South Dakota adult foster care home license: four adults, a resident owner, and DOH approval

What the state counts as an adult foster care home

SDCL 34-12-1.1(1) defines an adult foster care home as “a family-style residence that provides supervision of personal care, health services, and household services for no more than four aged, blind, physically disabled, developmentally disabled, or socially-emotionally disabled adults.”⁠¹ The same section lists adult foster care homes among “health care facilities.” Under SDCL 34-12-2, no person or company may establish, conduct or maintain one without first getting a license from the Department of Health.⁠¹⁠²

ARSD article 44:77, in effect since October 13, 2015, adds three definitions that decide whether your plan fits:⁠⁷

• Facility: “the family-style residence, other than an apartment.” An apartment unit cannot be licensed as an adult foster care home.
• Owner: “a person who resides at the adult foster care home who is responsible for the overall supervision, support, and care of the homes residents.” The license is built around a person living on site, not around an investor or an agency.
• Personal care: “limited assistance” with daily living. “Supervision of personal cares” means daily awareness of how each resident is doing, the ability to step in during a crisis, and “minimal assistance in the self-administration of prescribed medications.”

DOH’s consumer page puts it this way: these are “family residences licensed by the state” where adults get personal care, health supervision and household services “in a family atmosphere.”⁠¹²

Adult foster care, community living home, assisted living or residential living center

Four South Dakota categories overlap. Here is how they compare in the statutes and rules as of 2026-10-12:

Scroll the table sideways to see every column.

Sources: ⁠¹⁠⁴⁠⁶⁠⁸

Some notes on the boundaries:

• Community living home. The definition excludes settings certified or accredited under SDCL chapter 34-20A, Title 27A or Title 27B, so providers already certified through those systems are outside it.⁠¹ The community living home rules (ARSD 44:82, effective October 17, 2017) define the owner as “a person or organization” and allow an operator who is the owner’s designee.⁠⁸ If you want to own the home and staff it without living there, this license, not adult foster care, is the closer fit.
• Assisted living center. This covers any place giving “personal care and services that meet some need beyond basic provision of food, shelter, and laundry,” with no minimum size.⁠¹ If you plan more than four residents, or residents who need more help than ARSD 44:77:01:06 allows, see the South Dakota assisted living center license.
• Residential living center. SDCL 34-12-32 requires annual registration for anyone providing “room, meals, and daily living services, but not habilitative or health care” to two or more unrelated elderly or disabled people. No fee may be charged, and failure to register is a Class 2 misdemeanor. A home that adds supervision of personal care or health services to those basics fits the adult foster care definition instead.⁠¹⁠⁶⁠¹²
• Lodging only. Under SDCL 34-12-4, nothing in chapter 34-12 applies to lodging establishments or similar places that furnish only board and room, or either, to their guests.⁠⁵

Who can hold the license

ARSD 44:77:01:05 sets three criteria. The criteria reach family members who live in the home, not just the applicant:⁠⁷

1. Neither the owner nor any family member living at the residence may be “a habitual user of alcohol or drugs.”
2. Neither the owner nor any family member living at the residence may have a conviction for abusing or neglecting another person.
3. Anyone providing supervisory care and support in the home must be at least 18.

The home also “may not knowingly employ any person with a conviction for abusing another person” (ARSD 44:77:04:03).⁠⁷ The online application asks for the applicant’s and the applicant’s spouse’s names and dates of birth, so DOH treats the household, not just the applicant, as part of the license.⁠¹¹

Under ARSD 44:77:04:01, the owner is responsible for the daily overall operation of the home and must notify DOH in writing of any change of ownership.⁠⁷ SDCL 34-12-9 says no license under chapter 34-12 “shall be assignable or transferable,” so a buyer applies for a new license.⁠⁵

Which residents you can admit and keep

ARSD 44:77:01:06 is the rule that most limits an adult foster care home’s business model. You may admit and retain a resident who can:⁠⁷

• turn in bed and rise from a bed or chair alone or with limited help from one staff member for safety;
• transfer alone or with limited help from one staff member, without a mechanical lift;
• handle mobility, dressing, toileting, hygiene and bathing with limited help from one staff member, “but less than total assist”;
• do their own ostomy or catheter care;
• feed themselves with setup, cueing and supervision;
• take their own injections, or receive them from a licensed nurse;
• manage their own feeding tube, tracheotomy or peritoneal dialysis;
• stay free of restraints;
• need no skilled services, unless a Medicare-certified home health agency provides them under contract “for a limited time with a planned end date”;
• take action for self-preservation in an emergency “with limited direction”;
• not pose a danger to themselves or others, and not have communicable diseases that put others at risk;
• stay in stable, controlled condition without frequent medical intervention.

