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

Last Updated: March 24, 2021


In South Dakota regulations, 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, and 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 include:

– Programming that is therapeutic 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.
There are 20 memory care homes in South Dakota. The Office of Healthcare Facilities, under the umbrella of the state’s Department of Health, regulates assisted living in SD. For free help finding memory care there to meet your family’s needs and budget, click here.

 COVID-19 Vaccine in SD Memory Care
Staff and residents in South Dakota assisted living homes were among the first to receive immunizations against the coronavirus, beginning in December 2020. If your loved one lives in SD memory care, they should have received a shot by now. For more information, click here.


How Much Does Memory Care Cost in South Dakota?

The average cost of assisted living with memory care in South Dakota is $4,305 per month, which is about $51,660 annually. The national average is roughly $5,000 per month, making South Dakota one of the more affordable states for memory care. Assisted living without memory care usually costs about $1,000 less per month.

In Sioux Falls memory care costs about $4,125 per month and $49,500 per year. Sioux Falls is also the least-expensive city in SD for memory care. The most expensive place for memory care is Rapid City, where costs are about $5,058 per month and $60,696 annually. Costs are generally slightly higher in the western Black Hills and Badlands region of SD than in the eastern lakes and prairies areas. Areas including the Cheyenne River and Crow Creek reservations that make up much of the middle of South Dakota have few options for state-sanctioned memory care.

South Dakotans who live near the border of a neighboring state might be able to find more convenient and affordable memory care outside SD, but the average costs in these surrounding states are higher overall. South Dakota’s average monthly costs are more affordable than western neighbors Montana ($4,950) and Wyoming ($4,914), Nebraska ($4,950) to the south, Minnesota ($5,054) to the east, and North Dakota ($4,843). Those other states are all more expensive, with costs closer to the national average of $5,000.

 Did You Know? South Dakota ranks in the Top 10 for percentage of senior citizens with Alzheimer’s. About 13% of people there over 65 have the disease, and the number of South Dakotans with Alzheimer’s is expected to increase from about 18,000 in 2020 to 20,000 in 2025.


South Dakota Assisted Living Laws & Regulations

Admissions Process & Requirements

A doctor’s note is required to move into assisted living, including memory care, in South Dakota. The note is evidence that the new resident doesn’t have communicable disease, a chronic illness, or a disability beyond what the residence is able to handle. This could be your own doctor, or a medical professional who works for the residence and will conduct a needs assessment (see lower in this section) upon admission.

A person moving in must be able to carry out normal activities of daily living (ADLs), like eating and grooming, 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 ADLs including 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 self 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 must approve the assessment checklist, which includes the following:
– Nursing care needs
– Medication needs
– Ability to perform ADLs
– Ability to perform IADLs
– 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 could charge a one-time “community fee” when your loved one moves in. Community fees cover move-in costs including the assessments and things like deep cleaning and painting 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.


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 is 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 not a legal requirement in South Dakota that memory care residences be designed with features that are dementia-friendly. 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 with an eye on whether your loved one will be comfortable within the spaces.

 COVID-19 Visitation Rules in SD Memory Care
During the coronavirus pandemic, assisted living homes in South Dakota are much stricter about visitations. Meetings between loved ones are held outside (if possible) and visitors must wear masks and maintain six feet of distance. Other guidelines may apply for specific residences.


Staff & Training

Staffing must at all times be adequate to serve the needs of 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 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. This is the language in regulations, and its vagueness gives the community a lot of wiggle room. 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 are not trained to help residents who are non-ambulatory.

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 crystal clear on that process, because unfair discharges are a major 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 answer in writing. Ideally, there will be 30 days notice and a way to appeal the eviction. Be sure about this. If your loved one in South Carolina memory care has received an eviction notice and you need to know next steps, click here.


Financial Assistance for Residential Alzheimer’s Memory Care

HOPE Medicaid Waiver

The Home and Community Based Options and Person-Centered Excellence (HOPE) waiver is also called the Home and Community Based Services (HCBS) waiver, or the Elderly Waiver, available through South Dakota Medicaid. This program was designed to lower the number of people who needed to move out of their homes or assisted living into more expensive nursing-home care. Medicaid funds cannot pay for room-and-board costs of assisted living (including memory care), but expenses associated with getting help for activities of daily living (ADLs), private nursing care, and medical devices all may be covered. Recipients must be Medicaid-eligible, including income under $2,382 per month in 2021. For more information on HOPE, click here. To apply, visit your local Long Term Services and Supports office.


Veterans Affairs (VA)

Because of their increased rates of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD), veterans are statistically more likely to develop dementia. Relevant in all states including South Dakota is the VA’s Aid & Attendance income improvement pension program for veterans and surviving spouses, which is money added to veterans’ and survivors’ basic pensions. Applicants must be at least 65 years old (or disabled) and require assistance with activities of daily living (ADLs) like eating, bathing, and mobility. The cash assistance from these enhanced monthly benefits can be used as the recipient wishes, meaning it can go toward the cost of memory care. In addition, the cost of residential care can be deducted from income, effectively reducing the amount of calculable income used to determine the benefit amount. The latest (2021) maximum amount a veteran can receive through A&A is $27,540 per year, and surviving spouses can receive $14,928. Learn more here.

 Did You Know? As few as one out of seven veterans eligible for Aid & Attendance money have applied to receive it.

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 a single veterans’ home in South Dakota, the Michael J. Fitzmaurice State Veterans Home, 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. Payment for room and board and services is made directly from the VA to the facility. State veterans’ homes are typically reserved for veterans whose need for care stems at least 70 percent from their service. Veterans’ homes have a limited number of beds, so it’s best to contact the home directly and inquire about prioritization and availability. For contacts and more information, click here.


Other Options

Other ways to help pay for memory care include tax credits and deductions like the Credit for the Elderly and the Disabled, or the Child and Dependent Care Credit (if you claim your elderly loved one as a dependent). Remember also that medical and dental expenses can be deducted, and that might include some assisted living costs.

A reverse mortgage may be a good option for a married person moving into memory care, if their spouse continues to live in the home. Should the spouse move, the reverse mortgage would become due.

Elder care loans are for families to cover costs of moving into memory care, if you need a little help at first but can afford costs after the initial payments. For example, if one is waiting for a VA pension to be approved or waiting to sell a home.