South Dakota assisted living center license: DOH rules, beds and staffing

Who needs an assisted living center license in South Dakota

South Dakota defines an assisted living center by what it does, not by how many people live there. An assisted living center is “any institution, rest home, boarding home, place, building, or agency” run to provide “personal care and services that meet some need beyond basic provision of food, shelter, and laundry” ⁠¹. No resident minimum appears in the statute. A house serving two people can fall under it if staff help with bathing, dressing or medications.

Every health care facility or related institution needs a DOH license before it opens ⁠⁴. Running one without a license is a Class 1 misdemeanor. An unlicensed facility also cannot be paid with state or federal funds that pass through the state treasury ⁠⁴.

Several neighboring categories are easy to confuse with an assisted living center:

• Board and room only. Lodging places that provide only board and room are outside chapter 34-12 ⁠⁴.
• Residential living centers. If you give room, meals and “daily living services,” but no health care, to two or more unrelated elderly or disabled people for pay, you register with DOH every year instead of getting a license. Registration has no fee, and failing to register is a Class 2 misdemeanor ⁠⁴. Once you give personal care that counts as health-related, the assisted living definition applies.
• Adult foster care homes and community living homes. These family-style homes serve no more than four adults and have their own license types ⁠¹. See the South Dakota adult foster care home guide.
• VA medical foster homes. Homes approved by the U.S. Department of Veterans Affairs that serve only three or fewer veterans are exempt from chapter 34-12 ⁠⁴.
• Adult day care. South Dakota has no separate adult day license. A licensed assisted living center can run adult day care as a “nonresident program in a licensed facility” ⁠⁵. Day participants count toward your space and staffing ⁠⁵.

One license covers every address where you provide licensed services, and each address must display a current license ⁠⁵. Licenses cannot be transferred ⁠⁴. A buyer of an existing center applies through DOH’s change-of-ownership application ⁠⁶.

Decide your bed count first: the 16-bed line

Throughout article 44:70, the rules change at 16 beds. Decide your size before you design the building or write a budget.

Sources: fees ⁠³; modifications, dishwasher, emergency power and staffing ⁠⁵.

DOH sets each facility’s bed capacity from the physical plant and space rules. Your census may never exceed it, and you need DOH approval before changing capacity for construction or a change of purpose ⁠⁵. You cannot simply add a bed to a room that has space for one.

Choose who you will admit before you build

Under South Dakota’s rules, residents with fairly heavy needs can stay in assisted living, but each of those populations comes with its own building and staffing requirements. The online application asks you to tick each population you will serve and give in-service training dates for most of them. The list covers physically impaired residents, residents on oxygen, residents not capable of self-preservation, memory care (with the number of memory care beds), hospice, total ADL assistance, cognitive impairment, therapeutic diets, dining assistance, medication administration, adult day care and respite care ⁠⁸.

The baseline admission and retention rule lets you serve residents who can do the following ⁠⁵:

• Complete mobility, dressing, toileting (including incontinence, catheter or ostomy care), hygiene and bathing on their own or with staff help.
• Feed themselves with setup or supervision.
• Take their own medications, including injections, or have qualified staff give them.
• Live without restraints, except in a memory care unit.
• Receive any skilled services from the facility nurse, a credentialed therapist, a Medicare-certified home health agency or a Medicare-certified hospice.
• Stay in stable condition, without needing frequent nursing care or frequent contact with a physician, physician assistant (PA) or nurse practitioner (NP).

Nursing or rehabilitation services must stay under 8 hours a day and 28 hours a week per resident ⁠⁵.

The populations that change your plans:

• Residents not capable of self-preservation. Your building must meet the NFPA 101 Life Safety Code (2012 edition) health care occupancy chapters 18 or 19, or have complete automatic sprinkler protection ⁠⁵.
• Hospice. Hospice services come from a Medicaid-certified hospice under a written care plan. You need unlicensed assistive staff on duty who can give medications, and two staff on duty when the resident’s needs require it or the resident cannot self-evacuate. If a hospice resident becomes incapable of self-preservation, an unsprinklered building must start discharge planning before that happens ⁠⁵.
• Total ADL assistance (one or two staff doing the whole task) ⁠⁵:
  • Every direct care worker must be on the certified nurse aide registry.
  • A registered nurse (RN) assesses the resident at the start, after any significant change, and at least every six months.
  • A nurse works the day shift at least 32 hours a week whenever any resident needs two-person help, and a nurse is on call at all times.
  • Mechanical lifts need two trained staff, and toilet and bathing rooms must fit two-person assistance.
  • A facility that provides total assistance cannot use any staffing exception.
• Cognitive impairment. Screen residents with a validated tool at admission, every year and after any significant change. You also need exit alarms on unattended exit doors ⁠⁵.
• Memory care units ⁠⁵:
  • A physician, PA or NP order documents why the resident needs confinement.
  • Therapeutic programming is required.
  • Locked doors must meet NFPA 101 sections 18.2.2.2.5 and 19.2.2.2.5.
  • Staff assigned to the unit need unit-specific training, and at least one caregiver must be on the unit at all times.
  • The unit needs a fenced outdoor area with a fence at least 6 feet high and hard-surface walking paths.

