Goodwill and Other Intangible Assets (Details) (USD $)	12 Months Ended
	Dec. 31, 2014	Dec. 31, 2013	Dec. 31, 2012
Changes in the carrying amount of goodwill [Roll Forward]
Beginning balance, Goodwill	$ 4,057,456,000	$ 4,061,303,000
Goodwill acquired during period	1,123,000
Goodwill, Written off Related to Sale of Business Unit	(41,000)	(4,145,000)
Other changes to Goodwill	3,268,000	298,000
Ending balance, Goodwill	4,061,806,000	4,057,456,000	4,061,303,000
Indefinite and Finite Lived Intangible Assets (Excluding Goodwill) [Abstract]
Intangible Assets Gross (Excluding Goodwill)	356,225,000	357,631,000
Accumulated amortization on identifiable intangible assets	(257,283,000)	(227,657,000)
Identifiable intangible assets, net	98,942,000	129,974,000
Indefinite-Lived Intangible Assets (Excluding Goodwill)	12,000,000	12,000,000
Amortization of Intangible Assets [Abstract]
Future Amortization Expense, Year One	30,245,000
Future Amortization Expense, Year Two	19,974,000
Future Amortization Expense, Year Three	11,911,000
Future Amortization Expense, Year Four	9,308,000
Future Amortization Expense, Year Five	6,491,000
Intangible amortization expense	31,000,000	33,000,000	39,000,000
Long Term Care Group [Member]
Changes in the carrying amount of goodwill [Roll Forward]
Beginning balance, Goodwill	3,567,019,000	3,570,866,000
Goodwill acquired during period	1,123,000
Goodwill, Written off Related to Sale of Business Unit	(41,000)	(4,145,000)
Other changes to Goodwill	3,268,000	298,000
Ending balance, Goodwill	3,571,369,000	3,567,019,000
specialty care group [Member]
Changes in the carrying amount of goodwill [Roll Forward]
Beginning balance, Goodwill	490,437,000	490,437,000
Goodwill acquired during period	0
Goodwill, Written off Related to Sale of Business Unit	0	0
Other changes to Goodwill	0	0
Ending balance, Goodwill	490,437,000	490,437,000
Customer Relationships [Member]
Indefinite and Finite Lived Intangible Assets (Excluding Goodwill) [Abstract]
Intangible Assets Gross (Excluding Goodwill)	318,464,000	318,281,000
Accumulated amortization on identifiable intangible assets	(239,486,000)	(211,191,000)
Identifiable intangible assets, net	78,978,000	107,090,000
finite lived intangible asset estimated useful life range, minimum	6	6
finite lived intangible asset useful life range, maximum	15	15
trademark and trade names [Member]
Indefinite and Finite Lived Intangible Assets (Excluding Goodwill) [Abstract]
Intangible Assets Gross (Excluding Goodwill)	13,972,000	13,972,000
Accumulated amortization on identifiable intangible assets	(1,944,000)	(1,496,000)
Identifiable intangible assets, net	12,028,000	12,476,000
Noncompete Agreements [Member]
Indefinite and Finite Lived Intangible Assets (Excluding Goodwill) [Abstract]
Intangible Assets Gross (Excluding Goodwill)	23,402,000	24,991,000
Accumulated amortization on identifiable intangible assets	(15,757,000)	(14,970,000)
Identifiable intangible assets, net	7,645,000	10,021,000
finite lived intangible asset estimated useful life range, minimum	2	2
finite lived intangible asset useful life range, maximum	15	15
Other Intangible Assets [Member]
Indefinite and Finite Lived Intangible Assets (Excluding Goodwill) [Abstract]
Intangible Assets Gross (Excluding Goodwill)	387,000	387,000
Accumulated amortization on identifiable intangible assets	(96,000)	0
Identifiable intangible assets, net	$ 291,000	$ 387,000
finite lived intangible asset estimated useful life range, minimum	4	4
finite lived intangible asset useful life range, maximum	4	4