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Goodwill and Intangibles - Changes in Goodwill by Segment (Detail) (USD $)
In Thousands, unless otherwise specified
9 Months Ended
Sep. 30, 2013
Sep. 30, 2013
Home-based services segment [Member]
Sep. 30, 2013
Facility-based services segment [Member]
Dec. 31, 2012
Facility-based services segment [Member]
Goodwill [Roll Forward]        
Balance at beginning of period $ 169,150 $ 157,559 $ 11,591 $ 11,591
Goodwill from acquisitions 25,743 25,121    
Goodwill related to noncontrolling interest 622 622    
Balance at end of period $ 194,893 $ 183,302 $ 11,591 $ 11,591