South Dakota Residential Alzheimer’s Care (Memory Care): Laws, Costs & Financial Help

Legal Definition of Assisted Living / Memory Care in South Dakota

In South Dakota, residences that offer room and board with personal and health care services are called assisted living centers. Memory care, which is assisted living for people with dementia, is called secured units in assisted living centers. It must be designated by the state’s Department of Health as a safe space that promotes independence while allowing people to do as much as they physically can. Other rules for memory care, as of 2024, include:

• Beneficial Therapies must be provided.
• Confinement is not allowed.
• Staff must have training specific to the needs of residents.

A physician’s services must be available for every resident to receive medical care in an assisted living center, but someone who needs full-time nursing care should not be admitted. The amount of nursing care allowed is less than eight hours per day.

The Office of Healthcare Facilities, under the umbrella of the state’s Department of Health, regulates assisted living in South Dakota.

How Much Does Memory Care Cost in South Dakota?

The cost of assisted living and memory care can vary depending on where in South Dakota the residence is located. The table below lists the median monthly cost of both assisted living and memory care facilities in different areas of the state as of 2025. Individuals who are in the early to mid stages of dementia may be best suited for assisted living facilities, which are less expensive than memory care, while those with more severe symptoms or who are in the late stages of dementia will likely need memory care.

For context, the median cost of assisted living across the country in 2025 was $6,200/month, while it was $4,900/month in South Dakota in 2025.

South Dakota Assisted Living Laws & Regulations

Admissions Process & Requirements

A doctor’s note is required to move into all assisted living in South Dakota. The note is evidence that the new resident doesn’t have a communicable disease, a chronic illness, or a disability beyond what the facility can handle. This could be your doctor or a medical professional who works for the residence. To move in a patient must be able to carry out normal activities of daily living, like eating and bathing, with hands-on physical assistance. Additionally, new residents must be able to:

• Turn in bed and raise from a chair or bed without assistance or with the help of just one staff member.
• Get in and out of bed and chairs with help from only one staff member and without mechanical assistance.
• Complete activities of daily living like dressing, toileting, grooming, and bathing with help from only one staff member.
• Eat with help of just one staff member.
• Manage personal ostomy or catheter.
• Behave without putting themselves or others in danger.

Within 30 days of admission, every resident must be assessed for needs by a medical professional who works for the memory care community. The assessment must be renewed annually. The state’s Department of Health approves the assessment checklist, which includes:

• Nursing care needs
• Medication needs
• Ability to perform activities of daily living
• Ability to perform instrumental activities of daily living
• Mental health status
• Ability to walk or move from room to room
• Dietary needs

The cost of assessment might be included with the base rate, or the residence can charge a one-time community fee when your loved one moves in. Community fees cover move-in costs including the assessments and deep cleaning and painting of a new resident’s room. They usually run between $1,500 and $2,500.

Regulations in South Dakota do not require that someone has a diagnosis of dementia before moving into memory care. Alzheimer’s and related diseases including vascular, frontotemporal, and Lewy body dementias are difficult to diagnose, as symptoms change and vary. Expensive tests like PET brain scans are usually required for an accurate diagnosis, but this step is unnecessary because memory care staff should be trained to handle your loved one no matter their specific type of dementia.

And while it might be possible for someone to move into memory care in South Dakota on short notice, this is not a good idea. Finding the right home takes months of investigating residences and asking questions of staff and others who live there. Ideally, you would begin searching for memory care before a move becomes necessary. The sooner you begin investigating options, the more input the person with dementia can have on the decision.

Facility / Residence

Private units or bedrooms in assisted living in South Dakota must be at least 120 square feet for one person or 200 square feet for two people. Two people are the maximum allowed in a living unit. There must be at least one bathroom for every two resident units. Memory care in assisted living for people with dementia must be located on the ground floor and must have access to a secure outside area.