The building: plan approval, room sizes and fire safety

DOH’s licensing office says buildings “must meet state and federal construction, electrical, and plumbing requirements specific for the intended use” ⁠⁶. For new construction, you submit plans, specifications and a written narrative of the intended use to DOH. You need DOH approval before construction begins, and again before any change during construction ⁠⁵. Remodeling or a change in how an area is used also needs DOH approval in advance ⁠⁵. A building used partly for other purposes needs DOH approval for that joint occupancy, and those areas stay open to DOH inspection ⁠⁵. DOH lists an engineering staff contact for plan questions ⁠⁹.

Chapter 44:70:10 governs new facilities and any renovation, addition or change of space use ⁠⁵. For new resident rooms, it requires the following:

Source: ⁠⁵.

DOH can waive the 200-foot distance if the building has sprinklers and an automatic fire alarm dialer, residents can evacuate in eight minutes or less, all residents can self-evacuate with one staff member’s limited help, and staff carry call-system devices ⁠⁵. Rooms already licensed under older plans follow the older minimums: 75 sq ft per bed in shared rooms and 95 sq ft in a single room ⁠⁵. Every facility needs 10 sq ft of general storage per bed. It also needs at least 40 sq ft of dining, recreation and other central-use space for each bed and each adult day participant, and the dining part of that must be at least 20 sq ft per person (ARSD 44:70:10:08) ⁠⁵.

The fire and safety baseline ⁠⁵:

• NFPA 101 Life Safety Code, 2012 edition, chapter 32 or 33. Existing buildings need sprinklers and attic heat detection only after renovation of more than 50 percent of the facility.
• A manually operated, electrically supervised fire alarm system.
• Portable extinguishers rated at least 2-A:10-B:C. They are inspected monthly and maintained yearly, with one cabinet per 3,000 sq ft.
• An emergency staff call system that registers both visually and audibly at the staff station. It can use fixed stations at each bed, toilet and bath, a wireless device carried by the resident, or another DOH-approved system.
• Grab bars in all resident toilet and bathing areas, and ground-fault protection near sinks.
• No portable space heaters, halogen lamps, or household electric blankets or heating pads.
• Fire drills every quarter on each shift, or monthly if you do not run three shifts.

If you prepare any food on site, the state Food Code (ARSD 44:02:07) applies. Food must come from your licensed facility or from a licensed food service establishment ⁠⁵.

Staffing: two awake staff, unless DOH approves an exception

The default rule is at least two staff on duty at all times, with one on every floor that has occupied beds ⁠⁵. Staff on duty must be awake, unless DOH has approved an exception ⁠⁵. Small centers can ask DOH in writing for a staffing exception. The conditions depend on size and on whether the building is attached to a nursing facility or hospital:

Source: ⁠⁵. Evacuation times are measured under the NFPA 101 (2012) evacuation-capability definitions ⁠⁵.

Other staffing rules apply regardless of size ⁠⁵:

• Nurse. You must employ or contract with a licensed nurse who assesses and documents each resident’s personal care, medical, physical, mental and emotional needs.
• Medication aides. An RN trains any unlicensed staff who give medications, under the Board of Nursing rule at ARSD 20:48:04.01. Retraining is required every year.
• Training within 30 days of hire. All healthcare staff complete orientation within 30 days and repeat the education every year. Topics include fire response, emergencies and advance directives, infection control, accident prevention, resident rights, confidentiality, mandatory reporting, nutrition and hydration, and abuse and neglect. Cognitive impairment techniques are required if you admit those residents.
• Health screening. A licensed health professional evaluates each worker for reportable communicable disease before they start or within 14 days of hire. The review covers vaccination and tuberculin test history.
• Background. Supervisors must be 18 or older. You may not knowingly hire anyone with a conviction for abusing another person.
• Dietary. Your dietary manager (if you have one) and at least one cook need a current ServSafe or Certified Food Protection Professional sanitation certificate, or training DOH accepts as equivalent. If the person in charge of dietary services is not a dietitian, a dietitian consults on each resident at least quarterly and approves all menus.

