Assisted Living Admission Agreement in South Dakota: What to Check Before Signing

The admission agreement is the single most important document you'll sign during an assisted living placement in South Dakota — and most families sign it under pressure without reading the details. The facility's intake coordinator presents it alongside a stack of medical forms, and the implicit message is that everything is standard.

It isn't. South Dakota's administrative rules under ARSD 44:70 require specific disclosures, but what the agreement doesn't include matters as much as what it does.

What South Dakota Law Requires in the Agreement

Under ARSD 44:70, every assisted living center must complete a written admission agreement before or at the time of admission and before the resident commits to payment for proposed or actual care. The agreement must include:

A clear statement of all charges. The base monthly rate and any additional fees for higher-acuity services (medication management, incontinence care, mobility assistance) should be identified clearly. Some facilities quote a low base rate and add service tiers that effectively double the monthly cost within the first year. Ask for the facility's full rate schedule, including the cost of each individual add-on service and how any rate increases are handled, before signing.

The facility's discharge and transfer policies. This is where most families get caught later. South Dakota permits involuntary discharge when a resident's needs exceed the facility's licensed capacity — for example, when someone transitions from needing help with two ADLs to requiring continuous skilled nursing care. The agreement should spell out the conditions that can trigger a transfer or discharge, the written-notice rule (generally at least 30 days, unless the resident's health requires immediate transfer or discharge), and how the resident may appeal the facility's decision, including the right to a fair hearing. The state Long-Term Care Ombudsman should receive notice and can help families navigate the process.

The resident's rights under ARSD 44:70:09. South Dakota law requires facilities to inform residents, both orally and in writing, of their rights and the rules governing resident conduct at or before admission. Key protections include the right to manage personal finances (or to designate someone to do so), the right to privacy during personal care, the right to voice complaints without retaliation, and the right to be informed of a significant change in health or care. The admission agreement cannot waive these rights.

Cost Traps That Aren't Obvious at Signing

The "care level" escalation. Many South Dakota ALCs use a tiered pricing model — Level 1 for minimal assistance, Level 2 for moderate, Level 3 for significant daily support. The initial assessment might place your parent at Level 1, but a reassessment 30 days after admission (required by ARSD 44:70) frequently moves them to Level 2 or higher. That reassessment is based on the facility's own clinical judgment. Ask before signing how the care level is determined, who conducts the assessment, when any resulting cost increase takes effect, and what the cost difference is between each level.

Medication management fees. Some facilities charge a separate daily or monthly fee for medication administration — handling, dispensing, and documenting each dose. For a resident taking eight or more daily medications, this fee alone can add $300–$600 per month on top of the base rate. The admission agreement should itemize this.

Non-refundable community fees. A one-time "community fee" or "move-in fee" of $1,000–$3,000 is common. Some agreements make this fully non-refundable regardless of how long the resident stays. Others prorate it if the resident leaves within 90 days. Read the refund clause before writing the check.

What the Agreement Should NOT Include

Mandatory arbitration clauses. Some facilities include binding arbitration language that waives the resident's right to file a complaint in court. South Dakota does not prohibit arbitration clauses in assisted living agreements, but they are negotiable. You can cross out the clause before signing — the facility may accept the amendment rather than lose the placement.

Broad personal liability guarantees. If the agreement asks you (the adult child) to personally guarantee your parent's monthly charges, understand what you're signing. This is separate from your parent's obligation to pay. A personal guarantee means the facility can pursue you for unpaid balances even if your parent's assets are exhausted. If Medicaid will eventually cover the cost, a personal guarantee for the private-pay period should have a clear end date tied to the Medicaid application timeline.

Blanket consent to share medical records. The agreement should specify exactly who receives health information and for what purpose. A general release that allows the facility to share records with anyone for any reason goes beyond what HIPAA and South Dakota law require.

Before You Sign

Walk through the agreement with the facility administrator, not just the intake coordinator. Ask for 48 hours to review it — any facility that requires a same-day signature is creating unnecessary pressure. If the resident's care needs are likely to change within the first year, ask the administrator to walk you through the cost trajectory at each care level so you can model the actual annual cost, not just the advertised monthly rate.

The South Dakota Care Decision guide includes a Facility Evaluation Checklist that covers the specific provisions to verify in an admission agreement, along with a Care Cost Comparison Worksheet that models the real cost of assisted living against home care and skilled nursing over 12, 24, and 36 months. Get the complete toolkit.

See more South Dakota guides →