The cost of senior care in South Dakota splits sharply by setting. Assisted living runs about $4,900 a month, among the lowest in the nation, while a nursing home costs roughly $113,333 a year for a semi-private room. In-home care, by contrast, is expensive here: a non-medical caregiver at 44 hours a week runs about $101,244 a year.

This guide lays out what every senior-care setting in South Dakota costs side by side, what pushes the price up or down, and how families actually pay, from private funds to Medicaid for those who qualify.

In This Guide

The Cost of Senior Care in South Dakota by Setting

The figures below come from the CareScout Cost of Care Survey, its 2025 release (published March 2026), which is the most recent state-level data. They are medians from an industry survey, not government figures, and costs vary within the state and rise as care needs grow, so the price at any one provider can land higher or lower.

Read across the settings and South Dakota's picture is split. Facility care, both assisted living and the nursing home, sits below the national figures, while in-home care sits well above them. In South Dakota, a non-medical caregiver at 44 hours a week runs about $101,244 a year, against about $58,800 for assisted living and about $113,333 for a semi-private nursing-home room.

Care setting South Dakota (year) South Dakota (month) National (year)
Assisted living about $58,800 about $4,900 about $74,400
Nursing home, semi-private room about $113,333 about $9,444 about $114,975
Nursing home, private room about $122,275 about $10,190 about $129,575
Non-medical caregiver, in-home (44 hrs/wk) about $101,244 hourly rate: about $44 about $80,080

The in-home figure is based on about 44 hours of help a week. In its 2025 survey, CareScout merged the two in-home lines it used to report separately, homemaker and home health aide, into a single "non-medical caregiver" category, so this year's figure isn't a like-for-like match with either of those older lines. At about 44 hours a week, a non-medical caregiver in South Dakota runs about $101,244 a year, or roughly $44 an hour, and costs rise as care needs grow.

What Drives the Cost of Senior Care in South Dakota

The setting and the amount of care a person needs both move the bill: the survey's figures differ sharply by setting, and costs vary within the state and rise as care needs grow. Among facilities, assisted living in South Dakota costs about $58,800 a year, among the lowest in the nation, while a semi-private nursing-home room costs about $113,333. Both run below the national medians of about $74,400 and $114,975.

In-home care is where South Dakota breaks from the national picture. A non-medical caregiver here runs about $101,244 a year at 44 hours a week, roughly $44 an hour, well above the national figure of about $80,080.

Within any single setting, costs rise as care needs grow. When you compare quotes, ask what the base rate includes and what would raise it.

How Families Pay

For long-term care, families generally rely on private pay, long-term care insurance, or Medicaid. Here's how those options work in South Dakota.

Private pay, from savings, income, or the sale of a home, has to stretch a long way at South Dakota prices: about $113,333 a year for a semi-private nursing-home room, or about $101,244 a year for a non-medical caregiver at 44 hours a week.

South Dakota Medicaid, run by the Department of Social Services, pays for long-term care, including nursing-facility care and home- and community-based services, for eligible older adults and people with disabilities. South Dakota is a 1634 state, so anyone approved for Supplemental Security Income (SSI) is automatically eligible for Medicaid, with no separate application. For institutional and waiver long-term care, the state uses an income cap of 300% of the federal SSI benefit rate, about $2,982 a month for a single applicant in 2026, with a countable-resource limit of $2,000 for an individual; an applicant whose income exceeds that ceiling can still qualify by routing income through a qualified income (Miller) trust, which South Dakota's rules call a Medicaid income trust. When one spouse needs care, federal spousal-impoverishment rules let the at-home spouse keep a community spouse resource allowance of at least $32,532 and up to $162,660 in 2026.

South Dakota's main home- and community-based long-term-care waiver is the HOPE waiver, which lets home and community-based services go to people at risk of institutionalization whose medical needs require a nursing-home level of care., Two more rules shape long-term-care planning. South Dakota enforces a 60-month look-back on asset transfers, and like every state it must seek recovery from the estate of someone who received long-term-care Medicaid at 55 or older. South Dakota defines that estate broadly, reaching beyond probate property to assets passed on through joint tenancy, a life estate, or a living trust. Its rules bar recovery while a spouse is living or a child under 21, blind, or disabled survives, but that bar doesn't apply if the department finds the person owned assets that would have made them ineligible, and the department may later file a claim against the surviving spouse's own estate (the spouse can petition to limit it within six months of the recipient's death).

One gap matters for budgeting: Medicaid does not pay the room-and-board cost of assisted living. South Dakota Medicaid can cover assisted-living services through the HOPE waiver, but federal rules bar a home- and community-based waiver from paying room and board, so a resident on the waiver still pays for it. A family choosing assisted living should plan to pay room and board themselves, even where the waiver helps with the assisted-living services.

