Insurance Matters (Details) (USD $)	9 Months Ended
	Sep. 30, 2012 Lawsuit Center	Sep. 30, 2011	Dec. 31, 2011
Malpractice Insurance [Line Items]
Number of nursing centers	48
Workers compensation insurance, maximum annual aggregate self-insured amount	$ 3,000,000
Number of professional liability lawsuits	41
Other Insurance Industry Disclosures [Abstract]
Cash expenditures for self-insured professional liability costs	4,595,000	6,560,000
Non-current receivables for workers' compensation policy	1,238,000		750,000
Liability for workers compensation claims	454,000
Workers compensation insurance, non current receivable for excess premiums paid	718,000
Health insurance, maximum self-insured annual amount per individual	175,000
Scheduled for trial or arbitration over next 12 months
Malpractice Insurance [Line Items]
Number of professional liability lawsuits	6
Kentucky
Malpractice Insurance [Line Items]
Number of nursing centers	8
Professional liability insurance policies 1 | West Virginia
Malpractice Insurance [Line Items]
Number of nursing centers	2
Professional liability insurance policies 1 | Kentucky
Malpractice Insurance [Line Items]
Number of nursing centers	2
Professional liability insurance policies 2 | West Virginia
Malpractice Insurance [Line Items]
Number of nursing centers	1
Professional liability insurance policies 2 | Kentucky
Malpractice Insurance [Line Items]
Number of nursing centers	2
Professional malpractice liability insurance
Malpractice Insurance [Line Items]
Professional liability insurance, deductible	495,000
Liability for reported and estimated future claims	21,155,000
Professional malpractice liability insurance | Professional liability insurance policies 1
Malpractice Insurance [Line Items]
Insurance policy coverage limits per claim	250,000
Maximum claim amount on insurance	750,000
Professional malpractice liability insurance | Professional liability insurance policies 2
Malpractice Insurance [Line Items]
Insurance policy coverage limits per claim	1,000,000
Maximum claim amount on insurance	15,000,000
Prefunded deductible policy
Malpractice Insurance [Line Items]
Insurance policy coverage limits per claim	500,000
Professional liability insurance, annual coverage limit per facility	3,000,000
Liability for reported claims and estimates for incurred but unreported claims	$ 725,000