Net Revenues and Accounts Receivable (Details) (USD $) In Thousands, unless otherwise specified	3 Months Ended		9 Months Ended
	Sep. 30, 2013	Sep. 30, 2012	Sep. 30, 2013	Sep. 30, 2012
Net revenues by major payer classification
Net revenues	$ 410,492	$ 424,444	$ 1,240,507	$ 1,287,787
Percentage variance	(3.30%)		(3.70%)
Home Health [Member]
Net revenues by major payer classification
Net revenues	234,900	234,700	706,100	710,300
Hospice [Member]
Net revenues by major payer classification
Net revenues	175,600	189,700	534,400	577,500
Medicare [Member]
Net revenues by major payer classification
Net revenues	355,600	362,400	1,076,500	1,100,700
Percentage variance	(1.90%)		(2.20%)
Medicare [Member] | Home Health [Member]
Net revenues by major payer classification
Net revenues	191,800	185,000	577,700	561,700
Percentage variance	3.70%		2.80%
Medicare [Member] | Hospice [Member]
Net revenues by major payer classification
Net revenues	163,800	177,400	498,800	539,000
Percentage variance	(7.70%)		(7.50%)
Medicaid and Local Government [Member]
Net revenues by major payer classification
Net revenues	17,400	19,100	54,400	56,900
Percentage variance	(9.00%)		(4.40%)
Medicaid and Local Government [Member] | Home Health [Member]
Net revenues by major payer classification
Net revenues	10,800	12,200	33,100	35,700
Medicaid and Local Government [Member] | Hospice [Member]
Net revenues by major payer classification
Net revenues	6,600	6,900	21,300	21,200
Commercial Insurance and Other [Member]
Net revenues by major payer classification
Net revenues	37,500	42,900	109,700	130,200
Percentage variance	(12.50%)		(15.80%)
Commercial Insurance and Other [Member] | Paid at Episodic Rates [Member]
Net revenues by major payer classification
Net revenues	15,100	21,400	43,300	62,800
Percentage variance	(29.60%)		(30.90%)
Commercial Insurance and Other [Member] | Commercial Insurance Other [Member]
Net revenues by major payer classification
Net revenues	22,400	21,500	66,300	67,400
Percentage variance	4.50%		(1.60%)
Commercial Insurance and Other [Member] | Home Health [Member] | Paid at Episodic Rates [Member]
Net revenues by major payer classification
Net revenues	15,100	21,400	43,300	62,800
Commercial Insurance and Other [Member] | Home Health [Member] | Commercial Insurance Other [Member]
Net revenues by major payer classification
Net revenues	17,200	16,100	52,000	50,100
Commercial Insurance and Other [Member] | Hospice [Member] | Paid at Episodic Rates [Member]
Net revenues by major payer classification
Net revenues	0	0	0	0
Commercial Insurance and Other [Member] | Hospice [Member] | Commercial Insurance Other [Member]
Net revenues by major payer classification
Net revenues	$ 5,200	$ 5,400	$ 14,300	$ 17,300