The rule has one carve-out. A resident who is an immediate family member of the owner may receive care beyond these limits.⁠⁷ A home that accepts residents with developmental disabilities or mental illness must provide facilities and programs that fit their needs.⁠⁷

You must document an evaluation of each resident’s needs at admission, once a year, and after any significant change, on a form DOH developed. The evaluation also controls staffing: a caregiver may not leave the home during a shift to serve non-residents unless the resident evaluation documents that the resident may be left unsupervised. The only exception is emergency care on property next to the home.⁠⁷

The house: space, exits and fire code

Space. ARSD 44:77:02:14 requires “a minimum of 200 square feet of floor space” available to the resident, including an easily accessible bathroom and a dining area big enough for residents and your family to eat at one sitting. It also requires enough sleeping space for residents and your family. No resident may live in an attic. A finished basement is allowed only if the living quarters are completely separated from the heating plant and utility room by one-hour fire-resistant construction. DOH sets your bed capacity from these physical plant and space rules, and the resident census may never exceed it.⁠⁷

Fire code edition. ARSD 44:77:03:04 applies NFPA 101 Life Safety Code, 2012 edition (the one- and two-family dwelling provisions) to all newly licensed homes and to any renovation, addition or change in space use. Sprinklers are not required unless the municipality issuing your building permit requires them. ARSD 44:77:03:01 still names the 2000 edition as the general fire safety standard for each facility.⁠⁷ A person must be available to help whenever a resident is present.⁠⁷

Exits. Each level used for resident care needs two exits remote from each other. One must be a door or stairway to the outside at ground level. The other may be a window that opens from the inside without tools and has a clear opening of at least 20 inches wide by 24 inches high and at least 5.7 square feet, with a sill at 44 inches, as the rule states it. A ladder, folding stairs or trap door may not be the only way into a bedroom (ARSD 44:77:03:03).⁠⁷

Equipment and hazards (ARSD 44:77:02:10 and 02:14):⁠⁷

• a 2-A:10-B:C fire extinguisher on every level;
• a smoke detector with an audible alarm on every level, tested monthly, cleaned and given a new battery at least once a year;
• grab bars in every toilet room and bathing area residents use;
• ground-fault protection in wet areas and for outlets within six feet of sinks;
• no portable space heaters, halogen lamps, household electric blankets or heating pads;
• a galvanized metal vent pipe on any clothes dryer;
• oxygen stored and transfilled under NFPA 99, 2012 edition;
• a written, scheduled preventive maintenance program;
• powered exhaust ventilation in new or renovated toilet rooms (ARSD 44:77:03:05).

You must keep an evacuation plan and conduct and document at least four fire drills a year (ARSD 44:77:03:02).⁠⁷ The location must have “good, passable roads” and easy access for caregivers, visitors and firefighters (ARSD 44:77:02:13).⁠⁷ Any new construction, remodeling or change in the use of a space needs DOH approval first, with plans, specifications and a written narrative (ARSD 44:77:02:11).⁠⁷

Food, water, linens and temperature

• Meals. Residents must receive at least three meals a day, with portions from each of the five food groups in the USDA’s 2010 MyPlate guidelines unless a physician, physician assistant, nurse practitioner or qualified dietitian orders otherwise (ARSD 44:77:02:05).⁠⁷ Food handling must meet the sections of the state Food Service Code cited in ARSD 44:77:02:04, and any contracted food service must be an inspected, licensed food service establishment.⁠⁷ SDCL 34-12-12 says a chapter 34-12 licensee does not also need a lodging or food service license.⁠⁵
• Water. Use a public water system or a supply approved by the Department of Agriculture and Natural Resources. A private well must be tested for bacteria at least monthly. Hot water at fixtures residents use must stay between 100°F and 125°F (ARSD 44:77:02:09).⁠⁷
• Linens. Keep bed linens and towels equal to twice your licensed capacity (ARSD 44:77:02:07).⁠⁷
• Temperature. Keep occupied spaces at 68 to 80°F during waking hours and at least 64°F during sleeping hours, unless a resident wants their own room kept differently (ARSD 44:77:02:15).⁠⁷

