VA benefits for senior care in South Dakota cover more than most families realize. If your loved one is a veteran, the VA offers home-based medical care, nursing homes, and monthly cash payments that can help pay for the care they need. The challenge usually isn't eligibility. It's knowing what to ask for.

This guide covers every VA program that helps pay for or provide senior care, how to access them in South Dakota, and what happens when VA care isn't enough on its own.

In This Guide

VA Senior Care Benefits in South Dakota: Long-Term Care Options

The VA offers multiple long-term care programs. Access isn't automatic once a veteran is enrolled: VA also has to conclude the veteran needs that specific service for their ongoing treatment and personal care, and the service, or a space in the care setting, has to be available near them. That list isn't closed either: the VA says it may also consider other factors, like the veteran's service-connected disability status or insurance coverage.

Home Based Primary Care (HBPC)

A VA physician supervises a health care team that visits the veteran at home. HBPC is designed for veterans with complex medical needs who have difficulty getting to a clinic regularly. The team typically includes a doctor, nurse, social worker, and may include rehabilitation therapists and a dietitian.

This isn't the same as home health care through Medicare. HBPC provides ongoing, coordinated primary care at home, not just short-term skilled visits. For veterans who qualify, it's one of the best programs the VA offers.

Adult Day Health Care

Veterans attend a structured daytime program that provides social activities, companionship, recreation, care, and support. It also gives family caregivers reliable daytime respite. Programs may be at VA facilities or contracted community adult day centers.

Community Living Centers (VA Nursing Homes)

Community Living Centers are VA nursing centers designed to feel like home, providing nursing-home-level care. They serve veterans who need short-term rehabilitation (after surgery or hospitalization), long-term nursing care, hospice care, or respite care.

For South Dakota veterans, the nearest CLC may be at a VA medical center in the region. Your VA social worker can help you find the closest option and confirm eligibility.

Community Nursing Home Program

The VA contracts with community (non-VA) nursing homes so veterans can get nursing home care near home. A placement is not the same as free care. The VA covers some long-term care services under a veteran's standard health benefits and a copay can still apply to a covered service, while other services aren't covered under VA health care benefits at all, and a veteran may be able to pay for those through Medicaid, Medicare, or private insurance. Some veterans are exempt from copays because of their disability rating, income level, or special eligibility factors. For a veteran who isn't exempt, extended care carries no copay for the first 21 days of care in a 12-month period; starting on the 22nd day, the VA bases the copay on the level of care and the financial information the veteran provides on the Application for Extended Care Services (VA Form 10-10EC). For nursing home care, whether VA benefits help pay at all depends on the veteran's income and the level of their service-connected disability. In a largely rural state like South Dakota, this program matters: it lets a veteran receive nursing home care closer to home rather than traveling hundreds of miles to a VA facility. To start, ask the social work office at your nearest VA medical center to assess eligibility and locate a contracted home.

Respite Care

Enrolled veterans who meet the clinical criteria can get respite where it's available, overnight or daily, up to 30 days each calendar year, at home or as a short stay in a CLC or community nursing home. Respite from a community agency, adult day center, or nursing home also requires community care eligibility, and a veteran who isn't exempt may owe a copay after the first 21 days of extended care in a 12-month period, so ask the VA social worker about it before booking. The VA Caregiver Support Line is 1-855-260-3274, weekdays 8:00 a.m. to 8:00 p.m. Eastern Time.

Not sure which VA program fits your family's situation? Chat with Brevy to get a personalized recommendation.

South Dakota's State Veterans Home

South Dakota operates one state veterans home, the Michael J. Fitzmaurice State Veterans Home in Hot Springs, run by the South Dakota Department of Veterans Affairs; the department's application page points families to the home's main line, 605-519-5445, so call it and ask for admissions. It serves eligible South Dakota veterans and their spouses, widows, and widowers in a long-term care and independent living setting, and provides two levels of care.

Care Level Details
Skilled Nursing Long-term nursing care
Domiciliary Non-skilled residential (domiciliary) care for residents who need less intensive support

The department's history page lists 78 nursing beds and 24 domiciliary beds but also calls it a 100-bed facility, so ask the home about current capacity.

The home admits a veteran who is eligible for the payment of per diem for domiciliary care or nursing home care in a state home. A veteran domiciled in South Dakota within the past five years receives admission preference, as does a veteran who is a member of a federally recognized Indian tribe located wholly or partially within the state. Contact the home directly for current availability, rates, and admission policies.

