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Assisted Living in South Dakota
South Dakota ranks among the least expensive areas in the U.S. for assisted living care, which helped the state take 8th place overall in our 2024 Senior Living Report. The state’s population is growing at a healthy rate, even as others in the region decline, with close to 900,000 residents in total and 154,000 seniors as of the 2021 Census estimates. People of all ages have relatively good access to clean air and drinking water and a health care system that put South Dakota in 1st place in our report for patient satisfaction. Seniors, in particular, may benefit most from the significantly lower risk of respiratory illness and cancer from air pollutants.
The average cost for care in a South Dakota assisted living facility is $3,350 per month, according to the Genworth Financial 2020 Cost of Care Survey. Seniors who are still living in their own homes also save quite a lot on most other important costs of living, such as the savings of 28.8% on transportation and 16.2% on housing.
This guide is intended to help compare South Dakota’s assisted living costs with other areas. Medicaid and other possible sources of assistance are also explained. It also notes some local nonprofits and other government-supported organizations that help seniors. The guide has important information about the laws and regulations about South Dakota’s Assisted Living facilities.
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The Cost of Assisted Living in South Dakota
When trying to decide how to pay for assisted living, one of the first questions that comes up is "How much does it cost?" With the impact of inflation, it's more important than ever to have up-to-date information when making a financial plan for senior living. To help shed light on real senior living prices, Caring.com has compiled proprietary cost data from its network of over 75,000 senior living providers to offer insight into the average cost of assisted living in South Dakota and its 4 cities.
The Cost of Assisted Living in South Dakota's Top Cities
Assisted living prices in South Dakota vary between cities. Aberdeen and Sioux Falls offer some of the most affordable monthly rates at $2,795 and $3,500 respectively, while Rapid City carries a higher cost at $4,297. Across state borders in Bismarck, ND, seniors can expect to pay around $3,435 per month for assisted living.
South Dakota
$4,443
Aberdeen
$2,795
Sioux Falls
$3,500
Rapid City
$4,297
Bismarck, ND
$3,435
Inflation's Impact on the Cost of Assisted Living in South Dakota
On average, South Dakota's assisted living prices haven't been impacted as much by inflation as other states. Between 2022 and 2023, prices decreased by 2%, falling from $4,514 to $4,443 per month. That's significantly lower than the 10% increase experienced across the United States, from $4,070 in 2022 to $4,459 in 2023.
Neighboring states have shown varying results. Monthly prices in North Dakota rose by 14%, while Minnesota's increased by 1%. Although Iowa only saw a 2% cost increase, Nebraska's saw a bigger rise of 13%.
| Location | 2022 Cost (Historical) | 2023 Cost (Current) | 2024 Cost (Estimated) |
|---|---|---|---|
| South Dakota | $4,514 | $4,443 | $4,732 |
| U.S. Average | $4,070 | $4,459 | $4,802 |
| North Dakota | $3,047 | $3,472 | $3,653 |
| Minnesota | $4,399 | $4,433 | $4,314 |
| Iowa | $4,770 | $4,879 | $5,006 |
| Nebraska | $4,480 | $5,043 | $5,304 |
The Costs of Other Types of Senior Living
The level of assistance and amenities a community offers contribute to fluctuating senior living prices in South Dakota. While assisted living is $4,443 per month, memory care is more expensive at $5,350 due to its specialized services, and independent living costs less at $2,652.
Assisted Living
$4,443
Memory Care
$5,350
Independent Living
$2,652
Does Medicaid Cover Assisted Living in South Dakota?
Yes, but only for South Dakota Medicaid recipients who qualify for a waiver program. The relevant program for seniors and people with disabilities is the HOPE Waiver, which is described in more detail below. Medicaid and its waiver programs are intended to help low-income residents with limited assets and, as such, the recipient may be required to spend a certain amount of their monthly income on care services before Medicaid coverage takes over.
In any case, coverage for assisted living and some other home and community-based services via Medicaid isn’t guaranteed, even for those eligible for the HOPE Waiver program. There may be a waiting list at times, for example, or the requested services may be deemed unnecessary or inappropriate for the individual.
What Assisted Living Services Are Covered by Medicaid in South Dakota
Medicaid and the HOPE Waiver provide coverage for a long list of personal care and other services, which includes many assisted living facility services in particular. The South Dakota DHS website has a detailed list of the covered services and we’ve made a brief summary of the relevant points below for assisted living residents. Ultimately, the amount and type of services covered are determined for each person based on their specific needs.
