Business and Summary of Significant Accounting Policies - Narrative (Details) $ in Thousands	3 Months Ended	12 Months Ended
	Dec. 31, 2016 investment	Dec. 31, 2018 USD ($) center bed	Dec. 31, 2017 USD ($)	Dec. 31, 2016 USD ($)	Oct. 01, 2018 center
Accounting Policies [Line Items]
Number of nursing centers		72
Number of licensed nursing beds | bed		8,214
Number of licensed assisted living beds | bed		429
Number of equity method investees | investment	1
Period of retroactive adjustment for reimbursements		3 years
Number of nursing center facilities leased		57			34
Settlement of provider taxes | $		$ 2,200
Amortization of intangible asset | $			$ 384	$ 384
Tax Cuts and Jobs Act, income tax expense | $		0	5,476	0
Stock based compensation | $		$ 1,127	$ 1,027	$ 1,012
Leases, acquired-in-place
Accounting Policies [Line Items]
Number of nursing center facilities leased		7
Amortization of intangible asset | $		$ 384
Omega Healthcare Investors, Inc | Leases, acquired-in-place
Accounting Policies [Line Items]
Number of licensed nursing beds | bed		15
Minimum
Accounting Policies [Line Items]
Number of licensed nursing beds per nursing center | bed		48
Maximum
Accounting Policies [Line Items]
Number of licensed nursing beds per nursing center | bed		320
Omega Healthcare Investors, Inc
Accounting Policies [Line Items]
Number of nursing center facilities owned		34
Golden Living
Accounting Policies [Line Items]
Number of nursing center facilities owned		20
Other parties
Accounting Policies [Line Items]
Number of nursing center facilities owned		3