Accounting Policies (Details) (USD $)	3 Months Ended			9 Months Ended
	Sep. 30, 2013	Sep. 30, 2012	Jun. 30, 2012	Sep. 30, 2013	Sep. 30, 2012	Dec. 31, 2012
Accounting Policies [Abstract]
Operating funds	$ 6,100,000			$ 6,100,000		$ 5,400,000
Assets held in rabbi trust	33,100,000			33,100,000		27,700,000
Unamortized debt issuance costs	35,200,000			35,200,000		44,200,000
Incremental debt issuance costs			5,300,000		5,300,000
Capitalized debt issuance cost	500,000		4,100,000	500,000	4,100,000
Fixed assets, net	41,425,000			41,425,000		41,414,000
Goodwill, impairment loss				220,800,000
Obligations under insurance programs	62,091,000			62,091,000		56,536,000
Workers compensation and professional and general liability expenses	6,600,000	5,800,000		19,200,000	13,400,000
Employee health and welfare expenses	21,000,000	20,100,000		64,000,000	66,300,000
Percentage of Medicaid daily nursing home rate				95.00%
Net nursing home expense	$ 1,700,000	$ 2,400,000		$ 7,200,000	$ 6,700,000