South Dakota is home to 884,659 residents, including approximately 152,000 senior citizens who represent more than 17% of the total population. It’s estimated that about half of all seniors will require some form of paid long-term care during their lives. Although the majority of adults prefer to age in place and remain in their own homes or in the same community, many recognize that this isn’t always possible.

While many seniors turn to home health care agencies, assisted living facilities and adult day programs to meet their needs, nursing homes are another option. These facilities provide post-acute care and rehabilitation services to individuals who are leaving the hospital, and they offer skilled nursing care for seniors who are unable to live safely in a residential setting. South Dakota is home to 111 licensed nursing facilities. According to the Genworth Financial 2020 Cost of Care Survey, these facilities typically charge $7,011 per month for a semiprivate room and $7,521 for a private room.

This guide takes a look at the cost of nursing home care in South Dakota as well as possible alternatives and statewide resources that can help you identify the best care option for your needs.

The Cost of Nursing Home Care in South Dakota

With a median cost of $7,011, nursing homes in South Dakota charge $745 less than the national average, and rates are favorable when compared to other states in the Northern Plains. Nursing homes in North Dakota and Minnesota are as much as $5,156 more expensive with average prices of $12,167 and $11,026 per month, respectively. The cost in Wyoming is about $1,250 above the average paid in South Dakota. Seniors in Montana pay about $650 more per month, while the average rate is just $183 higher in Nebraska. Iowa is one of the most affordable states in the region, where seniors save about $440 a month on nursing home care.


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Nursing home prices vary significantly across the state. Yankton, which is included in the Sioux City, Iowa, metropolitan area, is one of the least expensive options. Average rates of $6,509 per month are about $500 lower than the state median. Rates in Rapid City and Sioux Falls are about $440 to $640 higher than the state median at $7,452 and $7,650, respectively. Nursing home care rates are also higher in Bismarck, North Dakota, at $10,646 and Omaha, Nebraska, at $8,182.


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Seniors in South Dakota can choose from several different forms of long-term care depending on their budget, preferences and personal needs. Adult day health care costs $1,647 per month, which is close to the U.S. median. Assisted living is 15% more affordable than the national average at $3,638. Home health agencies charge $5,339 per month for homemaker services and $5,529 for home health care services, a rate that’s slightly higher than average. Skilled nursing is the most expensive option with a median monthly cost of $7,011 for a semiprivate room. However, rates are more affordable here than in other parts of the country.


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Financial Assistance for Nursing Home Care in South Dakota

Most people do not pay for skilled nursing care entirely out-of-pocket. Rather, they utilize financial assistance programs to help cover the cost of nursing care. Of public financial assistance programs, Medicaid provides the most comprehensive coverage of nursing home care. But, not all seniors are eligible for Medicaid. And because each state operates its own Medicaid program within federal guidelines, eligibility and benefits vary from state to state. Below, we provide more information on Medicaid in South Dakota.

South Dakota’s Medicaid Program

Medicaid provides comprehensive medical care, including dental, vision and prescription drug coverage, to 118,950 low-income adults and children statewide. This program also pays for long-term care, including services provided by nursing homes and personal care aides, when these supports are medically necessary. Because the state has decided not to adopt new health care policies since the Marketplace opened, enrollment has changed very little since 2013. Still, Medicaid covers 14% of the state’s population and about 50% of the state’s 5,585 nursing home residents.

Long-term care benefits pay for nursing home care, including shelter, meals, skilled nursing and rehabilitative services, when individuals can’t live safely in the community. South Dakota is home to just over 110 nursing homes, and the majority of these facilities are certified to accept Medicare and/or Medicaid. South Dakota also gives seniors the option to receive these services at home or in another residential setting through the HOPE program, a Home- and Community-Based Services waiver that pays for adult day care, assisted living, in-home nursing care and many other services.

Medicaid Eligibility in South Dakota

Medicaid long-term care benefits are available to individuals who require a nursing home level of care and earn no more than $2,382 per month or up to 300% of the federal benefit rate. Assets are limited to $2,000, excluding a primary home, vehicle and personal belongings. State regulations require residents to use all of their income for long-term care minus a $60 monthly stipend and a spousal maintenance allowance. Applicants must be a U.S. citizen or provide proof of legal residency. You can learn more about the application process online or by calling (800) 305-3064.

Alternative Financial Assistance Options

  • Medicare: Medicare will cover the cost of one’s care in a skilled nursing facility for the first 20 days of their stay, and a portion of the costs up until day 100. After 100 days, the individual is responsible for all costs. Seniors must also have a “qualifying hospital stay” of at least 3 days prior to their admission to a nursing home in order to qualify for Medicare coverage.
  • Aid and Attendance: 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 skilled nursing care.
  • Reverse Mortgages: If you own a home, you may be able to use a reverse mortgage to help pay for nursing care. 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. This type of funding can be especially useful for married couples when only one partner needs nursing care, as the other residents of the home may continue living there. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan.
  • Long-Term Care Insurance: Seniors who already have long-term care insurance may be covered for skilled nursing care. Most policies cover at least a portion of the cost of nursing home care, but it depends on the specific policy terms. Note that older adults who are already in need of skilled nursing care will not be eligible to sign up for a LTC insurance policy.