- Homemaker and chore services
- Personal care
- Meals and meal preparation
- Emergency response systems
- Environmental accessibility adaptations
- Supervision and security
- Recreational programming and activities
- Social programming
- Community transition (moving from nursing home to assisted living)
- Specialized medical equipment and supplies
- Nutritional supplements
Room and board costs are never covered by South Dakota Medicaid or its waiver programs. The state limits the amount that assisted living facilities can charge for room and board, however, which is $693 per month as of 2022. This limit only applies to HOPE Waiver recipients in assisted living facilities that accept Medicaid.
Assisted Living Waiver Programs in South Dakota
HOPE Waiver
South Dakota helps eligible Medicaid recipients via waivers, which extend coverage to services that aren’t otherwise covered, such as care in assisted living facilities. The HOPE Waiver program is available to South Dakota seniors and people with disabilities who are assessed as in need of the relevant services in order to avoid being placed in a nursing home. If the individual’s care needs can be provided for in a less restrictive living environment — and one that’s less expensive — then the HOPE Waiver covers the cost of care.
How To Know If You’re Eligible for Medicaid in South Dakota
South Dakota Medicaid is designed to help people who can’t afford to pay for their required care. There are limits on the number of countable assets owned by the applicant and or a couple, as well as the maximum income allowed. These financial eligibility requirements are based on the SSI federal benefit rate, which changes each year. An individual must have income no higher than 300% of the monthly SSI payment. The income and asset limits for 2023 are listed below.
| Household Size | Number of Applicants | Income Limits Per Year* | Asset Limits: Applicant(s) | Asset Limits: Non-Applicants |
|---|---|---|---|---|
| One Person | 1 | $32,904 | $2,000 | |
| Two People | 1 | $32,904** | $2,000 | $148,620 |
| Two People | 2 | $65,808*** | $3,000 |
* Depending on the facility setting, a recipient may not be able to keep income up to this level.
** Income limit is for applicant only.
*** Income is limited to $2,742 per month per spouse.
Aside from the financial eligibility rules, applicants must meet the following requirements. Seniors who aren’t sure whether they’re eligible should ask for assistance from the agencies listed further below in this guide.
- Be aged 65+ (or blind or disabled)
- Must be a resident of South Dakota and planning to stay
- Be a U.S. citizen or legally admitted with valid immigration status
- Must have been assessed as having medical needs that meet a nursing home level of care
- Not currently residing in a hospital, nursing home or intermediate care facility
It’s important to note that the requirement for a nursing home level of care doesn’t necessarily exclude seniors in assisted living facilities. If it’s determined that the applicant could receive that level of care in an assisted living facility, they may qualify for Medicaid coverage of the services received there.
How to Apply for Medicaid in South Dakota
Applications can be submitted by mail or in person at DSS offices throughout South Dakota. Although it’s possible to apply for other Medicaid benefits online, the form for Medicaid assistance for long-term care must be printed and taken or mailed to the Department of Social Services.
Information You Will Need
Due to the income and asset limits mentioned above, applicants for Medicaid long-term care assistance should prepare as much information as possible regarding their financial situation. The following is a general list of requirements to keep in mind.
- Social Security number
- Valid identification and proof of age
- Immigration/citizenship documentation (if not a U.S. citizen)
- Proof of South Dakota residency
- Financial details (income, assets owned, life insurance policies, household expenses, etc.)
The financial details should include 90 days of the applicant’s most recent bank statements and bills showing the cost of large household expenses. Proof of state residency can be as simple as showing a utility bill for a South Dakota address.
How to Get Help Applying for Medicaid
South Dakota seniors and anyone acting on their behalf can contact the programs detailed below to get answers to questions and help with the application process. These services are provided at no cost.
| Program | Contact | Services provided |
|---|---|---|
| South Dakota Department of Social Services | Call (800) 305-3064 or view the map of local DSS offices on the website | The DSS is responsible for Medicaid enrollment, among other assistance programs. Staff at local offices can help in the application process for Medicaid, the HOPE Waiver program and the home and community-based services made available as a result. |
| Senior Health Information and Insurance Education | East region: (605) 333-3314 Central region: (605) 494-0219 West region: (605 342-8635 | The South Dakota SHIINE program provides free benefits counseling services for Medicare beneficiaries. Staff can give advice about how Medicare interacts with Medicaid and other programs and benefits. Seniors who expect to be dual-eligible for Medicare and Medicaid should contact SHIINE for help and answers. |
| Division of Long-Term Services and Supports | Call (605) 773-3656 statewide or contact a regional LTSS office | LTSS is a division of the South Dakota Department of Human Services that's responsible for providing access to home and community-based care, such as assisted living and in-home services. Specialists are available to help residents apply for long-term care assistance via Medicaid at regional offices throughout the state. |
Does Medicare Cover Assisted Living in South Dakota?