The administrator

The governing body names one administrator responsible for daily management, and that person designates a stand-in for absences. You must tell DOH in writing whenever the administrator changes ⁠⁵. The administrator must meet one of three paths ⁠⁵:

1. Licensed health professional

   This means a South Dakota-licensed physician, PA, NP, physical, occupational or speech therapist, therapy assistant, nurse, nursing facility administrator, dietitian, pharmacist, respiratory therapist or social worker.

2. Degree

   A graduate of an accredited higher-education program in long-term care or health service administration.

3. DOH-approved assisted living administrator course

   Until the course is finished, a qualified administrator with at least two years of administrator experience must supervise the new administrator.

Before DOH treats the administrator as qualified, you send a certificate of completion and a signed attestation that the administrator has read article 44:70 ⁠⁵. The online application has an upload field for exactly these documents ⁠⁸. DOH links the approved course from its assisted living page ⁠⁷.

Applying: the order DOH uses

1. Write to DOH. Send a written request for licensing information to the Office of Health Facilities Licensure & Certification, 600 East Capitol Avenue, Pierre, SD 57501 ⁠⁶. The office phone is 605-773-3356 ⁠⁹.

2. Answer DOH’s questions and open a file. DOH replies with the regulations and asks about your location, fiscal viability and ownership. It then opens a file for the proposed facility and sends application forms “when eligibility for licensure or certification is evident” ⁠⁶.

3. Get plan approval before construction. Submit plans, specifications and a narrative for new construction or remodeling, and wait for DOH approval before you build ⁠⁵.

4. Qualify your administrator. Collect the license, degree or course certificate, and the signed article 44:70 attestation ⁠⁵.

5. File the application. The application goes through the SD Healthcare Licensing System online ⁠⁶. By statute, it is verified under oath and must include ⁠²:

   • names and addresses of the applicant and operator, and of the principal officers of a firm or corporation
   • the facility address and whether you own, lease or sublease it, with a true copy of any lease
   • consent to DOH inspections
   • evidence that you can meet the minimum standards

   The online form also asks for your bed count and the resident populations you will serve ⁠⁸. Pay the fee with the application ⁠³.

6. Inspection and license. DOH issues licenses after application and inspection ⁠⁴. Once an application is in order, DOH may issue a provisional license to cover operation until the inspection is finished ⁠⁴. If DOH denies the application, it must give the reasons, and you can contest the denial under SDCL chapter 1-26 ⁠².

DOH does not publish a processing time for new assisted living center licenses or plan reviews.

Fees

No fee is refundable, and all fees go to the state general fund ⁠³. The statute allows DOH to issue annual or biennial licenses with prorated fees ⁠⁴. Renewal is done online through the same licensing system ⁠⁶. DOH’s rules and its licensing system do not state a renewal month or a license term for assisted living centers, and the online renewal form showed “Renewals are currently unavailable” when checked on 2026-10-12. Ask the Office of Health Facilities Licensure & Certification (605-773-3356) when your license expires and whether it is annual or biennial.

After you open: reports, surveys and resident rights

• Inspections. DOH inspects every licensed facility ⁠⁴ and publishes assisted living center survey reports online ⁠⁷. You have 10 days from receiving a statement of deficiencies to return a signed plan of correction on DOH’s forms ⁠⁵.
• Probationary license. If DOH issues a probationary license while a suspension or revocation hearing is pending, the center may not take new admissions during that period ⁠⁴.
• 24-hour reports. Seven kinds of events go to DOH through its online system within 24 hours: an attempted suicide, suspected abuse or neglect, a non-natural death that began on the property, a missing resident, a fire, loss of critical equipment for more than 24 hours, and unsafe water samples. Results of your internal investigation are due within five working days ⁠⁵.
• Admission paperwork. Each resident arrives with written orders from a physician, PA or NP and a physical exam. You evaluate needs at admission, at 30 days and every year after that ⁠⁵. Each resident sees a physician, PA or NP at least once a year ⁠⁵.
• Discharges. You may transfer or discharge a resident only for reasons the rule lists. You must give written notice at least 30 days ahead to the resident or their representative and to the state ombudsman, unless the resident’s health requires immediate transfer, and explain how to appeal. Your admission policies may not discriminate by payment source ⁠⁵.
• Visitation. Assisted living residents have a statutory right to visitors. Post your visitation policies on your website and inside the facility, and give residents copies before they sign an occupancy contract and every year after. Any restriction must be reviewed at least every 30 days ⁠⁴.
• Respite. If you offer respite care, each stay is capped at 30 days, and you need written policies for respite and adult day clients ⁠⁵.

