The Ensign Group, Inc. (ENSG) 10-Q 3 Aug 17 2017 Q2 Quarterly report Financial data

DEI Info Cover Page Document

DEI Info Cover Page Document - shares	6 Months Ended
	Jun. 30, 2017	Aug. 02, 2017
Entity Information [Abstract]
Entity Registrant Name	ENSIGN GROUP, INC
Entity Central Index Key	1,125,376
Current Fiscal Year End Date	--06-30
Entity Filer Category	Large Accelerated Filer
Document Type	10-Q
Document Period End Date	Jun. 30, 2017
Document Fiscal Year Focus	2,017
Document Fiscal Period Focus	Q2
Amendment Flag	false
Entity Common Stock, Shares Outstanding		50,868,326

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Jun. 30, 2017	Dec. 31, 2016
Current assets:
Cash and cash equivalents	$ 33,476	$ 57,706
Accounts receivable—less allowance for doubtful accounts of $39,759 and $39,791 at June 30, 2017 and December 31, 2016, respectively	243,248	244,433
Investments—current	13,643	11,550
Prepaid income taxes	10,343	302
Prepaid expenses and other current assets	23,135	19,871
Total current assets	323,845	333,862
Property and equipment, net	490,386	484,498
Insurance subsidiary deposits and investments	25,899	23,634
Escrow deposits	23,925	1,582
Deferred tax asset	23,013	23,073
Restricted and other assets	13,329	12,614
Intangible assets, net	34,184	35,076
Goodwill	73,159	67,100
Other indefinite-lived intangibles	24,444	19,586
Total assets	1,032,184	1,001,025
Current liabilities:
Accounts payable	32,915	38,991
Accrued charge related to class action lawsuit (Note 18)	11,000	0
Accrued wages and related liabilities	72,701	84,686
Accrued self-insurance liabilities—current	21,010	21,359
Other accrued liabilities	58,787	58,763
Current maturities of long-term debt	8,165	8,129
Total current liabilities	204,578	211,928
Long-term debt—less current maturities	284,465	275,486
Accrued self-insurance liabilities—less current portion	48,658	43,992
Deferred rent and other long-term liabilities	11,119	9,124
Deferred gain related to sale-leaseback	12,403	0
Total liabilities	561,223	540,530
Commitments and contingencies (Notes 15, 17 and 18)
Equity:
Common stock; $0.001 par value; 75,000 shares authorized; 53,173 and 50,795 shares issued and outstanding at June 30, 2017, respectively, and 52,787 and 50,838 shares issued and outstanding at December 31, 2016, respectively (Note 3)	53	52
Additional paid-in capital (Note 3)	258,632	252,493
Retained earnings	244,049	235,021
Common stock in treasury, at cost, 1,932 and 1,520 shares at June 30, 2017 and December 31, 2016, respectively (Note 3)	(38,405)	(31,117)
Total Ensign Group, Inc. stockholders' equity	464,329	456,449
Non-controlling interest	6,632	4,046
Total equity	470,961	460,495
Total liabilities and equity	$ 1,032,184	$ 1,001,025

Consolidated Balance Sheets Bal

Consolidated Balance Sheets Balance Sheet (Paranthetical) - USD ($) shares in Thousands, $ in Thousands	Jun. 30, 2017	Dec. 31, 2016
Current assets:
Allowance for doubtful accounts	$ 39,759	$ 39,791
Equity:
Common stock, par value	$ 0.001	$ 0.001
Common stock, shares authorized	75,000	75,000
Common stock, shares issued	53,173	52,787
Common stock, shares outstanding	50,795	50,838
Common stock in treasury, at cost	1,932	1,520

