Intangible Assets and Goodwill - Intangibles Assets (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Finite Lived And Indefinite Lived Intangible Assets By Major Class [Line Items]
Finite and indefinite lived intangible assets, gross	$ 32,463	$ 32,163	$ 45,042
Finite and indefinite lived intangible assets, accumulated amortization	(9,160)	(7,610)	(8,221)
Intangible assets, net carrying amount	23,303	24,553	36,821
Intangible assets
Assets disposed, gross		(12,879)
Assets disposed, accumulated amortization		2,123
Amortization expense	(1,550)	(1,512)
Balance at the start of the period
Assets acquired, gross	300
Bed Licenses Separable
Finite Lived And Indefinite Lived Intangible Assets By Major Class [Line Items]
Finite and indefinite lived intangible assets, gross	2,471	2,471	2,471
Finite and indefinite lived intangible assets, accumulated amortization	0	0	0
Intangible assets, net carrying amount	2,471	2,471	2,471
Intangible assets
Assets disposed, gross		0
Assets disposed, accumulated amortization		0
Amortization expense	0	0
Balance at the start of the period
Assets acquired, gross	0
Bed Licenses Included In Property And Equipment
Finite Lived And Indefinite Lived Intangible Assets By Major Class [Line Items]
Finite and indefinite lived intangible assets, gross	22,811	22,811	35,690
Finite and indefinite lived intangible assets, accumulated amortization	(4,166)	(3,483)	(4,760)
Intangible assets, net carrying amount	18,645	19,328	30,930
Intangible assets
Assets disposed, gross		(12,879)
Assets disposed, accumulated amortization		2,123
Amortization expense	(683)	(846)
Balance at the start of the period
Assets acquired, gross	0
Lease Agreements
Finite Lived And Indefinite Lived Intangible Assets By Major Class [Line Items]
Finite and indefinite lived intangible assets, gross	7,181	6,881	6,881
Finite and indefinite lived intangible assets, accumulated amortization	(4,994)	(4,127)	(3,461)
Intangible assets, net carrying amount	2,187	2,754	$ 3,420
Intangible assets
Assets disposed, gross		0
Assets disposed, accumulated amortization		0
Amortization expense	(867)	$ (666)
Balance at the start of the period
Assets acquired, gross	$ 300