VA Aid and Attendance

The Aid and Attendance pension is a higher VA pension rate, paid monthly, for veterans (or surviving spouses) who need help with daily activities.

2026 Rates

Category Maximum Annual Pension Rate
Veteran alone Up to $29,093
Veteran with one dependent Up to $34,488
Surviving spouse Up to $18,697

These are ceilings, not payments. The Maximum Annual Pension Rate is the maximum amount of pension payable, and the VA pays the difference between the claimant's income for VA purposes and that limit, so almost no one receives the full figure. The VA publishes these as annual rates but pays monthly: it subtracts countable income from the annual rate, divides what's left by 12, and rounds down to the whole dollar.

Who Qualifies

To be eligible, the veteran must:

  • Have served on active duty with at least one day during a wartime period (and a minimum length of service)
  • Have no dishonorable discharge
  • Meet at least one of four alternatives: be 65 or older, have a permanent and total disability, be a patient in a nursing home for long-term care because of a disability, or be receiving Social Security Disability Insurance or Supplemental Security Income
  • Need help from another person with daily activities like bathing, feeding, and dressing, or be largely bed-bound by illness, a nursing home patient because of a disability, or severely limited in eyesight
  • Have a net worth no higher than $163,699

The nursing-home and SSDI/SSI branches stand on their own, so a wartime veteran under 65 who receives SSI meets the test without any adjudicated disability rating. The VA's net-worth calculation counts the claimant's and their dependents' assets and their annual income together against that $163,699 limit; the primary home and a vehicle are excluded. Comparing assets alone against the limit gives the wrong answer.

The VA enforces a 3-year look-back period on asset transfers.

How to Apply

Everyone files 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 whether it will be added to a veteran's monthly compensation or to their pension.

The steps below are the pension route. The VA's condition for it is that "You may be eligible for this benefit if you get a VA pension," so a wartime veteran pursuing the pension route who is not already receiving a VA pension also files Form 21P-527EZ (Application for Veterans Pension), the means-tested wartime pension application. If the veteran is a nursing home patient, a nursing home official also completes VA Form 21-0779 to verify the stay.

If you are still gathering information, you can submit VA Form 21-0966 (Intent to File) first: the VA says "Submitting an intent to file can secure the earliest possible effective date for any retroactive payments you may be eligible to receive." Then apply online at VA.gov, by mail to the VA Pension Intake Center, or in person at a VA regional office. On how long a decision takes, the VA's own answer is "It depends." It works through claims in the order it receives them, unless a claim requires priority processing.

Don't do this alone. The South Dakota Department of Veterans Affairs and county Veterans Service Officers help veterans and their dependents prepare and file VA claims.

For the full application walkthrough, see our VA Aid and Attendance guide.

Veteran-Directed Care

The Veteran-Directed Care (VDC) program gives enrolled veterans of all ages a flexible budget, managed by the veteran or their representative, to hire and supervise their own workers, who can include family, friends, or neighbors.

VA medical centers deliver VDC through aging and disability network agencies, such as Area Agencies on Aging and aging and disability resource centers. An options counselor at the agency assesses the veteran's needs, plans their care and services, arranges fiscal management services, and keeps counseling and supporting the veteran. That makes VDC a fit for a veteran who wants control over their care and would rather be helped by people they know.

Veterans are eligible for VDC if they qualify for community care, meet the clinical criteria for the service, and it is available in their area. To enroll, contact the social work or Geriatrics and Extended Care office at your local VA medical center and ask for a VDC assessment.

Community Care Through the MISSION Act

The VA MISSION Act of 2018 lets an enrolled veteran get care from a community (non-VA) provider at the VA's expense. Two things always apply: the veteran has to be enrolled in or eligible for VA health care, and the VA care team has to approve the community care in advance, except in cases like urgent or emergency care. Beyond that, at least one condition must be met, including:

  • VA can't schedule an appointment within 20 days or a 30-minute average drive (primary care, mental health, non-institutional extended care), or 28 days or a 60-minute average drive (specialty care); failing either one is enough
  • You need a service VA doesn't provide at any VA health facility
  • You qualified under the old 40-mile rule as of June 6, 2018, and live in a state VA names, South Dakota among them
  • You and your VA provider agree community care is in your best medical interest

On May 19, 2025, the VA implemented language from the Dole Act that removes the extra step of review by a second VA doctor on the best-medical-interest pathway, making it faster for eligible veterans to access community care.

