Summary of Significant Accounting Policies (Details 3) (USD $) In Thousands, unless otherwise specified	12 Months Ended
	Dec. 31, 2013	Dec. 31, 2012	Dec. 31, 2011
Summary of Significant Accounting Policies
Amounts due from the Medicare program	$ 11,173	$ 11,858
Amounts due from various state Medicaid programs	10,234	11,345
Allowance for doubtful accounts
Balance at the beginning of the period	2,792	3,160	3,241
Provision for doubtful accounts	6,412	4,446	4,197
Write-offs	(4,923)	(4,814)	(4,278)
Balance at the end of the period	4,281	2,792	3,160
Deferred Finance Costs
Unamortized gross balance of deferred financing costs	2,077	3,822
Accumulated amortization related to deferred financing costs	2,263	2,824
Weighted average amortization period of deferred financing costs	12 years
Amortization of deferred financing fees
2014	1,352
2015	394
2016	34
2017	34
2018	34
SNF
Allowance for doubtful accounts
Provision for doubtful accounts	$ 2,005	$ 1,346	$ 1,464