Segment Information (Details) (USD $) In Thousands, unless otherwise specified	3 Months Ended								12 Months Ended
	Dec. 31, 2012	Sep. 30, 2012	Jun. 30, 2012	Mar. 31, 2012	Dec. 31, 2011	Sep. 30, 2011	Jun. 30, 2011	Mar. 31, 2011	Dec. 31, 2012	Dec. 31, 2011	Dec. 31, 2010
Segment Reporting Information [Line Items]
Revenue, Net	$ 1,529,945	$ 1,501,348	$ 1,536,027	$ 1,593,068	$ 1,557,085	$ 1,544,360	$ 1,555,906	$ 1,525,571	$ 6,160,388	$ 6,182,922	$ 6,030,670
Depreciation and amortization expense									(135,941)	(133,132)	(150,546)
Litigation And Other Professional Fees	(11,148)	(4,931)	(26,093)	(7,203)	(23,103)	(6,742)	(19,816)	(6,013)	(49,375)	(55,674)	(113,709)
Other miscellaneous charges, net									(67,803)	(16,093)	(147,231)
Operating Income (Loss)	122,529	133,731	66,088	124,830	106,115	117,053	97,414	112,361	447,178	432,943	189,154
Long Term Care Group [Member]
Segment Reporting Information [Line Items]
Revenue, Net									4,848,341	5,123,477	5,175,730
Depreciation and amortization expense									(69,818)	(64,484)	(58,271)
Litigation And Other Professional Fees									(49,175)	(55,031)	(113,279)
Other miscellaneous charges, net									(2,568)	(15,049)	(13,745)
Operating Income (Loss)									562,675	476,800	374,110
specialty care group [Member]
Segment Reporting Information [Line Items]
Revenue, Net									1,301,761	1,044,191	838,790
Depreciation and amortization expense									(15,595)	(16,221)	(17,094)
Litigation And Other Professional Fees									(200)	(643)	(430)
Other miscellaneous charges, net									(2,090)	0	(14,173)
Operating Income (Loss)									129,218	98,938	75,039
Corporate/Other [Member]
Segment Reporting Information [Line Items]
Revenue, Net									10,286	15,254	16,150
Depreciation and amortization expense									(50,528)	(52,427)	(75,181)
Litigation And Other Professional Fees									0	0	0
Other miscellaneous charges, net									(63,145)	(1,044)	(119,313)
Operating Income (Loss)									$ (244,715)	$ (142,795)	$ (259,995)