South Dakota Assisted Living Regulations for Memory Care (ARSD 44:70)

You are touring memory care facilities in South Dakota, and every brochure promises compassionate, specialized dementia care. What none of them mention is that South Dakota does not issue a standalone memory care license. Every "memory care" unit you visit is legally an assisted living center with a secured unit approval from the Department of Health — and the rules governing who can stay there are stricter than most families realize.

No Standalone Memory Care License

Under the Administrative Rules of South Dakota (ARSD) Title 44, Chapter 70, memory care is classified as a "secured unit" within a licensed assisted living center. The Department of Health oversees licensure and certification. This means there is no separate regulatory framework for dementia-specific care — memory care units must comply with the same assisted living rules, plus additional secured unit requirements.

This distinction matters because it determines what kind of care your parent can actually receive in these facilities — and when they will be forced to leave.

The One-Person Assist Rule

The regulation that catches families off guard is the physical assistance standard. To be admitted or retained in a South Dakota assisted living memory care unit, your parent must be able to:

• Rise from a bed or chair with the physical help of at most one staff member
• Transfer in and out of beds and chairs with single-person assistance — no mechanical lifts
• Complete basic activities of daily living (bathing, dressing, toileting, eating) with one-person help

The moment your parent requires two-person transfers, a Hoyer lift, or continuous skilled nursing exceeding eight hours per day, the facility is legally required to discharge them to a skilled nursing facility.

This creates a cliff that families do not see coming. A parent can be thriving in memory care for two years, then break a hip or experience a rapid decline in mobility, and suddenly the facility has no legal choice but to issue a discharge notice.

Secured Unit Physical Requirements

South Dakota's secured unit standards are specific about the physical environment:

• The unit must be on the ground floor of the building
• There must be direct, barrier-free access to a fenced, secured outdoor courtyard
• Private rooms must measure at least 120 square feet for a single occupant or 200 square feet for double occupancy
• Maximum two residents per room
• At least one bathroom for every two resident units

Notably, South Dakota does not mandate dementia-friendly design features like specialized lighting, color-coded pathways, or memory stations. Whether a facility includes these therapeutic elements is entirely at the operator's discretion — which is why independent facility vetting matters more in South Dakota than in states with prescriptive design requirements.

Confinement Orders and Resident Rights

Placing a resident in a secured (locked) unit requires a written physician's order that documents the specific cognitive symptoms justifying confinement. The facility must communicate the risks and benefits directly to the family. Without this order, confining a resident to a locked unit is a regulatory violation.

Residents and families retain significant rights under South Dakota law:

• Visitation: House Bill 1283 requires facilities to maintain written policies that permit and encourage family visits
• Complaint process: The South Dakota Long-Term Care Ombudsman Program investigates complaints, educates residents on their rights, and advocates for resident welfare
• Discharge protections: A facility cannot evict a resident unless it can demonstrate the resident's "needs and welfare" can no longer be met. The rules do not define this precisely, so facilities set their own internal discharge thresholds — making it essential to review the move-in agreement for guaranteed notice periods and appeal procedures

Staffing Minimums

ARSD 44:70 sets baseline staffing requirements:

• At least one awake staff member on duty overnight
• Minimum 0.8 hours of direct, hands-on care per resident per 24-hour period
• All staff in secured units must complete training on fire safety, emergency preparedness, infection control, resident rights, confidentiality, and dementia-specific care strategies

These are minimums. Higher staffing ratios correlate with better outcomes, but the state does not mandate specific resident-to-staff ratios beyond the 0.8-hour threshold.

Assisted Living vs. Memory Care vs. Nursing Home

The cost and care spectrum in South Dakota breaks down like this:

The 20–30% premium for memory care over standard assisted living buys you the secured environment and dementia-trained staff. But once physical care needs exceed the one-person assist threshold, the only legal option is the nursing home — at nearly double the cost.

Understanding these regulatory boundaries before your parent needs placement saves families from the shock of a forced mid-crisis transfer. The South Dakota Dementia Care Guide includes a facility vetting checklist that maps directly to ARSD 44:70 requirements, so you know exactly what to ask during tours and what to look for in the move-in agreement.

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