For South Dakota veterans in rural areas far from a VA medical center, the MISSION Act can be the difference between getting timely care and waiting months.

How VA Senior Care Benefits in South Dakota Work with Medicare and Medicaid

VA benefits don't replace Medicare or Medicaid, a veteran isn't required to enroll in Medicare to keep VA health care, and a veteran or surviving spouse can qualify for and receive VA pension and South Dakota Medicaid at the same time., But VA doesn't bill Medicare or Medicaid, and Medicare and the VA generally can't pay for the same service, so each time you get care you choose which benefit to use. If you delay Part B and later have to sign up because you lose VA health care or want more choice in where you get care, you'll pay a penalty that grows with each year you delayed and that you keep paying every year for the rest of your life. VA health care is not a shield against it.

  • VA + Medicare: Holding both is normal. VA pays for care it authorizes, at a VA or non-VA facility; if it authorizes only part of a non-VA hospital stay, Medicare may pay for covered services VA didn't authorize.
  • VA + Medicaid: Aid and Attendance and South Dakota Medicaid are separate programs that can interact for veterans needing long-term care. South Dakota Medicaid long-term care is administered by the South Dakota Department of Social Services and has its own income and asset rules. A veteran or surviving spouse may qualify for both, and the two are run under separate rules, but once Medicaid covers nursing-facility care for a veteran with no spouse or child (or a surviving spouse with no child), federal law caps the pension at $90 a month after the month of admission; the cap doesn't reach a State home that VA pays a nursing-home per diem, so check a state veterans home stay with an accredited Veterans Service Officer. At the eligibility step, South Dakota applies SSI income rules, under which the Aid and Attendance allowance is not counted as income, so only the basic pension counts toward the income limit. The share-of-cost step works differently. For a nursing-facility resident with no spouse at home, South Dakota's rules (ARSD 67:46:06:03) don't carry that exclusion forward, so Aid and Attendance that VA still pays at the full rate counts toward what the resident pays the facility, after the deductions below and subject to the federal $90 and State-home rules. For a resident whose spouse still lives at home, South Dakota's rules don't say how it's treated, so confirm that case directly. Not all of the income reaches the facility. Under 42 CFR 435.725(c)(1) the agency must deduct a personal needs allowance that is reasonable in amount for the resident's clothing and other personal needs while in the institution, which must be at least $30 a month, a federal floor rather than the amount South Dakota itself sets, and it must also deduct incurred expenses for medical or remedial care that are not subject to payment by a third party. South Dakota's own rule (ARSD 67:46:06:05) allows a nursing or intermediate care facility resident a deduction of $100 a month for personal needs. Where VA has cut a pension to the $90 Medicaid nursing-home rate, whether that $90 comes on top of the state personal needs allowance or instead of it is governed by South Dakota's own post-eligibility rules, so don't add the two together until the Department of Social Services confirms South Dakota's rule. Home- and community-based waiver services are a separate question: 42 CFR 435.725 does not on its own settle the post-eligibility treatment of income for waiver services, so a waiver household should ask the Department of Social Services which rule governs their share of cost.
  • The state veterans home: South Dakota law requires each resident to contribute toward their care, up to the home's actual cost of care.

The exact treatment depends on program rules and your circumstances, so confirm it with the South Dakota Department of Social Services and an accredited Veterans Service Officer before relying on it.

How to Get Started

1
Step 1

Confirm VA health care enrollment

If the veteran isn't already enrolled in VA health care, apply at va.gov/health-care/how-to-apply. Once the VA processes the application, it assigns the veteran to one of eight priority groups based on military service history, disability rating, income level, whether the veteran qualifies for Medicaid, and other benefits the veteran receives, with veterans who have service-connected disabilities assigned the highest priority. Some veterans are exempt from copays because of their disability rating, income level, or other special eligibility factors.

2
Step 2

Get help before you file

Don't file claims or applications alone. The South Dakota Department of Veterans Affairs was created to assist veterans and their dependents in preparing claims for federal VA benefits, and you can reach its representatives at (605) 333-6869 (Sioux Falls) or (605) 773-3269 (Pierre). Every South Dakota county also has a County Veterans Service Officer, and some of the reservations have a Tribal Veterans Service Officer; the majority of those offices are in the county courthouse or the tribal office.

