Memory Care vs. Nursing Home in South Dakota (2026)

If your parent has dementia in South Dakota, choosing between memory care and a nursing home is a heavy decision, and it gets easier once you see what each setting is built to do.

Memory care is a specialized form of assisted living for people with dementia, while a nursing home adds full-time nursing care, 24 hours a day, for someone who can't care for themselves anymore and may need ongoing medical care.1 Memory care in South Dakota is largely private-pay: standard assisted living runs roughly $4,900 a month, and in memory care the resident may need to pay extra for any special care. A semi-private nursing-home room runs about $9,444 a month and is what South Dakota Medicaid will help cover once someone qualifies.2,1,3,4 This guide walks through both so the setting matches the care your parent needs and the way your family can pay.

In This Guide

• The Core Difference
• At a Glance
• Who Each Setting Is Right For
• Costs and Who Pays
• How to Decide
• Frequently Asked Questions

The Core Difference

It is exhausting to weigh these two options while your parent is changing in front of you, so it helps to know that they are not really interchangeable. The National Institute on Aging (NIA) says long-term care facilities are not one-size-fits-all, and these two are built for different needs.1

Memory care in South Dakota is built into the licensing of assisted living centers rather than carried on a separate license of its own. The Administrative Rules of South Dakota that govern assisted living centers define a memory care unit as a distinct part of a facility in which the physical environment and design maximizes functioning abilities, promotes safety, and encourages independence for a defined specific population, staffed by persons trained to meet the needs of residents admitted to the unit.5 In practice, the rules require any locked doors to meet a fire-safety code, specific training for staff assigned to the unit, therapeutic programming written into the plan of care, and at least one caregiver on duty in the unit at all times.5 Nationally, memory care is a specialized form of assisted living for people with Alzheimer's and other dementias, and these settings generally offer supports beyond traditional assisted living, which can include specialized staff training, secured exits and enhanced visual cues.1

A nursing home includes all the services of an assisted living facility plus full-time nursing care, 24 hours a day, and it is meant for people who can't care for themselves anymore and may need ongoing medical care.1 In South Dakota, nursing facilities are licensed by the Department of Health under their own set of rules, ARSD article 44:73.7 Some nursing homes also have special Alzheimer's care units, often in a separate section of the building, where staff members have special training to care for people with dementia.1

Memory Care vs. Nursing Home at a Glance in South Dakota

Here is how the two settings compare on level of care, who each one serves, where the care is delivered in South Dakota, cost, and who pays.1,5,7,3,2,4

Who Each Setting Is Right For

Memory care is built around dementia itself: it is a specialized form of assisted living for people with Alzheimer's and other dementias.1 In South Dakota, staff assigned to a memory care unit must have specific training in its residents' needs, at least one caregiver must be on duty in the unit at all times, and a unit in an assisted living center must sit at grade level with direct access to an outside area.5

A nursing home fits when your parent can't care for themselves anymore and may need ongoing medical care, and it adds full-time nursing care, 24 hours a day, to the services of assisted living.1 South Dakota Medicaid can pay for nursing-facility care for people who meet a nursing-facility level of care and its financial rules.8,4 If your parent may need ongoing medical care as well as dementia care, ask nursing homes whether they have a special unit for people with Alzheimer's and what services it provides.1

Your parent's condition may progress after the move, so ask each community whether it has a special dementia unit and what services that unit provides, and whether your parent will be able to stay in the same room as the condition progresses, since changing rooms can be disorienting.9

Memory Care vs. Nursing Home Costs in South Dakota

The money question is a hard one, and the honest answer starts with two numbers. Standard assisted living in South Dakota runs about $4,900 a month statewide, among the lowest in the nation.3 In memory care, the resident pays for the room or apartment and may need to pay extra for any special care.1 A semi-private nursing-home room runs about $9,444 a month, and a private room about $10,190 a month.3 These come from the CareScout 2025 Cost of Care Survey, released in March 2026, which reports industry-survey medians rather than government rates, so treat them as a budgeting starting point.3 For memory care, ask each community for the total cost of care and whether its dementia unit is priced differently from the rest of the facility.1,9

The deeper difference is who pays. Memory care is largely private-pay. South Dakota Medicaid does not pay the room-and-board cost of an assisted living center, though care services for people who medically need a nursing-home level of care can be covered through the state's HOPE waiver.2 A nursing home is covered by South Dakota Medicaid for people who meet a nursing-facility level of care and the financial rules.8,4 Medicare does not fill this gap: it covers only a short, post-acute skilled-nursing stay of up to 100 days, usually after a qualifying hospital stay, not long-term custodial care in either setting.6 That funding difference belongs in the decision alongside the sticker price: a family paying privately for memory care may later turn to South Dakota Medicaid if a nursing home becomes necessary and your parent qualifies.4

Qualifying for nursing-home Medicaid in South Dakota involves two tests. The first is clinical: the state reviews your parent's medical, nursing and social needs and can assign a nursing-facility level of care if they need any of three things: physician-ordered care that only a licensed nurse can give or supervise, at least once every 24 hours; another person's help with any activity of daily living; or skilled therapy at least once a week. The state redetermines that classification every year.8 The second is financial. South Dakota is an income-cap state, so long-term-care eligibility uses an income ceiling of 300 percent of the federal Supplemental Security Income (SSI) benefit rate, about $2,982 a month for a single applicant in 2026; an applicant whose income is above that limit can still qualify by routing income through a Medicaid income trust, the qualified income or Miller trust, which pays what the applicant may not keep to the nursing facility each month. The countable-resource limit is $2,000 for a single applicant, and when one spouse needs care the at-home spouse can keep a community spouse resource allowance of up to $162,660 in 2026. 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. Its rules define that estate broadly: beyond probate property, it reaches assets passed on through joint tenancy, a life estate, a living trust or a similar arrangement. The state may not recover from the estate while your parent's spouse is living or while a child who is under 21, blind or disabled survives, but that protection does not apply if the state finds your parent owned property or assets that would have made them ineligible. The state may also file a claim against the surviving spouse's own estate, and the spouse can petition to limit it within six months of your parent's death. Because these rules are intricate, it is wise to get advice before applying if your parent's finances are near the limits.4

How to Decide

If your parent may need ongoing medical care as well as dementia care, look at nursing homes with special Alzheimer's care units, where staff members have special training to care for people with dementia.1

Learn More

Find personalized help comparing memory care and a nursing home in 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.