VA Aid and Attendance for Memory Care in South Dakota

When Alzheimer's or another dementia makes living alone unsafe, VA Aid and Attendance can help a wartime veteran or surviving spouse pay for memory care in South Dakota.1

If you are arranging dementia care for a veteran parent, the pension is needs-based, and the VA lets you subtract unreimbursed medical expenses, including memory-care costs, from the income it counts, so a parent whose income looks too high at first glance can still be eligible.1

In This Guide

• Key Takeaways
• How Much Memory Care Costs in South Dakota
• How Aid and Attendance Helps Pay for Memory Care in South Dakota
• When Dementia Meets the VA's Need-for-Care Test
• How Memory Care Costs Lower Your Countable Income for Aid and Attendance in South Dakota
• Who Qualifies
• How Aid and Attendance Works with South Dakota Medicaid
• How to Apply and Get Free Help
• Frequently Asked Questions
• Learn More

How Much Memory Care Costs in South Dakota

South Dakota does not issue a separate memory-care license. Instead, dementia care is built into the licensing of assisted living centers and nursing facilities overseen by the South Dakota Department of Health, where a "memory care unit" is a defined, regulated part of a facility: a distinct part whose physical environment and design maximize residents' functioning, promote safety, and encourage independence, staffed by people trained to meet the needs of the residents admitted to it.2 The rules then hold every memory care unit to specific requirements, including therapeutic programming written into the plan of care, locked doors that meet the fire-safety code, staff with specific training in the needs of the unit's residents, and at least one caregiver on duty in the unit at all times; under the assisted-living rules the unit must also sit at grade level with direct access to an outside area.2 You cannot shop for a memory-care license, but you can confirm that a facility operates a recognized memory care unit and then check it against those rules: ask what the dementia training actually covers, ask to see the programming in the plan of care, and look at the doors, the outdoor access, and the round-the-clock caregiver yourself.2

South Dakota's facility care is among the most affordable in the country. Per the CareScout 2025 Cost of Care Survey, assisted living runs about $4,900 a month, roughly $58,800 a year, one of the lowest figures in the nation and well below the national median of about $74,400 a year ($6,200 a month).3 Nursing home care is also below the national line, at about $9,444 a month ($113,333 a year) for a semi-private room and about $10,190 a month ($122,275 a year) for a private room.3 These are industry-survey medians, not government figures, and costs vary within the state. Memory care adds a secured setting and specialized staffing, so use the assisted-living figure as a starting point, not the final price, and ask each facility for its actual memory-care monthly rate.3

How Aid and Attendance Helps Pay for Memory Care in South Dakota

Aid and Attendance is the VA pension paid at a higher maximum rate for veterans and surviving spouses who need help with daily activities, so the figures below are the maximum for the whole pension, not an extra amount on top of the basic rate. It is paid monthly to the veteran or surviving spouse and can go toward the memory-care bill.1 The amount depends on who is receiving it:

These are 2026 maximums, effective December 1, 2025 through November 30, 2026. VA publishes these as annual rates and pays the pension monthly: under 38 CFR 3.273, the monthly payment is the annual maximum minus countable income, divided by 12.1 The pension is needs-based: to be eligible, the veteran's yearly family income and net worth have to meet limits set by Congress.1 Each figure above is a ceiling, the maximum amount of pension payable, and the VA pays the difference between the claimant's income for VA purposes and that limit rather than the full figure.1 Against South Dakota's memory-care costs, a benefit paid at the ceiling can cover a meaningful share of the bill.3 Read that share as the top of the range: the VA pays the difference between the claimant's income for VA purposes and the ceiling, so other income the VA counts does not stack on top of the pension, it reduces it, and a household with that income is awarded less than the table shows.1

When Dementia Meets the VA's Need-for-Care Test

One of the ways the VA recognizes a need for aid and attendance is needing help with daily activities such as bathing, dressing, feeding yourself, or protecting yourself from the ordinary hazards of daily living.5 A dementia diagnosis does not qualify anyone by itself; what the VA rates is the need. Its rule counts an incapacity, physical or mental, that requires care or assistance on a regular basis to protect a person from the hazards of their daily environment, and the need only has to be regular, not constant. When dementia has brought that need, it is the need the application has to document.5 Being a patient in a nursing home due to the loss of mental or physical abilities related to a disability is another way the VA recognizes the need, so a veteran whose dementia has progressed to nursing-facility care can qualify on that basis as well.5 The need is documented on VA Form 21-2680, part of the application, where a medical examiner fills out the examination information section.6

