Acquisitions Acquisitions by date (Details) (USD $)	3 Months Ended				0 Months Ended			0 Months Ended
	Mar. 31, 2014	Mar. 31, 2013	Dec. 31, 2013	Mar. 31, 2013 Operations acquired in business combinations	Mar. 02, 2014 Skilled nursing facility ARIZONA Beds	Mar. 04, 2014 Skilled nursing facility IDAHO	Mar. 31, 2014 Transitional Care Management company [Member] IDAHO	May 02, 2014 Subsequent Event [Member] Skilled nursing facility ARIZONA Beds	Apr. 02, 2014 Subsequent Event [Member] Home Health and Hospice Agency and Primary Care Group [Member] Idaho and Washington [Member]	May 04, 2014 Subsequent Event [Member] Assisted Living Facility [Member] CALIFORNIA Beds	May 04, 2014 Skilled nursing facility Subsequent Event [Member] CALIFORNIA Businesses	May 08, 2014 Skilled nursing facility Subsequent Event [Member] UTAH
Business Acquisition [Line Items]
Cash payment to acquire businesses					$ 9,108,000	$ 40,000		$ 10,125,000	$ 1,350,000	$ 16,000,000
Assets Acquired											1
Operational Skilled Nursing Beds					196			230		143
Goodwill	23,966,000		23,935,000	1,966,000			31,000
Payments to Acquire Property, Plant, and Equipment	$ 16,424,000	$ 5,216,000										$ 4,800,000