Caregivers, training and covering your absences

There is no numeric staffing ratio. ARSD 44:77:04:03 requires “sufficient caregivers to provide effective and safe supervision, support, and care.” Under 44:77:04:06, the owner or a caregiver must provide continuous care.⁠⁷ How often you have to be home depends on the resident evaluation: under 44:77:04:02, the owner “shall be present according to the needs of the resident as documented in the resident evaluation.” When you are away, you may arrange an alternative caregiver who meets the same criteria as the owner: 18 or older, no abuse or neglect conviction, and no habitual alcohol or drug use.⁠⁷

ARSD 44:77:04:04 requires an orientation and ongoing education program for all caregivers covering eight subjects. The rule sets no hour count:⁠⁷

1. Fire prevention and response.
2. Emergency procedures and preparedness.
3. Infection control and prevention.
4. Accident prevention and safety procedures.
5. Residents’ rights.
6. Confidentiality of resident information.
7. Incidents subject to mandatory reporting, and the home’s reporting mechanisms.
8. Care of residents with special and unique needs.

A caregiver with a reportable communicable disease may not return to caregiving until a physician or the physician’s designee determines the disease is no longer communicable (ARSD 44:77:04:05).⁠⁷

Medications and resident records

Medications must be “self-administered only by residents or by qualified personnel or caregivers licensed or authorized to administer drugs” (ARSD 44:77:05:01).⁠⁷ An unlicensed owner may therefore offer only the minimal help with self-administration that the “supervision of personal cares” definition allows.⁠⁷ Medications must be labeled with name, strength and expiration date and kept secure or in the resident’s room. Refrigerated drugs may share the food refrigerator if they are sealed in a container on the top rack or tray. Outdated drugs must be destroyed or disposed of properly.⁠⁷

ARSD 44:77:05:02 requires a record for each resident with:⁠⁷

• admission information (medications, allergies, diet);
• contacts for the resident’s clinician and for their power of attorney or immediate family;
• the DOH evaluation form;
• any abuse or neglect reports;
• medication disposition;
• discharge information.

Keep records at least ten years. If you close, notify DOH in writing at least 30 days ahead with your plan for the records, and publish their location in a local newspaper.⁠⁷

Applying to the Department of Health, in order

1. Request information in writing

   DOH’s licensure page tells prospective facilities to send a written request to the Office of Health Facilities Licensure & Certification, 600 East Capitol Avenue, Pierre, SD 57501. DOH responds with the applicable regulations and asks about location, fiscal viability and ownership. It opens a file and sends application forms “when eligibility for licensure or certification is evident.”⁠¹⁰ DOH’s general line is 605-773-3356.⁠¹¹

2. Get the house to the rule

   DOH says buildings “must meet state and federal construction, electrical, and plumbing requirements specific for the intended use.”⁠¹⁰ For a new adult foster care home, that means the 2012 Life Safety Code provisions, the exit and space rules, and plumbing under SDCL 36-25-15 and 36-25-15.1 (ARSD 44:77:02:08).⁠⁷ Ask your city whether it requires sprinklers for the building permit.⁠⁷

3. Choose a name

   Each home needs “a pertinent and distinctive name” that does not suggest services beyond the license or an ownership other than the real one (ARSD 44:77:01:03).⁠⁷

4. File the application

   The SD Healthcare Licensing System has an “Application for License to Operate an Adult Foster Care Home” that you can save and resume. It asks for the facility name, the applicant and the applicant’s spouse, contact details, the county and the physical and mailing addresses.⁠¹¹ SDCL 34-12-5 requires an application “verified under oath.” It must include a description of the facility stating whether it is owned, leased or subleased (attach a true copy of any lease), a signed consent to inspections, and “satisfactory evidence of the applicant’s ability to comply” with the minimum standards.⁠³

5. Inspection and decision

   DOH issues licenses to facilities that, “after application and inspection,” are found to comply (SDCL 34-12-7).⁠⁵ SDCL 34-12-8 allows a provisional license while an inspection is pending, or when an applicant falls short of a standard but commits to fixing it. The license states its conditions and term on its face.⁠⁵ If DOH denies the license, it must give reasons, and you may contest the denial under SDCL chapter 1-26.⁠³

6. Post the license

   The license shows the home and its address. It must be posted where the public can see it and remains DOH property (ARSD 44:77:01:02).⁠⁷

No state source sets a processing time for an adult foster care license.

