Skilled nursing at home (private duty nurse) costs in South Dakota
Here is the middle of the price range in South Dakota, and then — because it is the question that actually follows — who pays for it. The short answer on that second one surprises most people: Medicare does not.
The South Dakota median
$92.00 an hour
- Works out to, monthly
- $17,541
- Works out to, yearly
- $210,496
Our arithmetic, not the survey's. The survey reports this one by the hour, so the monthly and yearly figures assume a schedule: $92.00 an hour × 44 hours a week × 52 weeks ÷ 12 months. Fewer hours, smaller bill — the schedule is the biggest lever you have.
That is about 2% higher than the national median of $90.00 an hour. Within South Dakota the spread is usually wider still: a city costs more than a rural county, often by a great deal.
A licensed practical nurse or registered nurse who comes to the house for medical care such as wound care, injections, IV therapy, catheters, feeding tubes and medication management.
CareScout reported insufficient data in this state to publish a median for adult day health care in the 2025 survey, so no figure is shown for it here.
What this number is, and what it is not.
It comes from an industry cost-of-care survey — providers reporting their prices — not from a government rate table. There is no federal agency that publishes what assisted living costs, which is why the survey is the source of record here and why we label it plainly rather than dressing it up as official.
A median means half charged more and half charged less. It is not a quote for any particular home, agency or facility, and no provider is bound by it. Prices collected for the 2025 survey.
Where South Dakota sits
$92.00 an hour ranks South Dakota 24th of the 46 states priced for skilled nursing at home (private duty nurse): 23 charge more, 22 charge less.
Missouri is the next state up, at $95.00; Texas the next down, at $90.00.
The national median is $90.00, so South Dakota runs $2.00 above it — 2% more, or $4,576 a year ($2.00 × 44 hours a week × 52 weeks).
The column runs $43.00 (Mississippi) to $207.00 (Wyoming). South Dakota sits 30% up it, 2.14× the lowest, with 10 other within a tenth of it.
Of the 5 kinds of care South Dakota was priced for, this is its 2nd dearest standing: at best 5th of 50 for in-home care (non-medical caregiver), at worst 46th of 50 for assisted living community.
What $17,541 a month becomes
Our multiplication, holding the South Dakota median flat — no real bill does — with the same span of the state's least costly priced care beside it:
Six months
$105,248
$29,400 of assisted living community
One year
$210,496
$58,800 of assisted living community
Two years
$420,992
$117,600 of assisted living community
Three years
$631,488
$176,400 of assisted living community
Five years
$1,052,480
$294,000 of assisted living community
Care is bought in years, not months, and $17,541 a month is $210,496 a year.
Five years at the national median would be $1,029,600: $22,880 less than five years in South Dakota.
Inside South Dakota, five years of assisted living community runs $294,000 and five of nursing home, private room $611,400; this page's $1,052,480 sits 100% between them. Most families pay for more than one of these in sequence.
Against other care in South Dakota
Converted to a month on our schedule, set beside this page's $17,541:
Nursing home, private room
$10,190 a month
$7,351 a month less, $88,216 a year, 0.58× this page. South Dakota places 34th of 49 for it, 10 below its 24th here.
Nursing home, semi-private room
$9,444 a month
$8,097 a month less, $97,168 a year, 0.54× this page. South Dakota places 31st of 50 for it, 7 below its 24th here.
In-home care (non-medical caregiver)
$8,389 a month
$9,152 a month less, $109,824 a year, 0.48× this page. South Dakota places 5th of 50 for it, 19 above its 24th here.
Assisted living community
$4,900 a month
$12,641 a month less, $151,696 a year, 0.28× this page. South Dakota places 46th of 50 for it, 22 below its 24th here.
On the same monthly footing, skilled nursing at home (private duty nurse) is the 1st costliest of the 5 kinds of care priced in South Dakota, at $17,541. The conversions are ours; the medians are the survey's.
44 hours a week of in-home care in South Dakota is $8,389 a month against $4,900 for assisted living — 42% less. The first buys 44 hours and nothing else; the second includes the room, the meals, and someone awake overnight.
What the survey could not price in South Dakota
The 2025 survey priced 5 of the 6 kinds of care in South Dakota — skilled nursing at home (private duty nurse) among them, at $92.00 an hour. Too few providers reported adult day health care, so no median was published and there is no South Dakota page for it.