Unlike many other states, there is no legal requirement in South Dakota that memory care residences be designed with dementia-friendly features. A community for people with Alzheimer’s and related diseases should have bright lights and paint colors, an easy-to-navigate layout, and other physical elements that studies have shown are beneficial for those with memory loss. Because it’s not required, however, you’ll want to inspect residences you are considering whether your loved one will be comfortable within the spaces.

Staff & Training

Staffing must be adequate to serve the needs of all residents, including someone awake and on duty throughout the night. Regulations say a minimum of 0.8 hours of direct care from staff must be available to each resident every 24 hours. A licensed administrator must be hired at every residence for the overall management, with experience and education that are approved by the Department of Health. Ongoing education for all members of staff in memory care must include:

• Fire prevention and response
• Emergency preparedness and response
• Infection control and prevention
• Safety and accident prevention
• Resident rights
• Confidentiality of residents’ information
• Reporting of certain diseases and incidents
• Nutrition and hydration needs
• Caring for residents with dementia

Evictions & Discharges

Someone cannot be evicted from memory care in South Dakota unless their “needs and welfare” cannot be met. Since this is not specific, it gives each facility the ability to have its guidelines. Like in other states, if your loved one develops specific medical needs that staff is not trained to deal with, then an eviction would be necessary. An example of this would be if intravenous feeding becomes necessary, or if your loved one loses the ability to walk and staff is not trained to help non-ambulatory residents.

But what if a person becomes aggressive, or uses abusive language? Is there a stage of dementia that residence staff cannot handle? Every residence defines its own stricter guidelines on the process of evicting. Before agreeing to a move-in contract, it’s very important to be clear on that process, because unfair discharges can be a problem in assisted living throughout the country. Can someone be evicted for nonpayment or late payment of bills? Does the home help find a new place to live that’s appropriate? These are questions to ask early in the process and get the answers in writing. Ideally, there will be 30 days’ notice and a way to appeal the eviction. If your loved one in South Dakota memory care has received an eviction notice and you need to know the next steps, click here.

Financial Assistance for Residential Alzheimer’s Memory Care

Home & Community Based Options and Person Centered Excellence Waiver

South Dakota Medicaid’s Home & Community Based Options and Person Centered Excellence (HOPE) Waiver will pay for long-term care services and supports for qualified South Dakota residents, including those with dementia, who are in assisted living or memory care, as well as those who live in their own home or the home of a loved one. HOPE Waiver benefits are based on the needs of the individual and they can include adult day care, assisted living services, in-home nursing, meal delivery, homemaker services (cooking, cleaning, shopping, etc.), Personal Emergency Response Systems and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing/grooming, eating, toileting). The HOPE Waiver will not pay for room and board expenses in assisted living or memory care.

To qualify for the HOPE Waiver, applicants must meet two financial requirements – an asset limit ($2,000 for an individual as of 2026) and an income limit ($2,982/month for an individual as of 2026) – as well as the medical requirement of needing a Nursing Facility Level of Care (NFLOC). It should be noted that a dementia diagnosis does not guarantee a NFLOC designation.

Veterans Affairs (VA)

Qualified South Dakota veterans (or their surviving spouses) with dementia can also receive financial assistance through a Veterans Affairs (VA) Pension that they could use to pay for assisted living or memory care.

There are three levels of VA Pensions – Basic, Aid & Attendance (A&A) and Housebound. To qualify for any of them, veterans or their surviving spouses need to meet a net worth limit of $163,699 (effective Dec. 1, 2025 – Nov. 30, 2026), which is calculated by adding the total of their assets to their annual income. Some assets are exempt, like a primary home, primary vehicle and household furniture and appliances. VA Pension applicants also have to meet an income limit to be eligible – their income must be less than the VA Pension they are applying for in order for them to qualify. And veterans must meet a military service requirement, which includes not having received a dishonorable discharge.

To qualify for A&A, veterans or their surviving spouses must also meet a medical requirement, which is one of the following must be true:

• They need help to perform the Activities of Daily Living (mobility, bathing, dressing/grooming, eating, toileting) OR
• They have to stay in bed for at least a large portion of the day due to illness OR
• They are in a nursing home due to loss of mental or physical abilities OR
• Their eyesight is extremely limited (5/200 or less in both eyes even with glasses or contacts; or concentric contraction of the visual field to 5 degrees or fewer)

To qualify for Housebound, veterans must spend most of their time in their home due to a permanent disability.

