Memory Care in South Dakota

Table of Contents

Memory Care in South Dakota

Table of Contents

• The Cost of Memory Care in South Dakota
• South Dakota Medicaid Programs for Memory Care
• Can You Use Medicare to Pay for Memory Care in South Dakota?
• More Ways to Pay for Memory Care in South Dakota
• Memory Care Laws and Regulations in South Dakota
• Free and Low-Cost Resources for Seniors in South Dakota
• South Dakota COVID-19 Rules for Memory Care Facilities

Because of the specialized staff training and resources required to provide high-quality memory care, memory care typically costs more than other types of residential care. On average, memory care will cost 20-30% more than assisted living.

We've accounted for these increased costs by adding 25% to the average prices for assisted living as reported in the Genworth Financial 2021 Cost of Care Survey. South Dakota is one of the more affordable parts of the country for memory care. The state's monthly average of $4,188 represents potential savings of $1,437 per month compared to the national average. North Dakota residents pay an average of $51 per month more than their southern counterparts. Nebraska, Iowa and Minnesota each have significantly higher costs, with increases of around $900-$1,500 per month over South Dakota.

Sioux Falls is the most affordable of the two cities surveyed in South Dakota, with costs that are $550 below average for the state. Rapid City's average of $4,893 per month for memory care is significantly higher than Sioux Falls and the state overall. Up north in Bismarck, the cost of care is about $500 higher than the South Dakota average.

Medicaid in South Dakota doesn't directly cover memory care services, as is the case in the majority of states. The state program covers a wide range of services and items that are typically more useful for seniors in nursing homes or independent living environments, as opposed to people in community-based memory care programs. The HOPE Waiver provides somewhat of a workaround for this, however, by granting coverage for services received in memory care and other previously uncovered environments.

• Who is Eligible: Low-income seniors aged 65+ and people with disabilities who need help paying for medically necessary services.
• How to Apply: South Dakota's Department of Social Services is responsible for processing Medicaid applications. The DSS website provides printable forms, mailing addresses and an online application portal. Residents can also visit a nearby DSS office or call 800-305-3064 to begin the application process for Medicaid.

HOPE Waiver Program

This program gives eligible residents coverage for various services collectively referred to as Long-Term Care Medicaid or Home and Community-Based Services. Individuals who are eligible for the HOPE Waiver can receive Medicaid-funded services in a wider range of living arrangements. Most importantly for those seeking memory care, the HOPE Waiver allows Medicaid coverage of these services when provided in community-based environments, such as a typical assisted facility or standalone memory care unit.

• Who is Eligible: Low-income seniors aged 65+ and adults with disabilities who need a nursing facility level of care that can be provided in a less restrictive environment, such as memory care.
• How to Apply: Applications for long-term care programs and services, such as those covered via the HOPE Waiver, can be submitted in much the same way as the state Medicaid program. Application forms, information and assistance can be found on the DSS website. Alternatively, a call to the statewide helpline at 800-305-3064 puts residents in touch with regional offices.

Medicaid Eligibility for Seniors in South Dakota

The maximum allowable income for senior Medicaid recipients in South Dakota is 300% of the SSI Standard Benefit Amount — sometimes referred to as the Federal Benefit Rate and Federal Poverty Level — which calculates to $30,276 per year as of 2022. The asset limit is $2,000 for a single applicant and $3,000 for a couple if both people are applying for services. The rules become much more complicated in the case of a couple with one person applying for long-term care while their spouse remains in the family home or elsewhere in the community. As such, applicants with this particular living arrangement should contact staff at the resources outlined below in order to determine eligibility.

2022 Medicaid Income Limits for Seniors in South Dakota

Throughout the application process, applicants may be asked to prove certain facts, such as their identity, financial status, medical diagnosis or other relevant points. Requests for specific documents and information are sent to the applicant as the process moves along, and in many cases the state may be able to verify many of the details automatically for applicants who have applied for various other government programs.

• Must be a resident of South Dakota (generally this can be established by showing utility bills or other mail sent to the applicant at an address in the state)
• Must meet U.S. citizenship requirements
• Must have medical needs assessed (which determines the level and type of care that Medicaid will cover)

How to Get Help Applying for Medicaid in South Dakota

South Dakota residents without Medicaid coverage via the state plan should first start there, and the DSS may be the more useful contact in this case. Medicaid recipients who wish to apply for waiver services, including coverage of memory care, should instead contact the LTSS division. Medicare beneficiaries and people who expect to enroll soon can also contact the SHIINE program.

Unfortunately, Medicare does not generally cover the cost of Memory Care. Most Memory Care Facilities are considered to be "social settings," so Medicare does not cover the cost incurred in these facilities. The only exception to that is if you are receiving memory care services in a Nursing Home. While this situation is much less common, Medicare would sometimes cover the cost, depending on a number of circumstances.

That being said, Medicare does still cover qualified doctor visits, medications, etc., as it would if you were still at home, but it will not cover the cost of care received at the Memory Care Facility.

