Consolidated Statements of Cash Flows - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Cash Flows From Operating Activities:
Net income	$ 58,699,000	$ 55,682,000	$ 50,538,000
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	41,894,000	42,652,000	39,023,000
Equity in earnings of unconsolidated investments	(1,020,000)	(6,932,000)	(6,636,000)
Distributions from unconsolidated investments	5,241,000	7,829,000	8,059,000
Unrealized gains on marketable securities	(1,138,000)
Gains on sale of marketable securities	(18,000)	(262,000)	(816,000)
Gain on acquisition of equity method investment	(2,050,000)
Gain on sale of skilled nursing facility	(1,668,000)
Deferred income taxes	(718,000)	4,714,000	(4,791,000)
Stock–based compensation	1,778,000	1,678,000	509,000
Changes in operating assets and liabilities:
Accounts receivable	(9,398,000)	(4,236,000)	1,564,000
Federal income tax receivable	5,465,000	(800,000)	(1,462,000)
Inventories	(317,000)	355,000	60,000
Prepaid expenses and other assets	(1,743,000)	(796,000)	(477,000)
Trade accounts payable	3,467,000	(2,615,000)	(1,535,000)
Accrued payroll	516,000	1,190,000	574,000
Amounts due to third party payors	(1,281,000)	370,000	365,000
Accrued risk reserves	2,818,000	3,070,000	(4,541,000)
Other current liabilities	(2,050,000)	2,987,000	1,015,000
Obligation to provide future services	(715,000)	(349,000)	(204,000)
Other noncurrent liabilities	(591,000)	(507,000)	8,000
Deferred revenue	(172,000)	(136,000)	47,000
Net cash provided by operating activities	98,435,000	94,466,000	90,882,000
Cash Flows From Investing Activities:
Additions to property and equipment	(29,772,000)	(32,347,000)	(62,601,000)
Proceeds from the sale of skilled nursing facility	4,300,000
Investments in unconsolidated companies	(444,000)	(246,000)	(1,282,000)
Acquisition of equity method investment, net of cash acquired	(527,000)
Investments in notes receivable		(202,000)	(5,251,000)
Collections of notes receivable	1,553,000	4,282,000	1,636,000
Purchases of marketable securities	(13,311,000)	(31,244,000)	(48,620,000)
Sale of marketable securities	4,539,000	50,197,000	34,642,000
Net cash used in investing activities	(33,662,000)	(9,560,000)	(81,476,000)
Cash Flows From Financing Activities:
Principal payments under line of credit agreement	(45,000,000)	(20,000,000)
Principal payments under capital lease obligations	(3,696,000)	(3,481,000)	(3,278,000)
Dividends paid to common stockholders	(29,827,000)	(28,237,000)	(25,795,000)
Issuance of common shares	2,865,000	2,524,000	10,772,000
Repurchase of common shares	(867,000)		(8,195,000)
Equity attributable to noncontrolling interest		1,217,000
Tax expense from exercise of stock options			(1,096,000)
Entrance fee deposits (refunds)	(749,000)	(1,097,000)	59,000
Change in deposits			402,000
Net cash used in financing activities	(77,274,000)	(49,074,000)	(27,131,000)
Net Increase (Decrease) in Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents	(12,501,000)	35,832,000	(17,725,000)
Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents, Beginning of Period	67,421,000	31,589,000	49,314,000
Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents, End of Period	54,920,000	67,421,000	31,589,000
Balance Sheet Classifications:
Total Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents	67,421,000	67,421,000	31,589,000
Supplemental Information:
Cash payments for interest	4,899,000	5,183,000	4,528,000
Cash payments for income taxes	$ 9,182,000	$ 23,550,000	$ 27,668,000