A note on Medicare, because the assumption is common: Medicare doesn't pay for long-term custodial care, the help with bathing, dressing, and other daily activities, when that's the only care a person needs (hospice care is the exception). What it covers instead is skilled care, such as a limited stay in a skilled nursing facility after a hospital stay and part-time skilled nursing or therapy at home. For long-term custodial care, families generally rely on private pay, long-term care insurance, or Medicaid.

How to Plan and Budget

Start by matching the setting to the actual need, not the other way around. South Dakota's facility care is among the most affordable in the country while in-home care runs high, so staying home isn't automatically the cheaper choice here: a non-medical caregiver at 44 hours a week, about $101,244 a year, costs more than assisted living at about $58,800. A candid assessment of how much help a person truly needs is worth more than a default assumption.

Then build a realistic timeline. Estimate the monthly cost of the right setting, list the resources available to pay for it, and work out how long private funds will last before Medicaid would come into play. If Medicaid is likely to be part of the plan, the 60-month look-back and the estate-recovery rules above are reasons to start early and get advice. Two Brevy guides go deeper here: Medicaid Planning Strategies walks through how to position assets and income within the rules, and Medicaid Personal Needs Allowance, Explained covers the personal needs allowance.

Finally, budget for the add-ons, not just the base rate. Costs rise as care needs grow, so the figure you start with may not be the figure you finish with. A plan that assumes some increase is more likely to hold up than one built on today's lowest quote.

Frequently Asked Questions

How much does senior care cost in South Dakota?

It depends heavily on the setting. Per the CareScout 2025 Cost of Care Survey, released March 2026, assisted living runs about $58,800 a year (roughly $4,900 a month), a semi-private nursing-home room about $113,333 a year, a private room about $122,275, and a non-medical caregiver providing in-home help about $101,244 a year (at roughly 44 hours a week). These are industry-survey medians, and costs vary within the state and rise as care needs grow.

Why is in-home care so expensive in South Dakota?

In-home care in South Dakota runs about $101,244 a year for a non-medical caregiver at 44 hours a week (about $44 an hour), well above the national figure of about $80,080. That's more than assisted living at about $58,800, though less than a semi-private nursing-home room at about $113,333. The survey's figure assumes 44 hours of help a week, and costs rise as care needs grow.

Does Medicaid pay for senior care in South Dakota?

For nursing-facility care and home- and community-based services, yes, for eligible older adults and people with disabilities. South Dakota is a 1634 state, so anyone approved for SSI is automatically eligible for Medicaid, and long-term-care eligibility uses the 300% of the federal benefit rate income standard, about $2,982 a month for a single applicant in 2026, with a countable-resource limit of $2,000 for an individual. Home- and community-based care runs mainly through the HOPE waiver.

Does Medicaid cover assisted living in South Dakota?

Not the room-and-board cost. South Dakota Medicaid can cover assisted-living services through the HOPE waiver, but federal rules bar a home- and community-based waiver from paying room and board, so a resident on the waiver still pays for it. A family choosing assisted living should plan to pay room and board themselves, even where the waiver helps with the assisted-living services.

How do families pay for senior care in South Dakota?

For long-term care, families generally rely on private pay, long-term care insurance, or Medicaid. South Dakota Medicaid covers long-term care for eligible older adults and people with disabilities. Because South Dakota has a 60-month look-back on asset transfers and must seek recovery from the estate of someone who got long-term-care Medicaid at 55 or older, a recovery that can reach jointly held and trust assets and even a surviving spouse's later estate, planning early and getting professional advice usually pays off.

Learn More

Care TypesCost of Senior Care by State: Assisted Living, Nursing Home, and Home CareThe 2026 national median cost of assisted living, memory care, nursing homes, and in-home care, why your state differs, and your state's own cost guide. Care TypesAssisted Living in South DakotaAssisted living in South Dakota runs about $4,900 a month, among the nation's lowest. How the state licenses it, what it costs, and what Medicaid pays. Care TypesNursing Homes in South DakotaNursing homes in South Dakota in 2026: a semi-private room runs about $113,333/year, below the national median. What it costs, who pays, and how to choose. Care TypesMemory Care in South DakotaSouth Dakota has no separate memory care license. Dementia care is a regulated unit inside an assisted living center, priced above standard assisted living. Care TypesHome Care vs. Home Health in South DakotaHome care vs. home health in South Dakota: Medicare covers skilled home health, not non-medical home care on its own. That decides who pays. Care TypesAssisted Living vs. Nursing Home in South DakotaAssisted living vs. a nursing home in South Dakota comes down to level of care and who pays: about $4,900/month private-pay vs. roughly $113,333/year nursing.
MedicaidMedicaid Planning StrategiesSee which assets you keep, how the 5-year look-back works, and the legal moves that qualify you for Medicaid long-term care without losing the house. MedicaidMedicaid Personal Needs Allowance, ExplainedHow the Medicaid Personal Needs Allowance works in 2026: the $30 federal floor, what the states set, and how patient liability is calculated.

Find personalized help building a realistic senior-care budget for South Dakota at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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