Property and Equipment (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Property, Plant and Equipment [Line Items]
Total property and equipment, at cost	$ 35,630	$ 36,004
Less accumulated depreciation	22,730	22,495
Total property and equipment, net	12,900	13,509
Depreciation	4,900	5,000	$ 4,800
Housekeeping and Dietary equipment
Property, Plant and Equipment [Line Items]
Total property and equipment, at cost	22,596	22,349
Computer hardware and software
Property, Plant and Equipment [Line Items]
Total property and equipment, at cost	12,114	12,665
Other
Property, Plant and Equipment [Line Items]
Total property and equipment, at cost	$ 920	$ 990