Consolidated Statements of Inco

Consolidated Statements of Income - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2017	Jun. 30, 2016	Jun. 30, 2017	Jun. 30, 2016
Revenue	$ 448,279	$ 410,517	$ 890,019	$ 793,750
Expense:
Cost of services	366,946	330,538	722,433	636,846
Charge related to class action lawsuit (Note 18)	0	0	11,000	0
(Gain)/losses related to operational closures (Note 7 and 17)	(1,286)	0	2,731	7,935
Rent—cost of services (Note 17)	32,585	30,741	64,485	57,732
General and administrative expense	17,253	19,657	38,523	37,045
Depreciation and amortization	10,750	9,772	21,264	18,069
Total expenses	426,248	390,708	860,436	757,627
Income from operations	22,031	19,809	29,583	36,123
Other income (expense):
Interest expense	(3,053)	(1,446)	(6,498)	(2,816)
Interest income	288	278	578	513
Other expense, net	(2,765)	(1,168)	(5,920)	(2,303)
Income before provision for income taxes	19,266	18,641	23,663	33,820
Provision for income taxes	6,886	7,278	8,326	13,167
Net income	12,380	11,363	15,337	20,653
Less: net income attributable to noncontrolling interests	163	37	279	155
Net income attributable to The Ensign Group, Inc.	12,217	11,326	15,058	20,498
Amounts attributable to The Ensign Group, Inc.:
Net income attributable to The Ensign Group, Inc.	$ 12,217	$ 11,326	$ 15,058	$ 20,498
Basic:
Basic net income per common share attributable to The Ensign Group, Inc.	$ 0.24	$ 0.23	$ 0.30	$ 0.41
Diluted:
Diluted net income per common share attributable to The Ensign Group, Inc.	$ 0.23	$ 0.22	$ 0.29	$ 0.39
Weighted average common shares outstanding:
Basic	50,705	50,274	50,736	50,476
Diluted	52,548	51,931	52,593	52,134
Dividends per share	$ 0.0425	$ 0.0400	$ 0.0850	$ 0.0800

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2017	Jun. 30, 2016
Cash flows from operating activities:
Net income	$ 15,337	$ 20,653
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	21,264	18,069
Amortization of deferred financing fees	509	313
Amortization of deferred gain on sale-leaseback	(92)	0
Long-lived asset impairment	111	137
Write-off of deferred financing fees	0	197
Deferred income taxes	61	3
Provision for doubtful accounts	14,647	12,081
Share-based compensation	4,600	4,665
Excess tax benefit from share-based compensation (Note 2)	0	(1,534)
Change in operating assets and liabilities
Accounts receivable	(14,289)	(29,295)
Prepaid income taxes	(10,041)	268
Prepaid expenses and other assets	(4,533)	2,337
Insurance subsidiary deposits and investments	(4,358)	196
Charge related to class action lawsuit (Note 18)	11,000	0
Liabilities related to operational closures (Note 7 and 17)	2,620	7,558
Accounts payable	(4,379)	545
Accrued wages and related liabilities	(11,985)	(6,871)
Income taxes payable	(1,182)	(195)
Other accrued liabilities	1,550	760
Accrued self-insurance liabilities	3,759	6,814
Deferred rent liability	321	127
Net cash provided by operating activities	24,920	36,828
Cash flows from investing activities:
Purchase of property and equipment	(23,013)	(36,443)
Cash payment for business acquisitions	(41,645)	(56,081)
Cash payment for asset acquisitions	(310)	(777)
Escrow deposits	(23,925)	(6,704)
Escrow deposits used to fund business acquisitions	1,582	400
Cash proceeds from sale-leaseback	38,000	0
Cash proceeds from the sale of property and equipment and insurance proceeds	1,017	371
Restricted and other assets	(332)	(623)
Net cash used in investing activities	(48,626)	(99,857)
Cash flows from financing activities:
Proceeds from revolving credit facility (Note 15)	460,000	332,000
Payments on revolving credit facility and other debt (Note 15)	(451,052)	(247,316)
Issuance of treasury stock upon exercise of options	0	92
Issuance of common stock upon exercise of options	2,249	4,124
Repurchase of shares of common stock (Note 3)	(7,288)	(30,000)
Dividends paid	(4,350)	(4,097)
Excess tax benefit from share-based compensation (Note 2)	0	1,561
Purchase of non-controlling interest	(83)	0
Payments of deferred financing costs	0	(1,385)
Net cash (used in) provided by financing activities	(524)	54,979
Net decrease in cash and cash equivalents	(24,230)	(8,050)
Cash and cash equivalents beginning of period	57,706	41,569
Cash and cash equivalents end of period	33,476
Cash paid during the period for:
Interest	7,160	2,699
Income taxes	19,543	11,552
Non-cash financing and investing activity:
Accrued capital expenditures	$ 5,130	$ 5,682