In addition to the state programs mentioned above, those looking for resources to finance memory care may consider:

• Long-Term Care Insurance: Depending on the policy details, long-term care insurance may be used to pay for memory care services. It's best to sign up for a policy early, as coverage will likely be denied if one already has long-term care needs. More information about the intricacies of long-term care insurance can be found at longtermcare.acl.gov.
• Reverse Mortgages: Reverse mortgages allow some homeowners to take out a loan as an advance from the eventual sale of their primary residence. This can be a good way to fund memory care in the short-term, but the loans will need to be paid back after the sale of the home. The most commonly used type of reverse mortgages for seniors is the Home Equity Conversion Mortgage, which is the only reverse mortgage insured by the federal government.
• Veterans Benefits: The Department of Veterans Affairs offers several programs that veterans and their spouses may use to cover health care needs such as memory care. More information about these programs can be found on the VA website.

Memory Care Regulation

In South Dakota, personal care and memory care services are provided in assisted living facilities, also known as assisted living centers. ALCs are licensed by the South Dakota Department of Health’s Office of Health Facilities. To serve individuals with dementia or other specific conditions, facilities must obtain further certifications. Facilities may have secured units designed to enhance the safety and functionality of residents with dementia, with staff specifically trained to meet their needs. The department inspects each facility annually, with the first inspection taking place prior to licensing.

Each facility must assess and document the needs of new residents when they’re admitted into the facility, after 30 days of residency and on an annual basis going forward. Assessment measurements must be approved by the department, and the facility must also inform residents of the services the department permits it to provide.

Facility Scope of Care

Assisted living facilities must provide residents with individualized care that includes access to facilitated activities, outlets for their spiritual needs and physician services. Skilled nursing and rehabilitation services may be provided for no more than eight hours per day or 28 hours per week.

Residents may also receive services delivered on-site by third party providers, such as hospice agencies certified by Medicare. All third party providers must also adhere to the facility’s policies.

Admission Requirements

While South Dakota’s assisted living centers may admit the majority of individuals in need of memory care, state regulations also require facilities to deny admission to certain individuals. The table below lists the types of individuals centers may accept or deny.

Residents Who May Be Admitted

Older adults and people who:

• Can perform activities of daily living with the help of one staff member
• Have dementia
• Have mental or physical conditions
• Do not need restraints unless accepted into a secured unit
• Have stable and controlled conditions
• Can turn in and rise from bed with the help of no more than one staff member
• Can feed themselves with supervision and assistance
• Receive skilled nursing care from a Medicare-contracted provider for a limited duration of time

Residents Who May NOT Be Admitted

Those who:

• Require a mechanical lift
• Exhibit behaviors that endanger themselves or others
• Have communicable disease that pose a risk to others
• Require frequent or ongoing skilled nursing care or rehabilitative services
• Have needs that cannot be met by the facility

Care Plan Requirements

Care plans must include therapeutic programming for residents with dementia.

Medication Management Requirements

ALCs that accept individuals who require medication administration must employ a licensed nurse to oversee and record the condition of these residents on a weekly or more frequent basis. Staff who are not licensed must undergo medication administration training on an ongoing and annual basis.

Facility Requirements

Secured memory care units must be on the ground level and provide residents with access to a secure outdoor area. Throughout the assisted living center, private units must provide at least 120 square feet of living space, apart from the bathroom and closets. Two-bed rooms must provide at least 200 square feet of living space, and sleeping rooms in suites must offer a minimum of 100 square feet. In older facilities, up to four residents may share a bathroom, but in new facilities, each room must have direct access to its own bathroom.

Staffing Requirements

All facilities must employ a licensed administrator who has at least a high school diploma to manage and oversee the facility. To become an administrator, an employee must complete specialized certification training and a subsequent evaluation within one year.

ALCs must provide a minimum of 0.8 hours of direct care per resident during a 24-hour period, and there must be at least one awake staff member on duty at all times. Facilities that accept residents who require therapeutic diets must employ a registered dietitian.

Secured dementia care units in assisted living facilities must have at least one caregiving staff member present at all times. All staff in the unit must have received specialized dementia care training. Additionally, all AFC staff must receive ongoing training on residents’ rights and safety, nutritional and hydration needs, confidentiality, infection control and other relevant topics.

Medicaid Policy

Assisted living facilities may accept funding from the state through the Medicaid Home and Community-Based Options and Person Centered Excellence (HOPE) Waiver to help residents cover the cost of care services.

Reporting Abuse

Individuals who would like to file a complaint against an assisted living center or memory care provider should contact the South Dakota Department of Health by sending an email to DOHOLCcomplaint@state.sd.us, or calling 605-367-7499 or 605-367-4640. Anyone who files a complaint will remain anonymous.

Help and useful information is available from the following sources by phone, online or in person and is provided at no cost to seniors. Official and up-to-date resource directories for South Dakota are also included, which offer a quick way to connect with specific services and/or locations in the state.

Note: The following information was compiled and most recently updated on 2/13/2022. Since COVID-19 is a rapidly evolving crisis, be sure to contact your Memory Care Facility or local Area Agency on Aging for the most up-to-date information.