Goodwill and Other Intangible Assets Goodwill Changes (Details) (USD $)	3 Months Ended		9 Months Ended
	Sep. 30, 2014	Sep. 30, 2013	Sep. 30, 2014	Sep. 30, 2013	Dec. 31, 2013
Goodwill [Line Items]
Goodwill	$ 4,060,683,000		$ 4,060,683,000		$ 4,057,456,000
Reduction of Goodwill as a Result of Disposition			(41,000)
Goodwill, Other Changes			3,268,000
Intangible amortization expense	8,000,000	8,000,000	24,000,000	25,000,000
Long Term Care Group [Member]
Goodwill [Line Items]
Goodwill	3,570,246,000		3,570,246,000		3,567,019,000
Reduction of Goodwill as a Result of Disposition			(41,000)
Goodwill, Other Changes			3,268,000
specialty care group [Member]
Goodwill [Line Items]
Goodwill	490,437,000		490,437,000		490,437,000
Reduction of Goodwill as a Result of Disposition			0
Goodwill, Other Changes			$ 0