Segment Information (Details) (USD $) In Thousands, unless otherwise specified	3 Months Ended								12 Months Ended
	Dec. 31, 2011	Sep. 30, 2011	Jun. 30, 2011	Mar. 31, 2011	Dec. 31, 2010	Sep. 30, 2010	Jun. 30, 2010	Mar. 31, 2010	Dec. 31, 2011	Dec. 31, 2010	Dec. 31, 2009
Segment Reporting Information [Line Items]
Revenue, Net	$ 1,557,085	$ 1,544,360	$ 1,555,906	$ 1,525,571	$ 1,530,667	$ 1,516,207	$ 1,491,425	$ 1,492,371	$ 6,182,922	$ 6,030,670	$ 6,001,053
Depreciation and amortization expense									(133,132)	(150,546)	(137,682)
Litigation And Other Professional Fees	(23,103)	(6,742)	(19,816)	(6,013)	(42,111)	(36,731)	(29,361)	(5,506)	(55,674)	(113,709)	(77,449)
Other miscellaneous charges, net									(16,093)	(147,231)	(25,707)
Operating Income (Loss)	106,115	117,053	97,414	112,361	(32,668)	10,758	85,704	125,360	432,943	189,154	469,751
Long Term Care Group [Member]
Segment Reporting Information [Line Items]
Revenue, Net									5,123,477	5,175,730	5,271,388
Depreciation and amortization expense									(64,484)	(58,271)	(71,389)
Litigation And Other Professional Fees									(55,031)	(113,279)	(77,449)
Other miscellaneous charges, net									(15,049)	(13,745)	(16,281)
Operating Income (Loss)									476,800	374,110	530,600
specialty care group [Member]
Segment Reporting Information [Line Items]
Revenue, Net									1,044,191	838,790	712,768
Depreciation and amortization expense									(16,221)	(17,094)	(18,461)
Litigation And Other Professional Fees									(643)	(430)	0
Other miscellaneous charges, net									0	(14,173)	(163)
Operating Income (Loss)									98,938	75,039	87,972
Corporate/Other [Member]
Segment Reporting Information [Line Items]
Revenue, Net									15,254	16,150	16,897
Depreciation and amortization expense									(52,427)	(75,181)	(47,832)
Litigation And Other Professional Fees									0	0	0
Other miscellaneous charges, net									(1,044)	(119,313)	(9,263)
Operating Income (Loss)									$ (142,795)	$ (259,995)	$ (148,821)