Goodwill and Other Intangible Assets Goodwill Changes (Details) (USD $)	3 Months Ended
Mar. 31, 2015	Dec. 31, 2014
Goodwill [Line Items]
Goodwill	$ 4,064,951,000us-gaap_Goodwill	$ 4,061,806,000us-gaap_Goodwill
Intangible amortization expense	8,000,000us-gaap_AmortizationOfIntangibleAssets
Long Term Care Group [Member]
Goodwill [Line Items]
Goodwill	3,574,514,000	3,571,369,000
specialty care group [Member]
Goodwill [Line Items]
Goodwill	$ 490,437,000	$ 490,437,000

The aggregate expense charged against earnings to allocate the cost of intangible assets (nonphysical assets not used in production) in a systematic and rational manner to the periods expected to benefit from such assets. As a noncash expense, this element is added back to net income when calculating cash provided by or used in operations using the indirect method.

Reference 1: http://www.xbrl.org/2003/role/presentationRef

-Publisher FASB

-Name Accounting Standards Codification

-Topic 230

-SubTopic 10

-Section 45

-Paragraph 28

-Subparagraph (b)

-URI http://asc.fasb.org/extlink&oid=56944662&loc=d3e3602-108585

Reference 2: http://www.xbrl.org/2003/role/presentationRef

-Publisher FASB

-Name Accounting Standards Codification

-Topic 350

-SubTopic 30

-Section 45

-Paragraph 2

-URI http://asc.fasb.org/extlink&oid=6388964&loc=d3e16225-109274

Reference 3: http://www.xbrl.org/2003/role/presentationRef

-Publisher FASB

-Name Accounting Standards Codification

-Topic 350

-SubTopic 30

-Section 50

-Paragraph 2

-Subparagraph (a)(2)

-URI http://asc.fasb.org/extlink&oid=26713463&loc=d3e16323-109275

Name:	us-gaap_AmortizationOfIntangibleAssets
Namespace Prefix:	us-gaap_
Data Type:	xbrli:monetaryItemType
Balance Type:	debit
Period Type:	duration