Goodwill and Other Intangible Assets (Details) (USD $)	12 Months Ended
	Dec. 31, 2011	Dec. 31, 2010	Dec. 31, 2009
Changes in the carrying amount of goodwill [Roll Forward]
Beginning balance, Goodwill	$ 4,182,928,000	$ 4,100,362,000
Goodwill acquired during period	52,924,000	80,596,000
Other changes to Goodwill	11,434,000	1,970,000
Ending balance, Goodwill	4,247,286,000	4,182,928,000	4,100,362,000
Future Amortization Expense, Year One	41,301,000
Intangible Assets Gross (Excluding Goodwill)	484,763,000	492,216,000
finite lived intangible asset accumulated amortization and impairment losses		(232,407,000)
Accumulated amortization on identifiable intangible assets	(246,200,000)	(219,107,000)
Identifiable intangible assets, net	238,563,000	259,809,000
Future Amortization Expense, Year Two	35,966,000
Future Amortization Expense, Year Three	34,760,000
Future Amortization Expense, Year Four	31,913,000
Future Amortization Expense, Year Five	22,397,000
Finite-Lived Intangible Assets, Amortization Expense	41,600,000	38,900,000	39,200,000
Long Term Care Group [Member]
Changes in the carrying amount of goodwill [Roll Forward]
Beginning balance, Goodwill	3,504,340,000	3,422,340,000
Goodwill acquired during period	52,924,000	80,596,000
Other changes to Goodwill	11,394,000	1,404,000
Ending balance, Goodwill	3,568,658,000	3,504,340,000
specialty care group [Member]
Changes in the carrying amount of goodwill [Roll Forward]
Beginning balance, Goodwill	678,588,000	678,022,000
Goodwill acquired during period	0	0
Other changes to Goodwill	40,000	566,000
Ending balance, Goodwill	678,628,000	678,588,000
Other Intangible Assets [Member]
Changes in the carrying amount of goodwill [Roll Forward]
Intangible Assets Gross (Excluding Goodwill)	326,000	328,000
finite lived intangible asset accumulated amortization and impairment losses		(236,000)
Accumulated amortization on identifiable intangible assets	(248,000)
Identifiable intangible assets, net	78,000	92,000
finite lived intangible asset estimated useful life range, minimum	10
finite lived intangible asset useful life range, maximum	15
Developed Technology Rights [Member]
Changes in the carrying amount of goodwill [Roll Forward]
Intangible Assets Gross (Excluding Goodwill)	5,976,000	11,899,000
finite lived intangible asset accumulated amortization and impairment losses		(7,859,000)
Accumulated amortization on identifiable intangible assets	(3,575,000)
Identifiable intangible assets, net	2,401,000	4,040,000
finite lived intangible asset estimated useful life range, minimum	10
finite lived intangible asset useful life range, maximum	11
trademark and trade names [Member]
Changes in the carrying amount of goodwill [Roll Forward]
Intangible Assets Gross (Excluding Goodwill)	28,122,000	39,672,000
finite lived intangible asset accumulated amortization and impairment losses		(13,300,000)
Accumulated amortization on identifiable intangible assets	(837,000)
Identifiable intangible assets, net	27,285,000	26,372,000
Noncompete Agreements [Member]
Changes in the carrying amount of goodwill [Roll Forward]
Intangible Assets Gross (Excluding Goodwill)	42,010,000	48,036,000
finite lived intangible asset accumulated amortization and impairment losses		(24,545,000)
Accumulated amortization on identifiable intangible assets	(20,063,000)
Identifiable intangible assets, net	21,947,000	23,491,000
finite lived intangible asset estimated useful life range, minimum	5
finite lived intangible asset useful life range, maximum	15
Customer Relationships [Member]
Changes in the carrying amount of goodwill [Roll Forward]
Intangible Assets Gross (Excluding Goodwill)	408,329,000	392,281,000
finite lived intangible asset accumulated amortization and impairment losses		(186,467,000)
Accumulated amortization on identifiable intangible assets	(221,477,000)
Identifiable intangible assets, net	186,852,000	205,814,000
finite lived intangible asset estimated useful life range, minimum	8.5
finite lived intangible asset useful life range, maximum	15
Restatement Adjustment [Member]
Changes in the carrying amount of goodwill [Roll Forward]
Ending balance, Goodwill		(51,893,000)	(51,893,000)
Restatement Adjustment [Member] | Long Term Care Group [Member]
Changes in the carrying amount of goodwill [Roll Forward]
Ending balance, Goodwill			(51,893,000)
Restatement Adjustment [Member] | specialty care group [Member]
Changes in the carrying amount of goodwill [Roll Forward]
Ending balance, Goodwill			0
Scenario, Previously Reported [Member]
Changes in the carrying amount of goodwill [Roll Forward]
Ending balance, Goodwill		4,234,821,000	4,152,255,000
Scenario, Previously Reported [Member] | Long Term Care Group [Member]
Changes in the carrying amount of goodwill [Roll Forward]
Ending balance, Goodwill			3,474,233,000
Scenario, Previously Reported [Member] | specialty care group [Member]
Changes in the carrying amount of goodwill [Roll Forward]
Ending balance, Goodwill			678,022,000
trademark and trade names [Member]
Changes in the carrying amount of goodwill [Roll Forward]
Impairment of Intangible Assets, Indefinite-lived (Excluding Goodwill)		13,300,000
technology assets and related non-compete agreements [Member]
Changes in the carrying amount of goodwill [Roll Forward]
Impairment of Intangible Assets, Indefinite-lived (Excluding Goodwill)		$ 10,000,000