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Nursing Homes in South Dakota

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.

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.

Rapid City


Sioux Falls




Bismarck, ND


Omaha, NE


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.

In-Home Care


Home Health Care


Adult Day Care


Assisted Living Facility


Nursing Home Care


Does Medicaid Cover Nursing Home Care in South Dakota?

Certain individuals who require care in long-term care facilities, including nursing homes, are eligible for coverage through Medicaid in South Dakota. There are approximately 132,000 South Dakotans enrolled in Medicaid and its companion CHIP initiative, which focuses on children.

South Dakota has an estimated 104 nursing homes. These facilities have a medical director and licensed nurses on staff, and they focus on housing residents who need care from medical personnel. For eligible nursing home residents, Medicaid covers the cost of nursing care, room and board, food and therapy services. Generally, medical equipment is not covered, though hearing aids are.

A relevant program for seniors in need of nursing care is the Home & Community-Based Options and Person Centered Excellence Waiver. It makes use of Medicaid funds to serve individuals with advanced care requirements at home, in assisted living facilities and in other settings. Another offering, the Assistive Daily Living Services Program, aids those with quadriplegia by providing skilled nursing and other services.

Medicaid Eligibility in South Dakota

To qualify for nursing home coverage, applicants must be 65 or older; barring that, they must have a disability or be blind. Additionally, they must be in need of the level of care that typifies nursing facilities.

Income and asset limits also help determine if Medicaid will pay for nursing home care. For a single applicant, the income limit is $32,904 per year, and the asset limit is $2,000. The same income limit and asset limits apply to a married applicant whose spouse is not applying, but in such a circumstance, the asset limit for the non-applicant is $148,620. Spouses remaining in the community may benefit from asset protection via the Spousal Impoverishment Act. When both spouses are applying, the income limit rises to $65,808 per couple, and the asset limit becomes $3,000.

Household SizeNumber of ApplicantsIncome Limits Per Year*Asset Limits: Applicant(s)Asset Limits: Non-Applicants
One Person1$32,904$2,000
Two People1$32,904**$2,000$148,620
Two People 2$65,808***$3,000

* Except for a $60/mo. personal needs allowance, Medicare premiums and possibly a spousal income allowance for a non-applicant spouse, all of a recipient's monthly income must be put toward the cost of nursing home care.

** Income limit is for applicant only.

*** Income is limited to $2,742 per month per spouse.

Additionally, recipients must meet South Dakota residency and United States citizenship requirements.

How To Apply for Medicaid in South Dakota

To apply for Medicaid in South Dakota, seniors seeking long-term care coverage can print an application form and mail, fax or bring it to the nearest Department of Social Services office. Those offices can also send applications to seniors and provide assistance. Alternatively, for help or to have a form mailed to them, elders can call (800) 305-3064. Applicants can request an interview, but this is not a requirement.

Coverage is potentially available for medical bills from up to three months before the DSS receives a senior’s application; seniors seeking such coverage should submit proof of income for the months in question.

Information You Will Need


  • Identifying information, such as the applicant’s Social Security number, address and phone number
  • Citizenship documentation (if the applicant is not a US citizen)
  • Information regarding people helping the applicant with legal matters and/or the application itself
  • Identifying information for bank accounts, stocks and mutual funds and other financial accounts, such as 401(k)s and pensions
  • Insurance details and copies of cards (including for Medicare)
  • Details regarding cars, homes, real estate (such as land) and other property
  • Details regarding dependents and housing costs
  • Information on property the applicant or their spouse has sold, given away or traded over the past 60 months
  • Income details
  • Information on other programs the applicant has applied for

Additional Medicaid Support & Resources in South Dakota

While the Medicaid application process has many components, there are resources that can help interested parties learn more and apply. Below are some examples of the resources available to South Dakotans seeking Medicaid.

Long Term Services and Supports(605) 773-3656LTSS can help older individuals learn about various service options, and it purchases or dispenses services when appropriate. Its specialists also offer referrals, needs assessments and case management. The organization operates the HOPE Waiver as well.
Legal Services for Older IndividualsERLS: (605) 336-9230
DPLS: (605) 856-4444
LTSS funds senior-focused legal services that are available through East River Legal Services (ERLS) and Dakota Plains Legal Services (DPLS). Through these organizations, seniors may be able to access help with matters such as claim denials and errors. Services also include insurance education and eligibility establishment for Medicaid and other benefits.
American Council on AgingOnline OnlyThe ACOA has an online tool that helps seniors find someone who assists with Medicaid planning, plus a list of strategies that individuals who hope to qualify for Medicaid can employ. Another offering from the ACOA is a calculator that helps seniors determine how much to spend down to meet Medicaid's long-term care asset limits.
South Dakota Department of Social Services(800) 597-1603Along with handling Medicaid applications, the SDSS has published a handbook for Medicaid recipients that covers benefits and additional topics. The SDSS also maintains an online list of other resources for Medicaid recipients, and individuals with more questions can call the department.