Free and Low-Cost Resources for Seniors in South Dakota

There are a variety of low-cost and free resources available to seniors and their families in North Dakota. They can turn to the following agencies and statewide partners for help navigating long-term care decisions.

Dakota at Home(833) 663-9673Dakota at Home is the state’s Aging and Disability Resource Center, a free information and referral service that directs older adults and families to resources in their community. Counselors can provide more information about in-home care and caregiver resources. The ADRC can arrange Medicaid needs assessments, case management services and other supports.
Long-Term Care Ombudsman Program(866) 854-5465The long-term care ombudsman is part of a federally mandated program available to anyone who lives in a nursing home or is considering entering a residential care facility. These specially trained advocates provide information and advice and resolve disputes to ensure that health care facilities are upholding the resident bill of rights. Assistance is available through the statewide office or by contacting a local ombudsman.
Department of Human Services, Division of Long Term Services and Supports(605) 773-3656The Division of Long Term Services and Supports manages a variety of federal programs that support older adults statewide. This agency can connect seniors with delivered meals, accessible transportation, legal services and in-home care. It also manages the state’s Home- and Community-Based Services waiver, Medicare counseling program and caregiver support fund.
South Dakota State University Extension(605) 688-4792The SDSU Extension offers an array of creative programs and informational resources to support older residents, including seniors aged 65 and older. It sponsors healthy aging expos, writing workshops and educational webinars. Families can also tap into the center’s directory of caregiver resources, long-term planning aids and healthy aging guides.
South Dakota Long-Term Care Partnership Program(605) 367-5444Sponsored by the Department of Social Services and the Division of Insurance, the Long-Term Care Partnership is a public-private program that provides tax-qualified long-term care insurance to state residents aged 18 to 84 with an emphasis on serving those over 40. These policies can help residents access Medicaid long-term care while eliminating spend-down requirements.
AARP South Dakota(866) 542-8172Based in Sioux Falls, this statewide AARP chapter offers a variety of programs and resources for adults aged 50 and older. This national nonprofit is known for its annual tax preparation workshops and popular driver safety courses. AARP also engages in advocacy and education to help protect seniors from scams and fraud. 

Nursing Home Laws and Regulations in South Dakota

LicensingNursing facilities in South Dakota are regulated by the Department of Health, Office of Health Facilities Licensure & Certification. This agency sets standards for all aspects of nursing home care and conducts recertification inspections every nine to 15 months.
StaffingFacilities may employ licensed health professionals, including physicians, nurses, therapists, administrators, dieticians, social workers and pharmacists. Facilities must have sufficient staff on-site, including an adequate ratio of RNs and LPNs, to meet residents’ needs at all times. Each shift must have a qualified charge nurse on duty, and the facility must employ a director of nursing.
Staff TrainingNursing homes must develop a comprehensive training and orientation program for all staff members. Nurse aides must complete 75 hours of coursework with at least 16 hours of supervised practical training before providing direct care. Routine in-service training is required for all staff, including laundry, dietary and administrative workers. Facilities that operate special care units must provide dementia-specific training.
Admission RestrictionsLicensed nursing facilities may only admit residents they can care for safely and effectively and who have medical needs that are within the facility’s license classification. Admission must be ordered by a qualified medical professional, such as a physician, physician assistant or nurse practitioner.
Care PlanningNursing homes must create a comprehensive care plan for each resident that addresses the individual’s physical, medical and emotional needs. A comprehensive care plan must be developed within seven days of the individual’s initial assessment, and it must be approved by a qualified medical professional or an interdisciplinary care team.
Dietary and Nutrition ServicesNursing facilities must serve at least three daily meals that are nutritionally balanced and accommodate residents’ medical needs and personal preferences. South Dakota has strict requirements regarding meal preparation and planning, dining room structure and record keeping. Nursing facilities must employ a full-time dietary manager, and a qualified dietitian must assess each resident’s nutritional needs at the time of admission and then annually.
Specialized Rehabilitative ServicesSkilled nursing facilities must provide restorative care and therapeutic services as needed to promote residents’ optimal function and independence. These services may be provided by an occupational, physical or speech therapist or therapy assistant as ordered by a qualified medical professional.
Medication and Pharmaceutical ServicesNursing facilities must establish comprehensive policies and procedures for medication control, handling, administration and disposal. Residents’ medication records must be reviewed at least once a month by a licensed pharmacist. The facility must operate a full- or part-time pharmacy that’s managed by a licensed pharmacist.
ActivitiesNursing homes must provide organized recreational or therapeutic activities that accommodate residents’ abilities and interests. They must employ a qualified activities coordinator and maintain sufficient equipment, materials and supplies. Additionally, facilities must provide social services and access to a chaplain or clergy member.
Infection ControlTo prevent the spread of tuberculosis and blood-borne diseases, South Dakota nursing homes must have infection and disease prevention programs in place that are overseen by a qualified staff member. The facility must also have policies for managing residents or employees who have or are suspected of having a communicable disease.
Medicaid CoverageSouth Dakota’s Medicaid program pays for nursing home care for eligible residents who have a medical and financial need. Facilities must be certified by Medicaid to participate in this program.