Segment Information Segment Information (Details) (USD $) In Thousands, unless otherwise specified	3 Months Ended
	Mar. 31, 2014	Mar. 31, 2013
Segment Reporting Information [Line Items]
Revenue, Net	$ 1,571,038	$ 1,458,945
Depreciation and amortization expense	(33,736)	(31,989)
Settlements, litigations and other related charges	(7,052)	(22,619)
Other charges	(10,276)	(4,006)
Operating Income (Loss)	132,752	108,376
Long Term Care Group [Member]
Segment Reporting Information [Line Items]
Revenue, Net	1,191,253	1,141,585
Depreciation and amortization expense	(17,471)	(18,030)
Settlements, litigations and other related charges	(7,052)	(22,619)
Other charges	(2,511)	(2,752)
Operating Income (Loss)	152,584	129,817
specialty care group [Member]
Segment Reporting Information [Line Items]
Revenue, Net	379,672	316,729
Depreciation and amortization expense	(1,127)	(1,103)
Settlements, litigations and other related charges	0	0
Other charges	0	0
Operating Income (Loss)	31,729	28,109
Corporate/Other [Member]
Segment Reporting Information [Line Items]
Revenue, Net	113	631
Depreciation and amortization expense	(15,138)	(12,856)
Settlements, litigations and other related charges	0	0
Other charges	(7,765)	(1,254)
Operating Income (Loss)	$ (51,561)	$ (49,550)