Getting paid by Medicaid: the HOPE waiver

South Dakota Medicaid pays for assisted living through the HOPE waiver, run by the Department of Human Services (DHS), Division of Long Term Services and Supports (LTSS). Assisted living is a listed HOPE waiver service ⁠¹⁰. The waiver defines it as services in a homelike, non-institutional setting with 24-hour on-site response ⁠¹⁰. Each participant pays their remaining income, after allowed deductions, directly to you. DHS pays its share to you separately ⁠¹⁰.

The LTSS HCBS Provider Enrollment Manual (effective May 1, 2026) sets the enrollment order ⁠¹¹:

1. Get the DOH license first

   LTSS will not accept an assisted living enrollment request without a DOH license.

2. Request LTSS enrollment

   and pass the LTSS policy and procedure review. LTSS also reviews your setting under the federal HCBS Settings Rule. Assisted living providers get an onsite review only after the policy review is complete.

3. Receive initial approval

   Send a W-9 and certificates of insurance, then sign the LTSS contract. Your business must be registered with the Secretary of State.

4. Enroll with SD Medicaid

   through its provider portal. The LTSS contract must be in place first.

5. Complete onboarding and training

   in Therap, the system LTSS uses.

Assisted living providers then go through LTSS quality reviews on a three-year cycle. A denied applicant must wait 90 days to reapply ⁠¹¹. If your setting is newly built or on or near the grounds of an institution, it may face “Heightened Scrutiny.” That review can require extra evidence, public comment and CMS approval, and it can lengthen enrollment ⁠¹¹.

Rule changes in 2023 and 2026

Most of article 44:70 was rewritten effective August 30, 2023. Further amendments took effect September 24, 2026 (53 SDR 34). They touched these rules ⁠⁵:

• definitions
• admission and retention
• care policies, including adult day and respite
• intermittent nursing limits
• hospice
• total ADL assistance
• medication storage
• resident information

Requirements in this guide come from the rule text published after those amendments. If you drafted policies from an older copy of article 44:70, check them against the current rules. The rule text shows 53 SDR 34 on those sections but does not mark which words changed, and DOH has not published a side-by-side comparison. Ask DOH for the amendment summary before you finalize policies.

For other licensed care types in the state, see the South Dakota day care center license and the family day care registration guides.

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 34-12-5, Application for license Checked 12 Oct 2026 · Back to text ↑
3. 3
   South Dakota Legislature, SDCL 34-12-6, Amount of license fee Checked 12 Oct 2026 · Back to text ↑
4. 4
   South Dakota Legislature, SDCL chapter 34-12, Health Care Facilities and Related Institutions Checked 12 Oct 2026 · Back to text ↑
5. 5
   South Dakota Legislature, ARSD article 44:70, Assisted Living Centers Checked 12 Oct 2026 · Back to text ↑
6. 6
   South Dakota Department of Health, Get Licensed as a Healthcare Facility Checked 12 Oct 2026 · Back to text ↑
7. 7
   South Dakota Department of Health, Assisted Living Centers Checked 12 Oct 2026 · Back to text ↑
8. 8
   South Dakota Department of Health, SD Healthcare Licensing System, Application for a License to Operate an Assisted Living Center Checked 12 Oct 2026 · Back to text ↑
9. 9
   South Dakota Department of Health, Assisted Living Center Contact Information Checked 12 Oct 2026 · Back to text ↑
10. 10
    South Dakota Legislature, ARSD chapter 67:44:03, HOPE Waiver Services Checked 12 Oct 2026 · Back to text ↑
11. 11
    South Dakota Department of Human Services, LTSS HCBS Provider Enrollment Manual (effective May 1, 2026) Checked 12 Oct 2026 · Back to text ↑

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