South Dakota is home to a population that’s just under 885,000, and seniors aged 65 and older make up 17.2% of the state’s population. Elders in the state have access to many support programs and services administered by South Dakota’s State Unit on Aging, the Division of Long Term Services and Supports and various government agencies, non-profit organizations and church groups. South Dakota seniors who prefer to age in place in their own homes may need assistance from an in-home caregiver, also known as a homemaker. The statewide average cost of in-home care in South Dakota is $5,339, which is well above the national average of $4,290.

Keep reading to learn about the cost of in-home care in South Dakota and how it compares to prices in neighboring states. There’s also information on financial aid programs to help seniors pay for in-home care and a list of free and low-cost resources in South Dakota.

The Cost of In-Home Care in South Dakota

In-Home Care Costs in Nearby States

According to Genworth’s 2019 Cost of Care Survey, the average cost of in-home care in South Dakota is $5,339 per month, based on 44 hours of care per week. Home care costs in South Dakota are significantly higher than the national average of $4,290. Prices in many nearby states are also well above the U.S. average, including in Wyoming ($5,339), Minnesota ($5,529) and North Dakota ($5,148). Compared to South Dakota, in-home care is less expensive in neighboring Montana ($4,576), Nebraska ($4,671) and Iowa ($4,767).


South Dakota


United States Average






North Dakota



Cost of Other Types of Care in South Dakota

In-home care is on par with home health care as the second-most expensive type of senior care in South Dakota, where home health care also costs an average of $5,339 per month. The most expensive type of care is nursing home care at $6,844 per month, while assisted living averages $3,500 per month. At $2,427 per month, adult day health care is the lowest-priced option, but as with all other types of senior care in the state, that cost is also well above the national average of $1,625.


In-Home Care


Home Health Care


Adult Day Care


Assisted Living Facility


Nursing Home Care

The Cost of In-Home Care in South Dakota’s Top Cities

While the statewide average monthly cost of in-home care is $5,339, actual charges may be higher or lower than the average depending on the location, amenities and services. In-home care costs in Rapid City, located near the Wyoming border, are $6,673 per month. In contrast, average care costs are significantly lower at $5,053 per month in Sioux Falls along the South Dakota-Minnesota border. Since these are the only two cities in South Dakota on the Genworth survey, cities surveyed across South Dakota’s borders to the east in Mankato, MN, and Sioux City, IA, are both close in price for in-home care in Sioux Falls, SD. For a savings that is $2,300 – $4,000 less than care in South Dakota, seniors can move to Bismark, ND and pay only $2,669 per month for the same services.


Rapid City


Sioux Falls


Bismark, ND


Mankato, MN


Sioux City, IA

Financial Assistance for In-Home Care in South Dakota

Home and Community-Based Options and Person Centered Excellence Waiver

South Dakota seniors who meet the clinical criteria for nursing facility admission are aged 65 or older, and those who prefer to remain in their own homes may be eligible for enrollment in the Home and Community-Based Options and Person Centered Excellence Waiver, or HOPE.

This Medicaid waiver is designed to help reduce or prevent nursing home placement among frail seniors by funding in-home care, private duty nursing care, medical alert devices and specialized medical equipment to support seniors in their own homes.

Who Is Eligible?
To be eligible for enrollment in the HOPE Waiver, applicants must be South Dakota residents aged 65 and older, meet the financial criteria for Medicaid coverage, and be assessed by a physician as needing the level of care normally provided in a nursing home.

How to Apply
To apply for the HOPE Waiver, seniors can contact their nearest Department of Human Services, Long Term Services and Supports Office.

South Dakota Caregiver Support Program

The Caregiver Support Program provides support to adult family members and other informal caregivers who care for seniors aged 60 or older or adults of any age who have been diagnosed with a chronic health condition, Alzheimer’s disease or a similar form of memory loss.

This program provides caregivers with access to long-term services and supports, individual training and counseling, and respite care to prevent caregiver burnout, which can lead to the institutionalization of frail seniors.

Who Is Eligible?
Caregivers for seniors or the severely disabled who are receiving informal support from a family member, friend or neighbor may be eligible to receive services and respite care through the Caregiver Support Program.

How to Apply
For more information, call Dakota at Home at 1-833-663-9673.

VA Aid and Attendance Benefits and Housebound Allowance

The VA offers two enhanced VA pension programs that eligible veterans, dependents and survivors can use to help cover in-home care costs in South Dakota. The VA Aid and Attendance Benefits and the Housebound Allowance provide monthly cash benefits that can be used at the discretion of the beneficiary.

Who Is Eligible?
To qualify for either of these enhanced VA pension benefits, applicants must first be eligible for the regular VA pension.

To be eligible for Aid and Attendance, applicants also must require daily assistance from another person to perform one or more activities of daily living, be bedridden due to chronic illness or be legally blind.

For the Housebound Allowance, applicants need to be primarily limited to their own home as a result of a permanent disability, which may or may not be service-related. Alternatively, applicants may be eligible for the Housebound Allowance if they have one disability rated by the VA at 100%, and at least one additional permanent disability assessed by the VA as 60% or greater.

How to Apply
To apply for the VA Aid and Attendance Benefits or the VA Housebound Allowance, contact the nearest VA location or call the South Dakota Department of Veterans Affairs at 1-877-579-0015.

More Ways to Pay for In-Home Care

While the above programs help many people finance in-home care, they won’t 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 In-Home Care Resources in South Dakota

In addition to Medicaid-funded programs and services, there are a number of free and low-cost resources in South Dakota to help seniors who need in-home care.

ContactServices Provided
Dakota at Home833-663-9673Dakota at Home is South Dakota’s Area Agency on Aging and Disability Resource Center. Operated by the South Dakota Department of Human Services, this service provides free information and referrals for South Dakota residents of all ages who need support services, such as in-home care.
South Dakota Department of Veterans Affairs877-579-0015South Dakota’s Department of Veterans Affairs helps veterans, survivors and dependents secure local, state and federal benefits, including the VA Aid and Attendance and Housebound enhanced pension benefits. Veteran services officers can also help veterans access VA health care services, register for burial benefits, and arrange for transportation to VA health clinics.
South Dakota Adult Nutrition Program833-663-9673Seniors can access free and low-cost meals every weekday through South Dakota’s Adult Nutrition Program. The Program provides hot, nutritious meals that meet one-third of an older adult’s daily dietary needs, and meals are served in communal settings, such as seniors’ centers and church halls throughout the state. Some regional meal programs also offer low-cost home meal delivery service for housebound seniors.
South Dakota Senior Health Information and Insurance EducationContact the nearest SHIINE OfficeSouth Dakota seniors can access free, unbiased information and assistance with Medicare and supplemental health insurance by contacting the South Dakota Senior Health Information and Insurance Education program. Three SHIINE offices serve eastern, central and western South Dakota.
Division of Long-Term Services and SupportsContact the nearest LTSS officeSeniors aged 60 and older who need help accessing in-home and community-based services can contact South Dakota’s Department of Human Services, Division of Long Term Services and Supports.

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.

Scope of CareHome 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 RequirementsAlthough 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 RequirementsUnlicensed 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 RequirementsHome 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 RequirementsThere 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 CoverageSouth Dakota’s Home and Community-Based Options and Person Center Excellence (HOPE) Medicaid Waiver includes coverage for in-home care.
Reporting AbuseBy 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.