Does Medicare Cover Nursing Home Care in South Dakota?

Medicare provides limited coverage for short-term stays in a skilled nursing facility following a hospital stay, but seniors must meet a number of specific requirements. This benefit is available to beneficiaries who have been hospitalized for at least three days, excluding the date of discharge, so it’s most valuable for those who are recovering from an injury, illness or surgery.

Once seniors meet the hospitalization requirement, Medicare will pay for up to 100 days of skilled nursing per benefit period. The first 20 days are covered in full. Starting on day 21, beneficiaries must pay a daily coinsurance rate. After day 100, seniors are responsible for the entire cost.

What Does Medicare Cover?

Medicare covers a number of specific services, including:


  • Meals
  • A semiprivate room
  • Medications
  • Skilled nursing
  • Physical therapy
  • Occupational therapy
  • Speech therapy
  • Audiologist care
  • Medical supplies
  • Medical social services
  • Nutritional counseling
  • Ambulance transportation


What Isn’t Covered by Medicare?

Medicare does not cover long-term custodial care that addresses seniors’ day-to-day needs. This includes help with daily activities, such as bathing, dressing and using medical equipment.

For more information about Medicare and when it covers Nursing Home Care, read our Guide to Nursing Homes.

Medicare Support & Resources in South Dakota

Many people are curious if Medicare will pay for some or all of their nursing home costs. While Medicare usually isn’t a long-term solution for nursing home care, it may cover some initial expenses and make other aging-related expenses more affordable. Below are several organizations whose representatives give assistance with Medicare-related matters.

Senior Health Information & Insurance EducationCentral: (605) 494-0219
Eastern:(605) 333-3314
Western:(605) 342-8635
SHIINE offers free, unbiased information regarding Medicare to its clients, helping seniors make coverage decisions and maintain their benefits. Fraud prevention is another area of focus. SHIINE operates via regional coordinators and knowledgeable volunteers throughout South Dakota. 
BenefitsCheckUp(800) 794-6559BenefitsCheckUp helps seniors throughout the country identify potential sources of aid. Its filterable database contains links to information on Medicare Savings Programs and additional initiatives that may make health care costs more manageable. Seniors can also learn about prescription drug programs through BenefitsCheckUp. Clients seeking information over the phone may call the BenefitsCheckUp helpline.
Medicare Rights Center(800) 333-4114To ease the decision-making process, the Medicare Rights Center makes counselors accessible to individuals with questions regarding Medicare-related matters. Callers can contact the center for information on denials and appeals, bills and treatment problems, among other topics. The center offers its helpline for free. 633-4227Visitors to can access a high-level overview of the Medicare program, learn about basic costs and look up plans. The website has information on what to do about problems with Medicare cards and how to use Medicare coverage to pay for health services. For more assistance, seniors can call the website's associated helpline or make use of its chat feature.

Other Financial Assistance Options for Nursing Home Care in South Dakota

While Medicaid and Medicare are two of the most common programs used to pay for Nursing Home Care, there are other financial assistance options available, depending on your unique situation.

NameHow To ApplyHow It Works
Aid and AttendanceLearn more and apply online at 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 MortgagesLearn more about your options and how to apply at ftc.govIf 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. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan.
Long-Term Care (LTC) InsuranceLearn more about Long-Term Care Insurance and how to apply for a policy at who already have long-term care insurance may be able to use it to pay for skilled nursing care. 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 skilled nursing care 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. 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 NamePhone NumberDescription
South Dakota Area Agencies on AgingSouth 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 NamePhone NumberDescription
South Dakota Lifeline Program800-234-9473The LifeLine Program offers a discount on landline or mobile telephone service, ensuring that participants can stay in contact with loved ones.

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 NamePhone NumberDescription
South Dakota Home & Community-Based Options and Person Centered Excellence (HOPE) Waiver605-773-3656The 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.

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 NamePhone NumberDescription
South Dakota Adult Nutrition ProgramFunded 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 WheelsSouth 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)605-773-3413The 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.

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 NamePhone NumberDescription
South Dakota AT4ALL866-274-2594This 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 Program800-825-4595Through 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 NamePhone NumberDescription
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 NamePhone NumberDescription
South Dakota Social SecuritySocial 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 NamePhone NumberDescription
South Dakota Sales & Property Tax Refund for Senior & Disabled Citizens800-829-9188The 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 NamePhone NumberDescription
South Dakota Low Income Home Energy Assistance Program (LIHEAP)605-773-3165The 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 NamePhone NumberDescription
South Dakota VA Benefits and Health CareSouth 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.

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.

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