The short answer is that no, Medicare does not cover the cost of assisted living in South Dakota. Assisted living facilities are considered to be a “residential setting” and not a “clinical setting,” (think nursing homes). While Medicare doesn’t cover the cost of care received in an assisted living community, it does still cover things like approved medications, doctor visits, medical equipment, etc., just like it would if you lived at home.
For more information about when Medicare can be used to pay for senior living in a nursing home, and for Medicare-related resources, see our guide to Nursing Homes in South Dakota.
Paying for Assisted Living Facilities in South Dakota
This program is available to eligible South Dakotans who are intellectually and developmentally disabled. It provides benefits that include, among other things, residential support, nursing and specialized medical services. The CHOICES program does not provide funding for room and board.
To be eligible, applicants must:
- Have income that is capped at 300 percent of the SSI Federal Benefit Rate (FBR), which is currently $750. This puts the income cap at $2,250 per month.
- Be determined to have an intellectual or developmental disability as defined by the state.
To learn more about eligibility requirements, contact the Division of Developmental Disabilities, part of the Department for Human Services, or call 605-773-3438.
Other Financial Assistance Options for Assisted Living in South Dakota
Seniors who are not eligible (due to location, financial situation, or other factors) for other types of financial assistance, do still have some options. See the table below for an overview of some of the most common ways to make Assisted Living affordable.
| Name | HowToApply | HowItWorks |
|---|---|---|
| Aid and Attendance | Learn more and apply online at va.gov. | Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for Assisted Living. |
| Reverse Mortgages | Learn more about your options and how to apply at ftc.gov | If you own a home, you may be able to use a reverse mortgage to help pay for Assisted Living. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan. |
| Long-Term Care (LTC) Insurance | Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov. | Seniors who already have long-term care insurance may be able to use it to pay for Assisted Living. Most policies cover at least a portion of the cost, but it depends on the specific policy terms. Note that older adults who are already in need of Assisted Living will not typically be eligible to sign up for a LTC insurance policy. |
Free and Low-Cost Resources for Seniors in South Dakota
There are many resources in South Dakota that assist seniors in their retirement. Caring.com has compiled information on local organizations, programs and agencies and categorized them into care types for easy reference.
Area Agency on Aging
Retirees can find support and advice on various senior-related issues from their local Area Agency on Aging. The agency provides advice on topics such as financial assistance programs, in-home care and long-term care planning. It also connects seniors and caregivers with community-based resources.
| Program Name | Phone Number | Description |
|---|---|---|
| South Dakota Area Agencies on Aging | South Dakota's Area Agencies on Aging offer vital programs to help older adults live quality lives at home. Services include adult day care, hot, nutritious meals delivered or available at day programs and homemaker services that provide help with daily activities, such as light housekeeping, laundry, grocery shopping and meal preparation. AAA services in South Dakota also include coordinated medical and nonmedical transportation. |
Cash Assistance Programs
Cash assistance programs in South Dakota provide financial support to help low-income retirees remain in their own homes for as long as possible. Seniors and caregivers can apply for tax rebates and reductions, discounts on vital services and help covering the cost of heating and cooling their home.
| Program Name | Phone Number | Description |
|---|---|---|
| South Dakota Lifeline Program | 800-234-9473 | The LifeLine Program offers a discount on landline or mobile telephone service, ensuring that participants can stay in contact with loved ones. |
Food Assistance Programs
Local organizations help ensure elderly citizens have a balanced diet and receive essential vitamins and minerals to remain healthy. Through nutrition programs, congregate meals, home-delivered meals and food pantries, these programs help South Dakota seniors afford the nutritious food they need.
