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Acquisitions Acquisitions by date (Details) (USD $)
In Thousands, unless otherwise specified
0 Months Ended
Sep. 30, 2013
Dec. 31, 2012
Sep. 30, 2013
Operations acquired in business combinations
Sep. 30, 2012
Operations acquired in business combinations
Jan. 02, 2013
Home Health Operation
WASHINGTON
Feb. 02, 2013
Home Health Operation
TEXAS
Jan. 02, 2013
Hospice Operation
Arizona and California
Jul. 02, 2013
Skilled nursing facility
WASHINGTON
Apr. 02, 2013
Skilled nursing facility
TEXAS
Beds
Mar. 02, 2013
Skilled nursing facility
TEXAS
Beds
May 02, 2013
Skilled nursing facility
NEBRASKA
Beds
Mar. 02, 2013
Home health and hospice operation
WASHINGTON
May 02, 2013
Skilled Nursing and Assisted Living Facilities [Member]
WASHINGTON
Beds
Jun. 02, 2013
Assisted Living Facility
CALIFORNIA
Beds
Jun. 02, 2013
Assisted Living Facility
UTAH
Sep. 17, 2013
Urgent Care Centers [Member]
WASHINGTON
Business Acquisition [Line Items]                                
Business acquisitions     $ 45,364 $ 20,934                        
Cash payment to acquire businesses         2,801 375 1,825 4,499 7,114 4,508 2,846 1,137 11,585 4,263 2,856 1,555
Goodwill 24,754 21,557 3,197 2,279 1,966                     1,231
Other intangible assets     $ 4,152 $ 1,217 $ 815                      
Operational Assisted Living Units                         102 110 69  
Operational Skilled Nursing Beds               82 280 150 70   110