Fee and license term

SDCL 34-12-6 says “any application for a license to operate a health care facility must be accompanied by a fee.” It then lists annual fees for nursing facilities, assisted living centers, hospitals, community living homes ($150) and other types, but no fee for adult foster care homes, as published on 2026-10-12. Fees are not refundable.⁠⁴ Neither the DOH licensure page nor the SD Healthcare Licensing System application page states a fee for this license, so ask the Office of Health Facilities Licensure and Certification (605-773-3356) what, if anything, must accompany the application.⁠¹¹

SDCL 34-12-7 lets DOH issue annual or biennial licenses.⁠⁵ DOH runs an online “Adult Foster Care Home License Renewal” and a page to print the license.⁠¹¹ The sources do not say which term applies to adult foster care homes, so ask DOH how long your first license runs and when renewal is due.

Inspections, incident reports and enforcement

Licensed homes are subject to DOH inspection (SDCL 34-12-16). Refusing an inspection, including a complaint or follow-up inspection, is grounds for suspension or revocation, along with any rule violation and “practices detrimental to the welfare of the patient” (SDCL 34-12-19).⁠⁵ After a survey, you have 10 days from receiving the statement of deficiencies to submit a signed plan of correction on DOH forms. DOH may reject a plan that shows no path to compliance (ARSD 44:77:01:10).⁠⁷

ARSD 44:77:01:09 sets these reporting deadlines:⁠⁷

You need DOH approval before changing bed capacity, and before using part of the building for another purpose. Joint occupancy is approved only if it is “not detrimental to the welfare of the residents” (ARSD 44:77:01:04 and 01:08).⁠⁷

Getting paid: licensure and the HOPE waiver

SDCL 34-12-2.1 bars paying state or federal funds that pass through the state treasury to any health care facility without a chapter 34-12 license. Holding the license is a precondition for any public payment.⁠² The license alone does not create a payer, though. ARSD 67:44:03:06, as amended effective September 30, 2024, lists the services the HOPE waiver can cover. The list includes assisted living and community living home services, and it does not name adult foster care.⁠⁹ No official source reviewed for this guide says that a South Dakota Medicaid program pays adult foster care homes, so ask DOH and the Department of Social Services before you count on it. If you expect residents to rely on the HOPE waiver, the assisted living center or community living home route may be the one that can bill it.

Rule history

• ARSD article 44:77 took effect October 13, 2015 (42 SDR 51). The water supply rule was amended by SL 2021, ch 1, effective April 19, 2021, as the rule’s source note shows.⁠⁷
• The community living home category, a separate four-person license, has rules effective October 17, 2017 (ARSD 44:82).⁠⁸
• SDCL 34-12-1.1 was most recently amended in 2024 (SL 2024, ch 128), and SDCL 34-12-6 in 2022 (SL 2022, ch 103). As of 2026-10-12, SDCL 34-12-6 still lists no adult foster care fee.⁠¹⁠⁴

Sources

1. 1
   South Dakota Legislature, SDCL 34-12-1.1: Definitions Checked 12 Oct 2026 · Back to text ↑
2. 2
   South Dakota Legislature, SDCL 34-12-2 and 34-12-2.1: License required; unlicensed institutions ineligible for state or federal funds Checked 12 Oct 2026 · Back to text ↑
3. 3
   South Dakota Legislature, SDCL 34-12-5: Application for license, contents, issuance and denial Checked 12 Oct 2026 · Back to text ↑
4. 4
   South Dakota Legislature, SDCL 34-12-6: Amount of license fee Checked 12 Oct 2026 · Back to text ↑
5. 5
   South Dakota Legislature, SDCL chapter 34-12: Health Care Facilities (ss. 34-12-4, 34-12-7, 34-12-8, 34-12-9, 34-12-12, 34-12-16, 34-12-19) Checked 12 Oct 2026 · Back to text ↑
6. 6
   South Dakota Legislature, SDCL 34-12-32: Residential services for elderly or disabled persons, registration Checked 12 Oct 2026 · Back to text ↑
7. 7
   South Dakota Legislature, Administrative Rules, ARSD article 44:77: Adult Foster Care Checked 12 Oct 2026 · Back to text ↑
8. 8
   South Dakota Legislature, Administrative Rules, ARSD article 44:82: Community Living Home Checked 12 Oct 2026 · Back to text ↑
9. 9
   South Dakota Legislature, Administrative Rules, ARSD 67:44:03:06: HOPE waiver services covered Checked 12 Oct 2026 · Back to text ↑
10. 10
    South Dakota Department of Health, Get Licensed as a Healthcare Facility Checked 12 Oct 2026 · Back to text ↑
11. 11
    South Dakota Department of Health, SD Healthcare Licensing System: Applications and Renewals Checked 12 Oct 2026 · Back to text ↑
12. 12
    South Dakota Department of Health, Levels of Long-Term Care Checked 12 Oct 2026 · Back to text ↑

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