| Program Name | Phone Number | Description |
|---|---|---|
| South Dakota Adult Nutrition Program | Funded by government funds and private donations, the South Dakota Adult Nutrition Program aims to provide food security for seniors while encouraging socialization. The program helps promote the health and well-being of residents aged 60 years and older by providing access to proper nutrition. Hot meals are served on weekdays in various adult nutrition locations throughout the state. The congregate setting also serves as a daily fellowship opportunity for seniors. Home-delivered meals are also available. | |
| South Dakota Meals on Wheels | South Dakota Meals on Wheels serves seniors statewide through independently run food assistance programs and support services. Most programs, whose eligibility criteria may vary, are open to seniors aged 60 and over, offering services for free or at a low cost based on a sliding-fee scale. These include home-delivered meals for immobile seniors and nutritious congregate meals served in a social environment. Additional services vary by location, but may include pet meal delivery, transportation assistance for medical appointments and errands, and emergency meal delivery during rough weather conditions. | |
| South Dakota Commodity Supplemental Food Program (CSFP) | 605-773-3413 | The South Dakota Commodity Supplemental Food Program assists low-income seniors 60 and older to access healthy foods. Using federal funding, state agencies distribute USDA foods to public and nonprofit private local agencies, where eligible seniors can receive them. This program isn't designed to provide a complete diet, and local agencies can provide referrals to other nutrition and welfare programs to bridge the gap. |
| South Dakota Supplemental Nutrition Assistance Program (SNAP) | South Dakota's Supplemental Nutrition Assistance Program helps seniors and low-income state residents purchase healthy food. Program participants receive debit cards they can use to buy SNAP-eligible foods at grocery and convenience stores, though funds aren't intended to replace an entire food budget. To qualify, seniors must demonstrate a net monthly income at or below the state's poverty line, which as of 2023 is $1,133 for a single-member household. |
Financial Assistance for Senior Care and Senior Living
Whether living in their own home or in a senior living community, South Dakota seniors can find financial assistance from numerous local resources. These organizations help residents cover some of the costs associated with in-home or long-term care and connect them with other helpful community-based resources.
| Program Name | Phone Number | Description |
|---|---|---|
| South Dakota Home & Community-Based Options and Person Centered Excellence (HOPE) Waiver | 605-773-3656 | The Home & Community-Based Options and Person Centered Excellence Waiver aims to help seniors delay or avoid moving into a nursing home. Eligible seniors can receive a variety of services and supports at home or in the community, from personal care to nutritional supplements to specialized medical equipment. |
Free Used Medical Equipment
Due to the high cost of purchasing new medical equipment, several organizations in South Dakota collect lightly used medical devices such as wheelchairs, ramps and walkers and distribute them to local seniors and residents in need.
| Program Name | Phone Number | Description |
|---|---|---|
| South Dakota AT4ALL | 866-274-2594 | This program provides gently used durable medical equipment to South Dakotans in need. Available equipment may vary, but typically includes devices such as wheelchairs, scooters and patient lifts. All equipment is sanitized and refurbished before being distributed to seniors. |
| South Dakota iCanConnect Deaf-Blind Equipment Distribution Program | 800-825-4595 | Through the National Deaf Blind Equipment Distribution Program, Relay South Dakota distributes free communications equipment and software. Eligible seniors may receive braille devices, screen readers, specialized keyboards and other assistive devices they need to stay in touch with loved ones. |
Home Repair and Modifications
Seniors and those with disabilities can access a variety of local resources to help them pay for home repairs and modifications. Programs in South Dakota have different eligibility criteria and often assist retirees by providing grants or loans.
| Program Name | Phone Number | Description |
|---|---|---|
| South Dakota Weatherization Assistance Program (WAP) | Low-income households in South Dakota may qualify for free energy-efficiency upgrades. This program may pay for home weatherization projects such as sealing cracks, installing insulation and repairing heating systems. Funds are limited, so there may be a waiting list for seniors seeking services. |
Social Security Offices
Social Security offices in South Dakota help seniors and disabled people access the benefits they're entitled to. Older adults can contact their local office for information about receiving retirement benefits, disability allowance and Supplemental Security Income.
| Program Name | Phone Number | Description |
|---|---|---|
| South Dakota Social Security | Social Security is a source of income available to retirees and people who can no longer work because of a disability. The money for Social Security comes from a payroll tax levied on employers, employees and self-employed individuals. When you retire, you'll receive monthly payments based on how much you earned when you were working. |
Tax Assistance
Seniors can apply for tax assistance from several South Dakota resources. Elderly residents and those with disabilities could be eligible for tax exemptions on medical expenses, reductions on property tax and other tax assistance programs.
| Program Name | Phone Number | Description |
|---|---|---|
| South Dakota Sales & Property Tax Refund for Senior & Disabled Citizens | 800-829-9188 | The South Dakota Department of Revenue offers sales and property tax refunds to eligible residents. This refund is calculated based on an applicant's income. |
Utility & Energy Bill Assistance
Low-income seniors who are struggling to meet the costs of maintaining their homes can find support from organizations that offer assistance with utility and energy bills. South Dakota retirees could also qualify for emergency funding programs if they're in danger of losing utility services due to unpaid invoices.
