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.


South Dakota


The United States


North Dakota











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 $30,276 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 $137,400. 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 $60,552 per couple, and the asset limit becomes $3,000.

2022 Medicaid Income Limits for Seniors in South Dakota

Income Limits*
Asset Limits

Single Applicant



Married Couple

(Only One Spouse Applying)


$2,000 for applicant 

$137,400 for non-applicant

Married Couple

(Both Spouses Applying)



*Per year

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.


(605) 773-3656

LTSS 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.

ERLS: (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.

Online Only

The 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.

(800) 597-1603

Along 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.


Central: (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. 

(800) 794-6559

BenefitsCheckUp 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.

(800) 333-4114

To 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. 

(1-800) 633-4227

Visitors 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.

How to Apply
How It Works

Aid and Attendance

Learn more and apply online at

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

Learn more about your options and how to apply at

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. 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

Seniors 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

Understandably, seniors and their loved ones sometimes feel taken aback by the complexities of nursing home care and other elder-relevant topics. However, organizations and programs such as the following may help seniors and caregivers make sense of their options and transition into supportive living arrangements.


(605) 773-3269

The SDVA handles applications for the Michael J. Fitzmaurice State Veterans Home. This facility may be an option for senior military veterans and eligible spouses, including certain surviving spouses, in search of nursing care in a long-term setting. The SDVA also employs many veteran service officers who assist military veterans in identifying and accessing benefits at the federal and state levels. Officers can also provide help with applying to the Veterans Home.

(1-866) 854-5465

The LTCOP focuses on empowering current and prospective residents of long-term care facilities, such as nursing homes. The LTCOP also assists family members of residents. It provides education on residents' rights, makes recommendations and aids with conflict resolution. The LTCOP additionally seeks to uphold residents' quality of care, and it makes referrals when called for. Services are available confidentially.

(1-833) 663-9673

As the state's Aging and Disability Resource Center, Dakota at Home informs South Dakotans regarding elder care support. It runs a free phone line through which callers can learn about programs that help caregivers and older adults. Additionally, Dakota at Home has an options planning service, and it is the point of contact for the state's Caregiver Support Program.

(605) 773-3563

The South Dakota Long-Term Care Partnership may make long-term care insurance more affordable for seniors, with asset and inflation protection as added benefits. While there are no set age limits, the program generally brings clients aboard between the ages of 40 and 84. The program may help eligible seniors mitigate the spend-down requirements of Medicaid. It is a joint operation between the South Dakota Division of Insurance and the South Dakota Department of Social Services.

(605) 338-0551

Seniors with hearing or vision loss may find the South Dakota Lions Foundation helpful. It has dozens of clubs throughout the state. Every club helps local clients afford eyeglasses, and many clubs assist with the purchase of hearing aids as well.

(605) 361-1133

The Senior Companions program links volunteers with vulnerable seniors, particularly those in rural areas. Transportation, meal preparation and housekeeping are among the services volunteers can provide. Respite care is also available. This program's parent organization is the Evangelical Lutheran Good Samaritan Society.

COVID-19 Rules for Nursing Homes in South Dakota

The following information is based on research done on several government websites, including These rules apply to Independent Living Communities and other types of senior living facilities. We’ve most recently updated this data on 2/13/2022, but since COVID-19 is a rapidly evolving pandemic, contact your local senior living facility or Area Agency on Aging for more specific and up-to-date information.

Visitation Policies

Rules for South Dakota Communities

Are loved ones allowed to visit to provide emotional support?

Yes (Conditions Apply)

Are relatives allowed to visit for end-of-life care?


Are residents required to quarantine after visiting with a loved one?


Are visitors required to wear PPE (including masks) in order to visit residents?


Are non-medical contractors (such as hairdressers and entertainers) allowed in senior living facilities?


Are visitors checked for elevated temperatures?


Are visitors required to answer questions about health, travel, and potential virus contact?


Outings & Social Activities

Rules for South Dakota Communities

Are residents allowed to leave (errands, visiting family, etc.) for non-medical reasons?


Are residents who leave required to quarantine when they return?

No (Conditions Apply)

Are senior living communities required to cancel all group outings?


Are residents allowed to eat meals together in a common area?

Yes (Conditions Apply)

Are residents allowed to gather in common areas for group activites?

Yes (Conditions Apply)

COVID-19 Safety Measures for Staff and Residents

Rules for South Dakota Communities

Are staff members regularly required to do a temperature check?


Are staff members regularly tested for COVID-19?

Yes (Conditions Apply)

Are staff members members regularly required to do a health and safety screening, including questions about travel, contact with positive cases, etc?


Are residents regularly screened for COVID-19 symptoms?


Are residents regularly checked for elevated temperatures?


Are residents regularly tested for COVID-19?

Yes (Conditions Apply)

Nursing Home Laws and Regulations in South Dakota

Nursing Home Laws and Regulations in South Dakota
Nursing 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.
Facilities 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 Training
Nursing 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 Restrictions
Licensed 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 Planning
Nursing 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 Services
Nursing 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 Services
Skilled 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 Services
Nursing 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.
Nursing 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 Control
To 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 Coverage
South 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.