Goodwill and Other Intangible Assets (Details) (USD $)	3 Months Ended		9 Months Ended
	Sep. 30, 2013	Sep. 30, 2012	Sep. 30, 2013	Sep. 30, 2012	Dec. 31, 2012
Goodwill [Line Items]
Goodwill	$ 4,253,461,000		$ 4,253,461,000		$ 4,256,959,000
Goodwill, Other Changes			(3,498,000)
Intangible amortization expense	9,000,000	11,000,000	28,000,000	33,000,000
Long Term Care Group [Member]
Goodwill [Line Items]
Goodwill	3,719,303,000		3,719,303,000		3,722,801,000
Goodwill, Other Changes			(3,498,000)
specialty care group [Member]
Goodwill [Line Items]
Goodwill	534,158,000		534,158,000		534,158,000
Goodwill, Other Changes			$ 0