Consolidated Statements of Cash Flows - USD ($)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Cash Flows From Operating Activities:
Net income	$ 67,976,000	$ 58,699,000	$ 55,682,000
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	42,419,000	41,894,000	42,652,000
Equity in earnings of unconsolidated investments	(9,744,000)	(1,020,000)	(6,932,000)
Distributions from unconsolidated investments	3,902,000	5,241,000	7,829,000
Unrealized gains on marketable equity securities	(12,230,000)	(1,138,000)	0
Gains on sale of restricted marketable debt securities	(127,000)	(18,000)	(262,000)
Gains on acquisitions of equity method investments	(1,975,000)	(2,050,000)	0
Gain on sale of skilled nursing facility	0	(1,668,000)	0
Deferred income taxes	(4,052,000)	(718,000)	4,714,000
Stock–based compensation	1,878,000	1,778,000	1,678,000
Changes in operating assets and liabilities:
Accounts receivable	4,299,000	(9,398,000)	(4,236,000)
Federal income tax receivable	(2,560,000)	5,465,000	(800,000)
Inventories	29,000	(317,000)	355,000
Prepaid expenses and other assets	(287,000)	(1,743,000)	(796,000)
Trade accounts payable	(856,000)	3,467,000	(2,615,000)
Accrued payroll	2,208,000	516,000	1,190,000
Amounts due to third party payors	(1,000,000)	(1,281,000)	370,000
Accrued risk reserves	540,000	2,818,000	3,070,000
Other current liabilities	780,000	(2,050,000)	2,987,000
Obligation to provide future services	(137,000)	(715,000)	(349,000)
Other noncurrent liabilities	854,000	(591,000)	(507,000)
Deferred revenue	82,000	(172,000)	(136,000)
Net cash provided by operating activities	100,103,000	98,435,000	94,466,000
Cash Flows From Investing Activities:
Additions to property and equipment	(26,400,000)	(29,772,000)	(32,347,000)
Proceeds from the sale of skilled nursing facility	0	4,300,000	0
Investments in unconsolidated companies	(222,000)	(444,000)	(246,000)
Acquisition of equity method investment	(15,589,000)	(527,000)	0
Investments in notes receivable	(5,462,000)	0	(202,000)
Collections of notes receivable	1,379,000	1,553,000	4,282,000
Purchases of restricted marketable debt securities	(12,471,000)	(13,311,000)	(31,244,000)
Sale of restricted marketable debt securities	44,500,000	4,539,000	50,197,000
Net cash used in investing activities	(14,265,000)	(33,662,000)	(9,560,000)
Cash Flows From Financing Activities:
Principal payments under line of credit agreement	(45,000,000)	(45,000,000)	(20,000,000)
Principal payments under finance lease obligations	(3,923,000)	(3,696,000)	(3,481,000)
Dividends paid to common stockholders	(31,208,000)	(29,827,000)	(28,237,000)
Issuance of common shares	2,346,000	2,865,000	2,524,000
Repurchase of common shares	(872,000)	(867,000)	0
Distributions attributable to noncontrolling interest	(468,000)	0	0
Equity contributed by noncontrolling interest	0	0	1,217,000
Entrance fee refunds	(623,000)	(749,000)	(1,097,000)
Net cash used in financing activities	(79,748,000)	(77,274,000)	(49,074,000)
Net Increase (Decrease) in Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents	6,090,000	(12,501,000)	35,832,000
Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents, Beginning of Period	54,920,000	67,421,000	31,589,000
Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents, End of Period	61,010,000	54,920,000	67,421,000
Balance Sheet Classifications:
Cash and cash equivalents	50,334,000	43,247,000	59,118,000
Restricted Cash and Cash Equivalents	10,676,000	11,673,000	8,303,000
Total Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents	61,010,000	67,421,000	31,589,000
Supplemental Information:
Cash payments for interest	3,118,000	4,899,000	5,183,000
Cash payments for income taxes	$ 20,889,000	$ 9,182,000	$ 23,550,000