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South Dakota Assisted Living & Home Care Costs

Page Reviewed / Updated - September 10, 2019

In order to assist South Dakota residents in understanding the long-term costs of senior care throughout the state, this webpage covers the average cost of assisted living, in-home care, and adult day care. Care assistance programs, whether they provide care in the home, in the community, or a residential facility, will also be discussed.

The programs found on this page include all of the programs that are available via the state of South Dakota. However, there are a variety of other programs that are funded by other sources (private, federal, local) that also provide assistance with elder care. When searching for care assistance, it is highly recommended that one explore all options. In order to assist with this search, please use our Resource Locator Tool at no cost to you.

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South Dakota Elder Care Costs

Assisted Living / Memory Care

In 2019, the cost of assisted living averages $3,500 / month throughout the state of South Dakota. The average monthly cost of assisted living nationwide is approximately $4,000, so in comparison to the rest of the nation, South Dakota is one of the most affordable states when it comes to assisted living. Sioux Falls (Minnehaha County) is even more affordable, with an average cost of $3,125 / month. Rapid City (Pennington County) has the most expensive assisted living at an average monthly cost of $3,925, which is still lower than the monthly cost nationwide.

In addition to traditional assisted living, many assisted living facilities also offer Alzheimer’s Care, sometimes referred to as Memory Care. Due to the increased level of care and security, one should expect to pay an approximate additional $875 per month.

Home Care

Statewide in South Dakota in 2019, the average cost of home care (sometimes called custodial care) ranges between $23.00 and $27.00 / hour, with the average cost at $24.00 / hour. More affordable care can be found in Sioux Falls, the largest city in the state, at an average rate of $23.00 / hour. More costly care is found in Rapid City, the second largest city in SD, at an average rate of $27.00. 

While home care is non-medical in nature, such as providing assistance with activities of daily living, home health care also provides limited medical care. In general, home health care costs approximately $1.00 / hour more than does home care.

Adult Day Care

A more affordable option than home care, adult day care is a great option for elderly individuals who need assistance, but do not want to reside in a nursing home. As of 2019, the statewide average cost of adult day care in South Dakota is $71 / day, just under the nationwide daily average of $72. Those residing in the cities of Sioux Falls and Rapid City should also expect daily costs close to the statewide and nationwide average daily rate being $70 - $76.

South Dakota Financial Assistance Programs

Medicaid Programs for the Elderly

Medicaid is a program that is intended for low-income individuals and families, and is jointly funded by the state and the federal government. Through the South Dakota State Medicaid Plan, the cost of nursing home care is covered for eligible individuals who are elderly and / or disabled. Personal care, though limited in nature, is also available via the state plan.

The Personal Care Services Program, which is part of the state Medicaid plan, provides in-home services in order to delay or prevent nursing home placement. Supports include assistance with daily activities, such as bathing, eating, shopping, mobility, and light housecleaning. This program is an entitlement program, meaning all eligible residents of South Dakota are able to receive services

SD also offers one Medicaid Waiver, which unfortunately is not an entitlement. This means that there are a limited number of slots for individuals to receive services, and there may be a waiting list for eligible applicants. The HOPE (Home and Community-Based Options and Person Centered Excellence) Waiver, previously called the Home & Community Based Waiver Services for the Elderly provides personal care assistance either in the home of a senior or in an assisted living facility. Other supports may include adult day care, emergency response systems, private duty nursing, specialized medical equipment, and medication monitoring.


In South Dakota, the eligibility requirements for the state Medicaid plan and Medicaid waiver may differ, but both programs require limited income and assets. For the most part, an elderly South Dakota resident (as of 2019) must not have an income that is greater than $2,313 / month. This amount is set at 300% of the Federal Benefit Rate (FBR). The asset limit is currently $2,000, but does exclude one’s home (if owner occupied and valued under $585,000), a primary vehicle, and personal effects and belongings.

If an applicant is married and their spouse is not applying for long-term care Medicaid, all, or a portion of their income may be protected for their non-applicant spouse (often called the community spouse). This is referred to as a Monthly Maintenance Needs Allowance (MMNA) and allows up to $3,160.50 / month (in 2019) in income to be transferred from the applicant spouse to the community spouse. This is to prevent spousal impoverishment. Please note, this explanation is an oversimplification, as there are rules governing the MMNA.

In addition, a larger portion of assets is protected for the non-applicant spouse. As of 2019, a non-applicant spouse can retain half of the couple's combined assets, up to $126,420. This is known as the Community Spouse Resource Allowance (CSRA). The “protected share” (the amount the community spouse is able to retain) is subtracted from the couple’s total assets and if this figure is $2,000 or less, the applicant spouse is asset eligible. When over the asset limit, it is extremely important that neither spouse gives away assets or sells them under fair market value in order to meet the asset limit. This is in violation of Medicaid’s look-back rule and can result in a period of Medicaid ineligibility. In fact, with the look-back rule, all asset transfers dating back 5 years from the date of the Medicaid application are reviewed. Any violations during this time frame, regardless of whether the applicant or their spouse made them, can result in a penalty of Medicaid ineligibility.

Being over the asset and / or income limit(s) does not automatically disqualify one for Medicaid. However, the restructuring of finances to meet Medicaid’s eligibility requirements is complicated. It is highly recommended one seek the advice of a professional Medicaid planner

State (Non-Medicaid) Assistance Programs

In South Dakota, there are also two non-Medicaid programs that are state funded that offer assistance with senior care. These programs are also intended to prevent or delay institutional care of the elderly, allowing them to instead age at home.

The Division of Adult Services and Aging (ASA) In-Home Services program offers elderly South Dakota residents up to $750 worth of care services each month for care assistance. Supports may include personal care, telehealth, personal emergency response systems (PERS), nursing services, and medical supplies and equipment.

The Caregiver Support Program is intended to assist unpaid caregivers of frail seniors, including those with a diagnosis of Alzheimer’s, by providing supportive services. Personal care assistance, light housecleaning and laundry, grocery shopping, and meal preparation are benefits one may receive, in addition to respite care.

Other Financial Options for Care

In addition to the state specific programs that assist in covering the cost of elderly care in South Dakota, there are also federal and non-profit programs available. In order to find other programs that assist in paying for care or reduce your out-of-pocket cost, make sure to use our Resource Locator Tool.  This tool makes it easy to locate and consider all of your options and choose the program that best fits the circumstances. Eldercare loans and programs that aid veterans with assisted living are other available options.

Finding Affordable Care

As one can see, the state of South Dakota has some variance in cost of senior care throughout the state. Therefore, one can benefit from finding high quality providers at the most affordable rate in their specific geographic region. To assist in your search for affordable care, our company has partnered with several organizations that maintain databases of a large number of care providers. This service is free of charge. Click here to find affordable senior care

Top Cities for Senior Care in South Dakota

For more information about the costs and resources available in South Dakota cities, click on the links below.