Income Taxes (Details) (USD $) In Thousands, unless otherwise specified	12 Months Ended
	Dec. 31, 2013	Dec. 31, 2012	Dec. 31, 2011
Current deferred tax assets:
Continuing care contracts	$ 134	$ 607
Allowance for doubtful accounts	2,376	1,559
Deferred gains on sale lease back transactions	1,383	1,278
Insurance reserves	1,188	1,015
Tax credits	352	465
Tax loss carry forwards	6,679	9,190
Other	1,746	1,220
Total current deferred tax assets before valuation allowance	13,858	15,334
Valuation allowance:	(454)	(297)
Total current deferred tax assets	13,404	15,037
Non-current deferred tax assets:
Continuing care contracts	592	228
Deferred gains on sale lease back transactions	735	981
Insurance reserves	2,880	2,919
Tax credits	14,883	11,264
Tax loss carry forwards	32,139	26,592
Impairment of securities	470	501
Depreciable assets	5,990
Other	1,054	1,431
Total non-current deferred tax assets before valuation allowance	58,743	43,916
Valuation allowance:	(3,149)	(1,891)
Total non-current deferred tax assets	55,594	42,025
Current deferred tax liabilities:
Employee stock grants	(115)	(130)
Non-current deferred tax liabilities:
Depreciable assets		(1,674)
Lease expense	(11,401)	(696)
Goodwill	(1,173)	(1,087)
Identifiable intangibles/other liabilities	(1,190)	(1,008)
Total non-current deferred tax liabilities	(13,764)	(4,465)
Net deferred tax asset	55,119	52,467
Movement in valuation allowance for deferred tax assets
Balance at Beginning of Period	2,188	3,363	59,238
Amounts Charged/ (Credited) To Expense	1,415	(1,175)	(55,875)
Balance at End of Period	$ 3,603	$ 2,188	$ 3,363