Segment Information (Details) (USD $) In Thousands, unless otherwise specified	3 Months Ended								12 Months Ended
	Dec. 31, 2014	Sep. 30, 2014	Jun. 30, 2014	Mar. 31, 2014	Dec. 31, 2013	Sep. 30, 2013	Jun. 30, 2013	Mar. 31, 2013	Dec. 31, 2014	Dec. 31, 2013	Dec. 31, 2012
Segment Reporting Information [Line Items]
Revenue, Net	$ 1,627,938	$ 1,608,055	$ 1,610,584	$ 1,571,038	$ 1,536,169	$ 1,515,168	$ 1,503,116	$ 1,458,945	$ 6,417,615	$ 6,013,398	$ 5,878,464
Depreciation and amortization expense									(132,294)	(132,960)	(128,537)
Litigation And Other Professional Fees	(15,351)	(12,868)	(7,547)	(7,052)	2,150	(143,484)	(3,512)	(22,619)	(42,818)	(167,465)	(49,375)
Other miscellaneous charges, net									(139,253)	(99,802)	(65,713)
Operating Income (Loss)	28,573	135,742	130,246	132,752	143,574	(60,776)	106,680	108,376	427,313	297,854	410,335
Long Term Care Group [Member]
Segment Reporting Information [Line Items]
Revenue, Net									4,750,121	4,627,871	4,789,551
Depreciation and amortization expense									(69,089)	(71,310)	(69,582)
Litigation And Other Professional Fees									(42,818)	(167,465)	(49,175)
Other miscellaneous charges, net									(73,248)	(45,950)	(2,568)
Operating Income (Loss)									516,086	420,646	562,379
specialty care group [Member]
Segment Reporting Information [Line Items]
Revenue, Net									1,667,152	1,384,003	1,078,627
Depreciation and amortization expense									(4,498)	(4,539)	(8,431)
Litigation And Other Professional Fees									0	0	(200)
Other miscellaneous charges, net									(566)	0	0
Operating Income (Loss)									136,373	113,243	92,671
Corporate/Other [Member]
Segment Reporting Information [Line Items]
Revenue, Net									342	1,524	10,286
Depreciation and amortization expense									(58,707)	(57,111)	(50,524)
Litigation And Other Professional Fees									0	0	0
Other miscellaneous charges, net									(65,439)	(53,852)	(63,145)
Operating Income (Loss)									$ (225,146)	$ (236,035)	$ (244,715)