How Memory Care Costs Lower Your Countable Income for Aid and Attendance in South Dakota

This is the part families most often miss. Because the pension is keyed to the income the VA counts, you can subtract unreimbursed medical expenses, including the cost of memory care, from that income.1 Memory care in an assisted living center falls under VA's rule for a care facility other than a nursing home, which has its own conditions. The resident has to be receiving health care or custodial care in the facility and either qualify for Aid and Attendance (or be housebound), or have a physician, physician assistant, certified nurse practitioner, or clinical nurse specialist state in writing that a cognitive disorder means they need to be in a protected environment. The facility must be licensed where the state requires that type to be, and a residential facility must be staffed 24 hours a day with care providers. Meals and lodging count as medical expenses too when the facility provides or contracts for the resident's health or custodial care.1

Only the portion of those expenses above 5% of the applicable maximum annual pension rate is deductible. For 2026 that floor is $872 a year for a veteran with no spouse or child, an annual figure, not a monthly one, and it rises with dependents, though never with the Aid and Attendance increase itself.1

Here is how it works in practice. Suppose a veteran's memory-care unit charges in the range of South Dakota's care costs: the standard assisted-living rate alone is about $58,800 a year, and a secured memory-care unit's actual rate is set by each facility.3 If the whole bill qualifies under those conditions, only the first $872 falls below the floor, and nearly all of the $58,800 remains as a deductible medical expense.1 That deduction can wipe out most or all of a parent's countable income, which is why a veteran whose income looked too high to qualify can qualify once the memory-care bill is counted.1

Who Qualifies

To receive Aid and Attendance, a veteran generally must meet four conditions:5

• Wartime service and a discharge that is not dishonorable: a veteran who started active duty before September 8, 1980 needs at least 90 days of active duty with at least one day during a wartime period VA recognizes, such as World War II, the Korean conflict, the Vietnam War era, or the Gulf War. A veteran who enlisted after September 7, 1980 generally needs 24 months or the full period they were called or ordered to serve (with some exceptions), still with at least one day during wartime.5
• Age, disability, or care status: the veteran has to meet at least one of four alternatives, and any one of them satisfies the test. They are being at least 65 years old, having a permanent and total disability, being a patient in a nursing home for long-term care because of a disability, or getting Social Security Disability Insurance or Supplemental Security Income.5
• Net worth under $163,699 for 2026, counting the claimant's and their dependents' assets and annual income together but excluding the primary home, the car, and basic household items.5
• A documented need for aid and attendance, such as needing another person's help with daily activities like bathing, feeding, and dressing. A diagnosis alone does not meet it; the need does.5

The VA also applies a 3-year (36-month) look-back: it reviews assets transferred for less than fair market value in the three years before you file, and a disqualifying transfer can create a penalty period.5 A surviving spouse can qualify under the Survivors Pension with the same net worth limit.1

How Aid and Attendance Works with South Dakota Medicaid

Aid and Attendance and South Dakota Medicaid are separate programs that can interact when a veteran needs long-term care. Aid and Attendance is administered federally by the VA, while Medicaid long-term care in South Dakota is run by the South Dakota Department of Social Services and has its own income and asset rules.7 A veteran or surviving spouse may qualify for both, but a federal cap changes the pension once Medicaid pays for nursing-facility care: for a veteran with no spouse or dependent child, or a surviving spouse with no dependent child, the VA pension can be no more than $90 a month for any month after the month of admission, and that reduced pension is treated as an aid and attendance allowance.7 Federal law bars that $90 from reducing what Medicaid pays the facility. The cap also does not reach a stay in a State Veterans Home for which VA pays a nursing-home per diem, so check a State Veterans Home stay with an accredited Veterans Service Officer rather than assume the $90 applies.7