Thin reporting also tends to mean fewer such providers locally — a supply problem before it is a price one, and a good question for the counselor below.
Who actually pays for this
This is the part most cost pages leave out, and it is the part that changes what a family does next.
Medicare does not pay for long-term care
Medicare pays for short stretches of skilled care — a limited stay in a skilled nursing facility after a qualifying hospital admission, or skilled home health under specific conditions. It does not pay for custodial care: help with bathing, dressing, meals, medication reminders and supervision. That is what most people need, and for years at a time.
Medicare's own page on long-term care ↗ says the same thing in its own words. It is worth reading once, because almost everyone assumes the opposite.
Medicaid may pay — after a spend-down
Medicaid is the largest payer of long-term care in the country, but it is needs-based: it begins once income and countable savings are inside the limits South Dakota sets. Getting there by spending savings on care is what people mean by a spend-down. There is also a look-back period, so gifts and transfers made in the years beforehand matter.
Veterans: Aid and Attendance may help
A wartime veteran, or a surviving spouse, who needs help with daily activities may qualify for an addition to the VA pension called Aid and Attendance. It is an income-and-net-worth benefit, it is paid monthly, and a great many families who qualify have never heard of it. Accredited veterans service organizations help with the claim for free.
Otherwise: savings, family, and long-term care insurance
Most families pay out of pocket first — from savings, a pension, the sale of a house, or several relatives contributing. A long-term care insurance policy bought years ago pays a daily or monthly amount if the policy's conditions are met; if there is a policy in the family, find it and read what triggers it before you need it.
Working out which of these applies to one particular family is exactly what a free South Dakota counselor does all day. They are paid by a federal grant, not by commission, and they have nothing to sell you. The Eldercare Locator (ACL): 1-800-677-1116 ↗ will connect you to the area agency on aging for your county.
Who to ask in South Dakota
South Dakota's free counseling program is Senior Health Information and Insurance Education (SHIINE), on 1-888-854-5321. It is grant-funded and sells nothing.
the South Dakota Department of Social Services decides Medicaid long-term care here — not a facility, and not us. South Dakota runs it as Nursing facility, assisted living and home care (institutional) Medicaid and HOPE waiver home and community based services, with a 60-month look-back on gifts and transfers.
Beside $17,541 a month — our comparison, its limits — that is what "spend-down" means: a single applicant's monthly income may not top $2,982, which this bill clears 5.9 times over and countable assets may not top $2,000, or about 3 days of skilled nursing at home (private duty nurse) at this rate.
Verified 2026-08-02 against CareScout (formerly Genworth) Cost of Care Survey 2025, fielded July-November 2025 (effective 2026-01-01)— an industry survey, not a government figure. Why we use it.
Verified 2026-08-02 against SHIP National Technical Assistance Center (effective 2026-01-01)— an industry survey, not a government figure. Why we use it.
Verified 2026-08-02 against South Dakota Department of Social Services, South Dakota Medicaid Coverage Groups, with the Department's medical assistance application form EA-240 (effective 2026-01-01)
Common questions
- Does Medicare pay for skilled nursing at home (private duty nurse) in South Dakota?
- No. Medicare pays for short stretches of skilled care after a qualifying hospital stay, and for skilled home health in limited circumstances. It does not pay for long-term custodial care — help with bathing, dressing, meals and supervision — which is what most families are actually paying for.
- Is skilled nursing at home (private duty nurse) dearer in South Dakota than in other states?
- $92.00 an hour places South Dakota 24th of the 46 states the survey priced for it: 23 charge more and 22 charge less. The national median is $90.00. That ranking is our arithmetic on the survey's published medians, not a ranking the survey itself publishes.
- Is this the price I will be quoted in South Dakota?
- No. It is the middle of a range from an industry cost-of-care survey: half of the providers surveyed charged more, half charged less. Prices vary a great deal between a city and a rural county in the same state, and no facility is bound by this figure.
- Who can help me work out how to pay for it?
- South Dakota runs its free counseling program as Senior Health Information and Insurance Education (SHIINE), on 1-888-854-5321. It is paid for by a federal grant, sells nothing, and the Eldercare Locator (1-800-677-1116) will connect you to the area agency on aging that covers your county.