing and grooming, laundry and housekeeping, and escorting clients to appointments.
Care Plan Requirements
Although care plans are not required for clients of in-home caregivers, seniors who receive homemaker services through Medicaid must have a current care plan in place.
Medication Management Requirements
Unlicensed in-home caregivers may not administer prescription or over-the-counter medications. They can provide medication reminders and assist with self-administration of medications.
Staff Screening Requirements
Home care agencies that employ in-home caregivers are required to screen all employees who deliver direct services to seniors. Screening must include a state background check.
Staff Training Requirements
There are no state-mandated training requirements for in-home, non-medical caregivers in South Dakota. However, most home care agencies will only hire caregivers who have completed basic first aid training and have a suitable combination of hands-on experience and formal education working with seniors.
Medicaid Coverage
Reporting Abuse
By law, homemakers in South Dakota who have concerns regarding the neglect, abuse or exploitation of any senior must make a written or oral report within 24 hours to a local law enforcement agency, the state attorney general or the Department of Human Services.

Frequently Asked Questions

How Much Does In-Home Care Cost in South Dakota?

The average cost of in-home care in South Dakota is $5,339 per month, based on 44 hours of care per week. Actual costs vary depending on the location. Prices are lowest in Sioux City along the eastern border at $5,053 per month and highest along the western border in Rapid City at $6,673 per month.

Does South Dakota Medicaid Pay for In-Home Care?

Yes. Seniors who meet the financial criteria for Medicaid enrollment, are aged 65 and older and are assessed as needing the level of care typically provided in a nursing home setting can apply for the HOPE Waiver, a home and community-based Medicaid Waiver that funds in-home care.

Are There Transportation Assistance Programs in South Dakota?

Many regional paratransit services are available throughout South Dakota, although most of these services are based in urban areas, such as Sioux Falls. Seniors can learn about the transportation assistance programs in their area by contacting their nearest State Agencies on Aging office.

What Support Can Help Me Age at Home?

As people age, they often develop physical and cognitive limitations that can make everyday tasks, such as cooking, cleaning and caring for their pets, a challenge. Congregate dining programs and meal delivery services, barrier-free transportation and in-home care can all help older adults remain safe and healthy in their own homes as they age.

What Types of Services Does a Home Care Aide Provide?

Also known as homemakers, home care aides provide non-medical assistance and support. Duties may include grocery shopping, meal prep, light housekeeping, pet care and companionship. Home care aides can also provide medication reminders, and those with access to a vehicle may escort seniors to medical appointments, social events and help with errands.

How to Find an In-Home Care Provider in South Dakota

Whether you are looking for yourself or a loved one, finding a quality home care provider can be a stressful process. When you hire an in-home care aide you’re placing a lot of trust in the hands of the person by inviting them into your home, so you’ll want to be diligent in your search. At, we’re here to help – we’ve created a helpful checklist below that can help guide you through the process of both determining your needs and finding a home care agency that will provide the best care possible.

Find Home Care Agencies Near You

To find quality home care providers near you, simply input the zip code or city where you would like to start your search. We have an extensive directory of home care agencies all across the nation that includes in-depth information about each provider and hundreds of thousands of reviews from seniors and their loved ones.

2017, 2019, 2020, 2021

Right at Home Southeast South Dakota

1400 W Russell St, Sioux Falls, SD, 57104

They make my day and help me take care of myself. I wish that part of it could be paid by medicare.
They make my day and help me take care of myself. I wish that part of it could be paid by medicare.


Kore Cares

3101 W 41st St #210,, Sioux Falls, SD, 57105

I am very pleased; I know that when they come, my house will actually be cleaned properly. Every caregiver has gone above and beyond my expectations.
I am very pleased; I know that when they come, my house will actually be cleaned properly. Every caregiver has gone above and beyond my expectations.

Home Instead – Sioux Falls, SD

5421 W 41st St, Suite 208, Sioux Falls, SD, 57106

I am very pleased with the Staff of Home Instead .I had moved over to this company because of the lack understanding from an other Homecare company . Since I’ve discussed these concerns with the Staff … (read more)
I am very pleased with the Staff of Home Instead .I had moved over to this company because of the lack understanding from an other Homecare company . Since I’ve discussed these concerns with the Staff … (read more)

Eli Home Care LLC

707 W 11th St , Sioux Falls, SD, 57104

Choosing a reliable home health care agency is a crucial step to ensure your family members will have the level of care they deserve. The needs of your family are always in our focus and everything we … (read more)
Choosing a reliable home health care agency is a crucial step to ensure your family members will have the level of care they deserve. The needs of your family are always in our focus and everything we … (read more)

Interim HealthCare of Sioux Falls, SD

3626 S. Southeastern Ave., Sioux Falls, SD, 57103

The staff at Interim is absolutely incredible between taking care of my father and helping me as his care giver they are truly a blessing, my father has late stage Alzheimer’s and they are so dedicate … (read more)
The staff at Interim is absolutely incredible between taking care of my father and helping me as his care giver they are truly a blessing, my father has late stage Alzheimer’s and they are so dedicate … (read more)

Good Samaritan Society

5320 W. 49th St. Ste 47, Sioux Falls, SD, 57106

Comfort Keepers In Home Care

4300 S. Louise #302, Sioux Falls, SD, 57106

Home Helpers

431 N. Phillips Ave, Suite 301, Sioux Falls, SD, 57104

SYNERGY HomeCare of Dakota Dunes

108 E 38th St Suite 600,, Sioux Falls, SD, 57105

Home Care Assistance of South Dakota

5009 So. Western Ave., Ste. 220, Sioux Falls, SD, 57108

Sioux Falls Primary Home Care Services

201 N Minnesota Ave #101l , Sioux Falls, SD, 57104