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Investments (Narrative) (Details)
3 Months Ended 9 Months Ended
Sep. 30, 2018
USD ($)
Jun. 30, 2018
GBP (£)
Sep. 30, 2017
USD ($)
Sep. 30, 2018
USD ($)
Sep. 30, 2017
USD ($)
Sep. 30, 2018
GBP (£)
Dec. 31, 2017
USD ($)
Dec. 31, 2017
GBP (£)
Schedule of Investments [Line Items]                
Money Market Investments $ 86,000,000     $ 86,000,000     $ 217,600,000  
Payments to Acquire Marketable Securities       $ 0 $ 0      
Document Fiscal Year Focus       2018        
Cumulative Realized Gain (Loss) on Marketable securities       $ 37,300,000        
Proceeds from sales of marketable equity securities       66,700,000 0      
Equity in earnings (losses) of affiliates, net 9,537,000   $ (532,000) 13,047,000 1,448,000      
Equity Securities without Readily Determinable Fair Value 27,400,000     27,400,000     $ 19,900,000  
Gain on cost method investments 8,487,000   0 8,487,000 0      
Impairment loss on cost method investments 2,500,000     2,500,000        
Graham Healthcare Group [Member]                
Schedule of Investments [Line Items]                
Revenue from Related Parties $ 2,500,000   $ 4,500,000 $ 9,500,000 $ 14,100,000      
Intersection Holdings [Member]                
Schedule of Investments [Line Items]                
Equity Method Investment, Ownership Percentage 11.00%     11.00%   11.00%    
Residential Home Health Illinois [Member] | Graham Healthcare Group [Member]                
Schedule of Investments [Line Items]                
Equity Method Investment, Ownership Percentage 40.00%     40.00%   40.00%    
Residential Hospice Illinois [Member] | Graham Healthcare Group [Member]                
Schedule of Investments [Line Items]                
Equity Method Investment, Ownership Percentage 42.50%     42.50%   42.50%    
Residential Healthcare Michigan hospital joint venture [Member] | Graham Healthcare Group [Member]                
Schedule of Investments [Line Items]                
Equity Method Investment, Ownership Percentage 40.00%     40.00%   40.00%    
Celtic Healthcare Allegheny Health Network Joint Venture [Member] | Graham Healthcare Group [Member]                
Schedule of Investments [Line Items]                
Equity Method Investment, Ownership Percentage 40.00%     40.00%   40.00%    
York Joint Venture [Member] | KIHL [Member]                
Schedule of Investments [Line Items]                
Equity Method Investment, Ownership Percentage 45.00%     45.00%   45.00%    
Loan commitment to affiliate | £           £ 25,000,000    
Advances to Affiliate | £           £ 22,000,000   £ 16,000,000
Payments to Fund Long-term Loans to Related Parties | £   £ 6,000,000            
Loan Receivable, Payment Terms 25 years              
Loan Receivable Fixed Interest Rate 7.00%              
Earnings of two investments [Member]                
Schedule of Investments [Line Items]                
Equity in earnings (losses) of affiliates, net $ 7,900,000