Business Segments (Tables)

12 Months Ended

Dec. 31, 2017

Segment Reporting [Abstract]

Reconciliation of Revenue from Segments to Consolidated [Table Text Block]

Segment revenues by major payor source were as follows:

	Year Ended December 31, 2017
	Transitional and Skilled Services		Assisted and Independent Living Services		Home Health and Hospice Services		All Other			Total Revenue		Revenue %
Medicaid	$	603,104	$	30,469	$	11,230	$	—		$	644,803	34.9	%
Medicare	417,870		—		98,014		—			515,884		27.9
Medicaid-skilled	102,875		—		—		—			102,875		5.6
Subtotal	1,123,849		30,469		109,244		—			1,263,562		68.4
Managed care	281,563		—		21,823		—			303,386		16.4
Private and other	139,798		106,177		11,336		25,058		(1)	282,369		15.2
Total revenue	$	1,545,210	$	136,646	$	142,403	$	25,058		$	1,849,317	100.0	%
(1) Private and other payors also includes revenue from all payors generated in other ancillary services for the year ended December 31, 2017.

	Year Ended December 31, 2016
	Transitional and Skilled Services		Assisted and Independent Living Services		Home Health and Hospice Services		All Other			Total Revenue		Revenue %
Medicaid	$	521,063	$	26,397	$	10,498	$	—		$	557,958	33.7	%
Medicare	396,519		—		80,500		—			477,019		28.8
Medicaid-skilled	87,517		—		—		—			87,517		5.3
Subtotal	1,005,099		26,397		90,998		—			1,122,494		67.8
Managed care	247,844		—		17,664		—			265,508		16.0
Private and other	121,860		97,239		7,151		40,612		(1)	266,862		16.2
Total revenue	$	1,374,803	$	123,636	$	115,813	$	40,612		$	1,654,864	100.0	%
(1) Private and other payors also includes revenue from all payors generated in other ancillary services and urgent care centers for the year ended December 31, 2016.

	Year Ended December 31, 2015
	Transitional and Skilled Services		Assisted and Independent Living Services		Home Health and Hospice Services		All Other			Total Revenue		Revenue %
Medicaid	$	430,368	$	19,642	$	8,946	$	—		$	458,956	34.2	%
Medicare	332,429		—		63,074		—			395,503		29.5
Medicaid-skilled	71,905		—		—		—			71,905		5.4
Subtotal	834,702		19,642		72,020		—			926,364		69.1
Managed care	194,743		—		12,027		—			206,770		15.4
Private and other	96,943		68,487		6,309		36,953		(1)	208,692		15.5
Total revenue	$	1,126,388	$	88,129	$	90,356	$	36,953		$	1,341,826	100.0	%
(1) Private and other payors also includes revenue from all payors generated in other ancillary services and urgent care centers for the year ended December 31, 2015.

Schedule of Segment Reporting Information, by Segment [Table Text Block]

The following table sets forth selected financial data consolidated by business segment:

	Year Ended December 31, 2017
	Transitional and Skilled Services(3)		Assisted and Independent Living Services(3)		Home Health and Hospice Services		All Other			Elimination			Total
Revenue from external customers	$	1,545,210	$	136,646	$	142,403	$	25,058		$	—		$	1,849,317
Intersegment revenue (1)	3,023		—		—		3,035			(6,058		)	—
Total revenue	$	1,548,233	$	136,646	$	142,403	$	28,093		$	(6,058	)	$	1,849,317
Segment income (loss) (2)	$	140,272	$	16,736	$	19,717	$	(95,440	)	$	—		$	81,285
Interest expense, net of interest income													$	(12,007	)
Income before provision for income taxes													$	69,278
Depreciation and amortization	$	29,928	$	6,334	$	945	$	7,265		$	—		$	44,472

(1) Intersegment revenue represents services provided at the Company's operating subsidiaries to the Company's other business lines.

(2) Segment income (loss) includes depreciation and amortization expense and excludes general and administrative expense and interest expense for transitional and skilled services, assisted and independent living services and home health and hospice businesses. General and administrative expense is included in the "All Other" category.

(3) The Company's campuses represent facilities that offer skilled nursing, assisted and/or independent living services. Revenue and expenses related to skilled nursing, assisted and independent living services have been allocated and recorded in the respective reportable segment.

	Year Ended December 31, 2016
	Transitional and Skilled Services(3)		Assisted and Independent Living Services(3)		Home Health and Hospice Services		All Other			Elimination			Total
Revenue from external customers	$	1,374,803	$	123,636	$	115,813	$	40,612		$	—		$	1,654,864
Intersegment revenue (1)	2,929		—		—		2,184			(5,113		)	—
Total revenue	$	1,377,732	$	123,636	$	115,813	$	42,796		$	(5,113	)	$	1,654,864
Segment income (loss) (2)	$	118,118	$	11,701	$	16,571	$	(54,543	)	$	—		$	91,847
Interest expense, net of interest income													$	(6,029	)
Income before provision for income taxes													$	85,818
Depreciation and amortization	$	26,298	$	4,157	$	924	$	7,303		$	—		$	38,682

(1) Intersegment revenue represents services provided at the Company's operating subsidiaries to the Company's other business lines.

(2) Segment income (loss) includes depreciation and amortization expense and excludes general and administrative expense and interest expense for transitional and skilled services, assisted and independent living services and home health and hospice businesses. General and administrative expense is included in the "All Other" category.

(3) The Company's campuses represent facilities that offer skilled nursing, assisted and/or independent living services. Revenue and expenses related to skilled nursing, assisted and independent living services have been allocated and recorded in the respective reportable segment.

	Year Ended December 31, 2015
	Transitional and Skilled Services(3)		Assisted and Independent Living Services(3)		Home Health and Hospice Services		All Other			Elimination			Total
Revenue from external customers	$	1,126,388	$	88,129	$	90,356	$	36,953		$	—		$	1,341,826
Intersegment revenue (1)	2,447		—		—		881			(3,328		)	—
Total revenue	$	1,128,835	$	88,129	$	90,356	$	37,834		$	(3,328	)	$	1,341,826
Segment income (loss) (2)	$	136,744	$	11,463	$	13,584	$	(68,709	)	$	—		$	93,082
Interest expense, net of interest income													$	(1,983	)
Income before provision for income taxes													$	91,099
Depreciation and amortization	$	18,008	$	3,338	$	980	$	5,785		$	—		$	28,111

(1) Intersegment revenue represents services provided at the Company's operating subsidiaries to the Company's other business lines.

(2) Segment income (loss) includes depreciation and amortization expense and excludes general and administrative expense and interest expense for transitional and skilled services, assisted and independent living services and home health and hospice businesses. General and administrative expense is included in the "All Other" category.

(3) The Company's campuses represent facilities that offer skilled nursing, assisted and/or independent living services. Revenue and expenses related to skilled nursing, assisted and independent living services have been allocated and recorded in the respective reportable segment.