3
Step 3

Gather records

You'll need the veteran's DD-214 (discharge papers), medical records documenting the need for care, and financial information. If you can't find the DD-214, the National Personnel Records Center can provide copies (request through va.gov).

Frequently Asked Questions

Do you have to be service-connected disabled to get Aid and Attendance?

No. Aid and Attendance doesn't require a service-connected disability at all. It requires wartime service, no dishonorable discharge, a net worth (assets plus annual income) no higher than $163,699, a qualifying need for aid and attendance (such as help with bathing, feeding, or dressing), and any one of the following: being 65 or older, having a permanent and total disability, being a patient in a nursing home for long-term care because of a disability, or receiving SSDI or SSI.

Can a veteran's spouse live in South Dakota's state veterans home?

In some cases, yes. The Michael J. Fitzmaurice State Veterans Home serves eligible South Dakota veterans and their spouses, widows, and widowers. A spouse may be admitted with the veteran if the two have been married and living together for at least one year before applying and their combined income is no more than $400 a year above VA's maximum income limit for pension; other rules apply if the veteran lives in a health care facility. A surviving spouse must not have remarried, must be at least 60, must have been married to and living with an eligible veteran for at least a year before the death, and must have lived in South Dakota for the year before applying. Contact the home directly for current eligibility and admission policies.

How long does it take to get Aid and Attendance approved?

The VA's own answer is "It depends." It works through claims in the order it receives them, unless a claim requires priority processing. The South Dakota Department of Veterans Affairs and county Veterans Service Officers help veterans and their dependents prepare and file these claims.

What if the VA denies the Aid and Attendance claim?

You have options. If the VA denies a pension claim, or grants less than you expected, there are three paths: a Supplemental Claim (submit new and relevant evidence the VA didn't have when it reviewed the case before), a Higher-Level Review (a higher-level reviewer re-examines the case to see whether an error or a difference of opinion changes the decision, with no new evidence submitted), or an appeal to the Board of Veterans' Appeals (a Veterans Law Judge reviews the case). For most VA benefits, a Higher-Level Review or a Board Appeal has to be requested within 1 year of the date on the decision letter, and the letter states the deadline; a Supplemental Claim can be filed at any time, though the VA recommends filing within 1 year to keep your effective date. An accredited VSO representative's services on a VA benefit claim are always free. Only accredited attorneys and claims agents may receive fees from claimants at all, and even they may charge only for representation provided after the VA has issued notice of its initial decision on the claim (38 CFR 14.636), so no one should charge you to prepare and file the initial pension application. That condition attaches to any stage after an initial decision, a Supplemental Claim or Higher-Level Review as much as a Board appeal, and any fee charged must be reasonable.

Does the VA pay for assisted living?

The VA doesn't directly operate assisted living facilities, but Aid and Attendance is paid to the veteran as an increase to the monthly VA pension, and the household can put that money toward assisted living. Assisted living fees can also count as deductible medical expenses when VA calculates the award, each part on its own terms: care from a health care provider counts; help with daily activities from other staff counts if the veteran is receiving health or custodial care there and needs aid and attendance, is housebound, or a clinician states in writing they need a protected environment; and meals and lodging count if the facility provides or contracts for the veteran's care. Veteran-Directed Care is a different tool: its flexible budget is for hiring and supervising workers who help a veteran live at home or in their community, so ask the VA social worker making the referral whether it fits an assisted living plan.

Next Steps

If you're caring for a veteran who needs help, start by calling the South Dakota Department of Veterans Affairs at (605) 333-6869. They can assess which benefits apply and help you file.

Learn More

VA BenefitsVA benefits for senior care nationwideA complete guide to VA benefits for senior care: long-term care, Aid and Attendance, pensions, DIC, and home grants for older veterans and surviving spouses. VA BenefitsVA Aid and Attendance in South DakotaVA Aid and Attendance in South Dakota for 2026: who qualifies, ceilings up to $34,488 a year, how to apply, and free help from SDDVA and county officers. VA BenefitsSouth Dakota Disabled Veteran Property Tax ExemptionSouth Dakota's disabled veteran property tax exemption takes $200,000 off a P&T-rated veteran's home. Who qualifies, surviving spouses, and the Nov. 1 deadline. 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 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 TypesCost of Senior Care in South DakotaSenior care costs in South Dakota: assisted living about $4,900 a month, a semi-private nursing-home room about $113,333 a year. Each setting, and how to pay. 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.
Your next step Find personalized help navigating VA senior care benefits 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.

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