| Program Name | Phone Number | Description |
|---|---|---|
| South Dakota Low Income Home Energy Assistance Program (LIHEAP) | 605-773-3165 | The South Dakota Low Income Home Energy Assistance Program distributes financial support for energy bills during the winter months. To qualify, seniors must submit documentation proving their household's income falls under maximum requirements and they're responsible for paying their home's heating costs. As of 2023, a single-person household is eligible for LIHEAP with a $6,795 maximum income. LIHEAP payments go directly to the heating company. The associated Energy Crisis Intervention Program provides immediate assistance for seniors facing disconnection notices. |
Veteran's Services
South Dakota retirees who have served in the U.S. military can find support from local veteran services. These offices and organizations help vets access the benefits they're eligible for and provide advice and information on a variety of issues.
| Program Name | Phone Number | Description |
|---|---|---|
| South Dakota VA Benefits and Health Care | South Dakota VA Benefits and Health Care provides senior veterans with VA claims assistance and benefits. Health care is available at multiple veteran's medical facilities throughout the state. Vet centers are also located in multiple South Dakota cities to offer counseling and referral services. For an immediate crisis, veterans can reach help by dialing 988 and pressing 1. South Dakota is also home to three national cemeteries. |
Assisted Living Laws and Regulations in South Dakota
The South Dakota Department of Health and specifically the Office of Health Facilities Licensure and Certification are tasked with licensing and inspecting assisted living and other health care facilities. The applicable state regulations must be followed by all facilities, and those that accept Medicaid and/or Medicare must also meet federal standards.
| Topic | Rule |
|---|---|
| Assisted Living Service Plan Requirements | The service plan is drafted after a resident is evaluated by a medical professional. The screening covers cognitive abilities, mobility, skilled nursing needs, ADL ability, and dietary preferences. The service plan details, based on the screening, the process of providing those services, including who performs the task and how frequently it occurs. |
| Assisted Living Admission Requirements | Although each facility is responsible for setting its own admission requirements, it's prohibited to accept or retain a resident who needs a certain type or amount of care that can't reasonably be provided. Any facility that provides specialized services, such as Alzheimer's care, must meet additional licensing requirements relevant to those services before admitting such residents. |
| Assisted Living Scope of Care | Residents are provided assistance with activities of daily living (mobility, hygiene and dressing) as well as supervision and security. Residents must not have unstable medical conditions that require frequent nursing care. ALFs must provide activities and meet residents’ spiritual needs. There should be three meals a day, and snacks in between. Facilities must coordinate at least annual access to a medical professional such as a physician or nurse practitioner. |
| Assisted Living Medicaid Policy | South Dakota covers some of the costs and services associated with assisted living through its Medicaid HCBS waiver programs such as HOPE and CHOICES. The state does not allow for family supplementation for those with HCBS waivers. Not all assisted living facilities accept Medicaid as a form of payment. Contact your prospective communities for their policy on Medicaid programs. |
| Assisted Living Facility Requirements | The capacity of each assisted living facility is determined by the Department of Health. For assisted living facilities built after January 9, 2012, each residential room must have a bathroom with a sink. Each living unit or bedroom must house a maximum of two people, as the state allows for double-occupancy rooms but does not allow for larger units. Assisted living regulations also cover aspects such as lighting, ventilation, pest control, and security. |
| Medication Management Regulations | The acquisition, storage, usage, and disposal of all medication is strictly controlled. Medication must be prescribed by qualified individuals, such as a physician or nurse practitioner, and monthly reviews of resident medication usage must be handled by a pharmacist. Residents can self-administer medications if deemed appropriate. Staff members who pass training may then administer medications to residents. |
| Staffing Requirements | South Dakota regulations state that assisted living facilities must have “adequate staff” on duty based on the number of residents and the amount and type of care services. Care time per resident should not be less than 48 minutes. At least two staff members must be on duty at all times. Assisted living facilities must have an awake staff member during regular sleeping hours, and must contract or employ an administrator, LPN, an RN, and assistive staff. |
| Staff Training Requirements | All new employees must participate in an orientation program within 30 days of hire and receive ongoing education each year. The subjects must include fire prevention, safety and emergency procedures, resident rights, nutrition/hydration needs and handling of claims of abuse or neglect. |
| Background Checks for Assisted Living | Employees of assisted living facilities aren't required by law to submit to a background check, although many facilities do make it a requirement. The regulations simply state that the administration must not knowingly allow anyone convicted of a crime of abuse to work in the facility. |
| Requirements for Reporting Abuse | ALR staff members are required by law to report “knowledge or reasonable suspicion of abuse, neglect or exploitation of elders” to their facility administrator within 24 hours. Administrators must report incidents to state authorities within an additional 24 hours. If you have reason to suspect abuse or neglect of an elder, please contact the South Dakota Adult Protective Service at 833-663-9673 or fill out an Adult Protective Service Referral Form. |
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