Living Will and Advance Directive in South Dakota: What Dementia Families Need

A dementia diagnosis makes advance directive planning urgent in a way that most families do not expect. Your parent can articulate their wishes about feeding tubes, ventilators, and comfort care today — but progressive cognitive decline will eventually take that ability away. Every month you wait narrows the window.

Living Will vs. Healthcare Power of Attorney

South Dakota recognizes two distinct advance directive documents, and dementia families need both:

Living will. A written declaration specifying your parent's preferences for end-of-life medical treatment — whether they want life-sustaining procedures, artificial nutrition and hydration, or comfort-focused palliative care when they have a terminal condition or are permanently unconscious.

Durable Power of Attorney for Health Care. A document designating a specific person (the agent) to make medical decisions on your parent's behalf when they can no longer make those decisions themselves. Unlike a living will, which only applies to end-of-life scenarios, the healthcare POA covers all medical decisions — from consenting to surgery to choosing between care facilities.

The living will tells doctors what your parent wants. The healthcare POA tells doctors who speaks for your parent when they cannot speak for themselves.

Legal Requirements in South Dakota

South Dakota's requirements for executing advance directives are straightforward:

Living will:

• Must be signed by the declarant (your parent)
• Must be witnessed by two adult witnesses
• Witnesses cannot be the attending physician, an employee of the healthcare facility, or anyone entitled to a portion of the estate
• Notarization is recommended but not strictly required

Healthcare POA:

• Must be signed by the principal
• Must be acknowledged before a notary public
• Your parent must have the cognitive capacity to understand the document at the time of signing

Both documents should be completed while your parent is in the early stages of dementia and can clearly express their preferences and understand the legal implications of what they are signing.

Why Dementia Makes This Different

For most people, advance directives address a distant hypothetical. For dementia families, the scenario they describe is inevitable. The questions are not abstract:

• When your parent can no longer swallow safely, do they want a feeding tube?
• If they develop pneumonia in late-stage dementia, do they want hospitalization and antibiotics, or comfort care at their current residence?
• At what point do they want to transition to hospice-focused care?

These decisions become real within years, not decades. And they become exponentially harder when family members disagree about what the parent would have wanted — especially when no written directive exists.

A well-drafted living will eliminates the guesswork and the sibling conflicts. It puts your parent's own words on paper while they can still form them.

Specific Provisions to Include

Generic advance directive forms cover the basics, but dementia families should ensure these specific provisions are addressed:

Cognitive decline threshold. At what stage of dementia does your parent want to shift from curative treatment to comfort care? Some people want aggressive medical intervention throughout; others want to stop pursuing treatments once they no longer recognize family members.

Feeding and hydration. Difficulty swallowing is one of the most common late-stage complications. The directive should explicitly state preferences about tube feeding and IV hydration.

Facility transfers. When a medical crisis occurs in a memory care unit, the default response is an ambulance to the emergency room. If your parent prefers to remain in their facility for comfort care rather than being transported to a hospital, that preference needs to be documented.

DNR/DNI orders. A Do Not Resuscitate or Do Not Intubate order is a separate medical order, not part of the advance directive itself. But the living will should clearly state the parent's position so the healthcare POA agent can request the appropriate medical orders.

Making the Documents Accessible

Advance directives are useless if no one can find them during an emergency. Distribute copies to:

• Your parent's primary care physician
• The memory care facility or home care agency
• The designated healthcare POA agent
• Each sibling involved in care decisions
• The parent's medical record at the local hospital

South Dakota does not have a state registry for advance directives, so the responsibility for distribution falls entirely on the family.

When Capacity Has Already Been Lost

If your parent can no longer understand what an advance directive means, they cannot execute one. At that point, medical decisions fall to the healthcare POA agent if one was previously appointed, or to the next-of-kin hierarchy under South Dakota law if no agent was named.

Without any advance directive or healthcare POA, the default decision-maker is typically the spouse, then adult children. But this creates problems when siblings disagree, and it provides no guidance about what the parent would have wanted.

The South Dakota Dementia Care Guide includes templates for both advance directive documents, a distribution checklist, and guidance on having the conversation with your parent while they can still participate.

See more South Dakota guides →