At the eligibility step, South Dakota uses SSI income rules, under which the Aid and Attendance allowance is not counted as income, so of the VA pension only the basic portion counts toward the income limit.7 The next step works differently. For a nursing-facility resident with no spouse at home, South Dakota's regulations do not carry that exclusion into the calculation of what the resident pays toward the facility: an Aid and Attendance amount the VA is still paying at the full rate counts there, subject to the $90 and State-home rules above. Not all of it reaches the facility: before the bill is set, the agency is required to deduct a personal needs allowance, which South Dakota's rule sets at one hundred dollars a month, an amount for any family at home, and incurred expenses for medical or remedial care that no third party pays, such as Medicare and other health insurance premiums. That is a duty the state owes rather than a deduction a family has to ask for.7 A resident whose spouse still lives at home is budgeted under different rules that do not say how Aid and Attendance is treated, so confirm that household's figure with the Department of Social Services. A parent receiving Medicaid home- and community-based waiver services rather than nursing-facility care also falls outside the facility calculation described here, so ask the South Dakota Department of Social Services which rule applies to a waiver participant and what it leaves the household each month.7

Because the exact treatment of Aid and Attendance income and assets in a Medicaid eligibility determination depends on program rules and individual circumstances, confirm how the two will interact with the South Dakota Department of Social Services and an accredited Veterans Service Officer before relying on it.7 For privately paid memory care, this coordination does not apply; it comes into play once Medicaid is covering the cost of care.7

How to Apply and Get Free Help

The need itself is always documented on VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance), on which a medical examiner fills out the examination information section. That form covers Aid and Attendance that will be added to monthly compensation as well as Aid and Attendance added to a pension.6 The steps below are the pension route, which is the one most memory-care families are on: the VA's condition for it is that you may be eligible for this benefit if you get a VA pension. On that route, a wartime veteran who is not already receiving a VA pension files VA Form 21P-527EZ (Application for Veterans Pension) along with the 21-2680.6 You can apply online at VA.gov, by mail to the VA Pension Intake Center, or in person at a VA regional office, and an accredited attorney, accredited claims agent, or accredited Veterans Service Organization representative can file the claim for you.6 On how long a decision takes, the VA's own answer is "It depends." It processes claims in the order it receives them, unless a claim requires priority processing, so it is worth filing as soon as the need is clear.6

You do not have to do this alone. South Dakota veterans and their dependents can get help preparing and filing VA claims, including pension benefits for certain wartime veterans, through the South Dakota Department of Veterans Affairs and the state's county and tribal service officers.4

What If the Claim Is Denied

If the VA denies the claim or grants less than you expected, an initial decision opens three decision review options. You can file a Supplemental Claim with new and relevant evidence the VA did not have when it reviewed the case before, request a Higher-Level Review by a higher-level reviewer (no new evidence is submitted), or appeal to the Board of Veterans' Appeals for review by a Veterans Law Judge. You elect one of the three, not several at once: under 38 CFR 3.2500(b), only one of those reviews may be pending on the same claim or issue at a time, so a second cannot be filed while the first is pending final adjudication.8 The menu narrows after that: following a Higher-Level Review decision the choices are a Supplemental Claim or a Board Appeal, and following a Board decision they are a Supplemental Claim or an appeal to the U.S. Court of Appeals for Veterans Claims, which has to be filed within 120 days of the date on the Board's decision letter.8 That appeal is filed with the Court, not with the VA. A notice of appeal that is properly addressed and mailed is deemed received on the date of the legible U.S. Postal Service postmark on the envelope, so a postmark inside the 120 days is what makes it timely.8 A Higher-Level Review or a Board Appeal generally has to be elected within one year of the date the VA issues notice of its decision, while a Supplemental Claim can be filed at any time after that notice. The main exception is a contested claim, where several people claim a benefit only one of them can receive: there the only route is a Board Appeal, filed within 60 days of the notice.8 File a Supplemental Claim inside the year anyway: one the VA receives more than one year after the decision notice takes an effective date no earlier than the date the VA receives it, which can cost back pay. And if you switch to a Supplemental Claim from another review option after the year has run, continuous pursuit of the original claim is broken unless the VA grants an extension of the one-year period for good cause.8 An accredited attorney, claims agent, or Veterans Service Organization representative can help you request the review, and the VA's search tool will find one near you.8

Compare Care Settings in South Dakota

Aid and Attendance can help pay for any care setting. See how it works for the others:

• How Aid and Attendance Pays for Assisted Living in South Dakota
• How Aid and Attendance Pays for a Nursing Home in South Dakota
• How Aid and Attendance Pays for In-Home Care in South Dakota

Learn More

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.