There is no medical requirement for VA Basic Pensions.

Qualified veterans or their surviving spouses are entitled to their Maximum Annual Pension Rate (MAPR) minus their annual income. The following MAPRs are effective from Dec. 1, 2025 to Nov. 30, 2026:

VA Basic Pension MAPRs

• Veterans without spouses or children: $17,441
• Veterans with dependent spouses or children: $22,839
• Surviving spouses without dependent children: $11,699
• Surviving spouses with dependent children: $15,311
• Two veterans married to each other: $22,839

VA Aid & Attendance MAPRs

• Veterans without spouses or children: $29,093
• Veterans with dependent spouses or children: $34,488
• Surviving spouses without dependent children a maximum of $18,697
• Surviving spouses with dependent children: $22,304
• Two veterans married to each other and one qualifies for A&A: $33,548
• Two veterans married to each other and one qualifies for A&A and one for Housebound: $38,350
• Two veterans married to each other and both qualify for A&A: $46,143

VA Housebound MAPRs

• Veterans without spouses or children: $21,313
• Veterans with dependent spouses or children: $26,710
• Surviving spouses without dependent children: $14,298
• Surviving spouses with dependent children: $17,902
• Two veterans married to each other and one qualifies for Housebound: $26,710
• Two veterans married to each other and both qualify for Housebound: $30,580
• Two veterans married to each other and one qualifies Housebound and the other for A&A: $38,350

Veterans Homes

Veterans with dementia might also look into living in a veterans’ home. In addition to nursing care and assisted living, memory care is often provided in veterans’ homes. There is one veterans’ home in South Dakota. The Michael J. Fitzmaurice State Veterans Home is located in Hot Springs about one hour from Rapid City. Veterans residing in Eastern SD may be better served by crossing the state border with Minnesota, as there are veterans’ homes in Luverne and Fergus Falls, both quite close to South Dakota. In addition to nursing home care and assisted living, memory care is provided. This is a facility that provides long-term residential care for veterans. Neighboring states also have veterans’ homes. Your loved one might consider looking there for more options as there are no requirements that one must live in the state. For example, Minnesota has five veterans’ homes statewide. Additionally, Nebraska has four homes, Montana has three facilities and North Dakota has one. More info.

Supplemental Security Income

Dementia patients age 65 and over with limited income and assets may qualify for Supplemental Security Income (SSI). These funds can be used to pay for the cost of assisted living or memory care. As of 2026, the maximum SSI benefit for an individual is $994/month and for a married couple it’s $1,491/month.

To qualify for SSI, applicants must be age 65 and over or have a significant disability, and they must meet an income limit and an asset limit. As of 2026, individuals may meet the SSI income limit if they earn less than $2,073/month OR they get less than $1,014/month from non-work sources, like Social Security benefits or pension payments. They may meet the SSI asset limit if they have $2,000 or less in countable assets. For couples, the income limit is $3,067/month in work income or $1,511/month in non-work income, and the asset limit is $3,000.

Other Options

1) Eldercare loans exist for families to cover the costs of moving into memory care while waiting for other financial resources to become available. For example, if one is waiting for a VA pension to be approved or waiting to sell a home. More on bridge loans for memory care.

2) Some tax credits and deductions can provide financial relief for seniors with dementia and their families. Seniors with limited financial resources can claim the Credit for the Elderly and/or the Disabled, as long as no one can claim them as a dependent. If someone (like an adult child) can claim the senior as a dependent, they can utilize the Child and Dependent Care Credit, and they can deduct any medical or dental expenses they paid for the senior.

3) A reverse mortgage loan can be a viable option for some senior homeowners who are in need of extra income to help pay dementia care. However, reverse mortgages are not recommended for every senior homeowner who needs extra income, so it’s important to consult with a professional before taking out one of these loans.