South Dakota Home Care Assessment: How the LTSS Level of Care Determination Works

What the Assessment Determines

The LTSS (Long Term Services and Supports) assessment is the clinical gateway to South Dakota's HOPE Waiver, Structured Family Caregiving, and other services that require an LTSS determination.

The assessment answers one core question: does your parent meet the nursing-facility level of care (NFLOC) standard? This means demonstrating that they need the kind of daily, hands-on assistance that would otherwise require placement in a skilled nursing facility.

It's not a pass/fail medical test. It's a functional evaluation — how well can your parent actually perform the tasks of daily living, and what happens when they can't?

The interRAI Assessment Tool

South Dakota uses the interRAI assessment system to evaluate home care applicants. This is a standardized, evidence-based tool (not something the LTSS Specialist invents on the spot) that generates a Resource Utilization Group (RUG) score.

The interRAI assessment covers:

Physical function — Can your parent transfer from bed to a chair? Walk across a room? Get in and out of the bathroom? Dress themselves? These aren't abstract questions — the Specialist observes your parent performing these tasks and rates them on a defined scale from independent to fully dependent.

Cognitive function — Is your parent oriented to time, place, and person? Can they make consistent decisions about daily activities? Do they remember medications, appointments, or recent events? Cognitive impairment weighs heavily in the assessment.

Behavioral symptoms — Does your parent wander? Become agitated or combative during care? Resist bathing or medication? Display paranoia, hallucinations, or socially inappropriate behavior? These factors affect both the level of care determination and the type of services authorized.

Health status — Active diagnoses, medication complexity, pain levels, skin integrity (pressure ulcers/wounds), fall history, and nutritional status all feed into the algorithm.

Environmental factors — The Specialist evaluates the home itself: safety hazards, accessibility barriers, and whether the living situation can safely support the care plan.

The RUG score that comes out of this assessment quantifies your parent's care needs in a way that determines both eligibility and the scope of authorized services.

What to Expect During the Visit

An LTSS Specialist schedules an in-home visit. They'll meet with your parent and, if possible, with you or another family member who can provide context on daily functioning.

The Specialist will:

• Observe your parent's mobility, balance, and ability to perform physical tasks
• Ask questions about daily routines, eating habits, medication management, and social engagement
• Review medical records, medication lists, and any recent hospital or rehab discharge summaries
• Assess the physical safety of the home environment
• Talk to family members about what care looks like on a bad day versus a good day

Schedule the assessment for your parent's worst time of day. If mornings are hardest — stiff joints, confusion before medications take effect, difficulty getting out of bed — request a morning appointment. The assessment captures a snapshot, and you want it to reflect reality, not a best-case performance.

How to Prepare

The most common reason families feel the assessment underestimated their parent's needs is that the parent performed better during the visit than they do on a typical day. This is especially common with dementia — a phenomenon called "showtiming," where the person temporarily rallies in the presence of a visitor.

Document incidents in advance:

• Falls in the past 90 days (dates, circumstances, injuries)
• Medication errors — missed doses, double doses, wrong medications taken
• Episodes of confusion, wandering, or getting lost (even inside the home)
• Meals skipped or food left to spoil in the refrigerator
• Unsafe cooking incidents (leaving the stove on, burning food)
• Hygiene neglect — going days without bathing, wearing the same clothes repeatedly
• Emergency room visits or urgent care trips

Bring this documentation to the assessment. A written log carries more weight than verbal descriptions because it shows a pattern, not a single bad day.

Have your parent's medication list printed and current. Include all prescription and over-the-counter medications, dosages, and the prescribing physician for each.

Be honest, not optimistic. When the Specialist asks how your parent manages bathing, the answer "they can do it with some help" is different from "they haven't bathed in a week because they're afraid of falling in the tub." Specificity matters — it's the difference between meeting the NFLOC standard and falling short.

After the Assessment

The LTSS Specialist compiles the assessment into a formal level of care determination. If your parent meets NFLOC:

• A care plan is developed specifying authorized services (personal care hours, homemaker, respite, adult day, SFC, home modifications, PERS)
• The determination is sent to DSS to pair with the financial eligibility review
• Once both clinical and financial eligibility are confirmed, services can begin

If your parent does not meet NFLOC:

• They may still qualify for Personal Care Services (PCS) under the Medicaid state plan, which has a lower clinical bar (medical necessity rather than nursing-facility level of care) but a stricter income limit ($994/month)
• You can request a reassessment if your parent's condition declines
• If you believe the assessment missed critical information, you can appeal within 30 days

The Assessment as Advocacy

Think of the LTSS assessment not as a bureaucratic hurdle but as your opportunity to demonstrate, with documentation, exactly how much help your parent needs. The Specialist is bound by the interRAI scoring algorithm — they can only authorize what the data supports. Your job is making sure the data reflects your parent's real daily life, not their best performance for a visitor.

The South Dakota Home Care Navigator includes a pre-assessment documentation worksheet designed to capture exactly the information the interRAI tool evaluates, so you can walk into the assessment fully prepared.

See more South Dakota guides →