Description of Business

Description of Business	6 Months Ended
	Jun. 30, 2017
DESCRIPTION OF BUSINESS [Abstract]
Organization, Consolidation and Presentation of Financial Statements Disclosure [Text Block]	DESCRIPTION OF BUSINESS The Company - The Ensign Group, Inc. (collectively, Ensign or the Company), is a holding company with no direct operating assets, employees or revenue. The Company, through its operating subsidiaries, is a provider of health care services across the post-acute care continuum, as well as other ancillary businesses. As of June 30, 2017 , the Company operated 222 facilities, 41 home health, hospice and home care agencies and other ancillary operations located in Arizona, California, Colorado, Idaho, Iowa, Kansas, Nebraska, Nevada, Oregon, South Carolina, Texas, Utah, Washington and Wisconsin. The Company's operating subsidiaries, each of which strives to be the operation of choice in the community it serves, provide a broad spectrum of skilled nursing, assisted living, home health, home care, hospice and other ancillary services. The Company's operating subsidiaries have a collective capacity of approximately 18,400 operational skilled nursing beds and 4,700 assisted living and independent living units. As of June 30, 2017 , the Company owned 56 of its 222 affiliated facilities and leased an additional 166 facilities through long-term lease arrangements and had options to purchase 10 of those 166 facilities. As of December 31, 2016 , the Company owned 50 of its 210 affiliated facilities and leased an additional 160 facilities through long-term lease arrangements, and had options to purchase nine of those 160 facilities. Certain of the Company’s wholly-owned independent subsidiaries, collectively referred to as the Service Center, provide certain accounting, payroll, human resources, information technology, legal, risk management and other centralized services to the other operating subsidiaries through contractual relationships with such subsidiaries. The Company also has a wholly-owned captive insurance subsidiary (the Captive) that provides some claims-made coverage to the Company’s operating subsidiaries for general and professional liability, as well as coverage for certain workers’ compensation insurance liabilities. Each of the Company's affiliated operations are operated by separate, wholly-owned, independent subsidiaries that have their own management, employees and assets. References herein to the consolidated “Company” and “its” assets and activities in this quarterly report is not meant to imply, nor should it be construed as meaning, that The Ensign Group, Inc. has direct operating assets, employees or revenue, or that any of the subsidiaries, are operated by The Ensign Group, Inc. Other Information — The accompanying condensed consolidated financial statements as of June 30, 2017 and for the three and six months ended June 30, 2017 and 2016 (collectively, the Interim Financial Statements) are unaudited. Certain information and note disclosures normally included in annual consolidated financial statements have been condensed or omitted, as permitted under applicable rules and regulations. Readers of the Interim Financial Statements should refer to the Company’s audited consolidated financial statements and notes thereto for the year ended December 31, 2016 which are included in the Company’s annual report on Form 10-K, File No. 001-33757 (the Annual Report) filed with the Securities and Exchange Commission (SEC). Management believes that the Interim Financial Statements reflect all adjustments which are of a normal and recurring nature necessary to present fairly the Company’s financial position and results of operations in all material respects. The results of operations presented in the Interim Financial Statements are not necessarily representative of operations for the entire year.

Significant Accounting Policies

Significant Accounting Policies	6 Months Ended
	Jun. 30, 2017
Accounting Policies [Abstract]
Basis of Presentation and Significant Accounting Policies [Text Block]	SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES Basis of Presentation — The accompanying Interim Financial Statements have been prepared in accordance with accounting principles generally accepted in the United States (GAAP). The Company is the sole member or shareholder of various consolidated limited liability companies and corporations established to operate various acquired skilled nursing and assisted living operations, home health, hospice and home care operations, and related ancillary services. All intercompany transactions and balances have been eliminated in consolidation. The condensed consolidated financial statements include the accounts of all entities controlled by the Company through its ownership of a majority voting interest. The Company presents noncontrolling interest within the equity section of its condensed consolidated balance sheets. The Company presents the amount of condensed consolidated net income that is attributable to The Ensign Group, Inc. and the noncontrolling interest in its condensed consolidated statements of income. Estimates and Assumptions — The preparation of Interim Financial Statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenue and expenses during the reporting periods. The most significant estimates in the Company’s Interim Financial Statements relate to revenue, allowance for doubtful accounts, intangible assets and goodwill, impairment of long-lived assets, general and professional liability, workers' compensation and healthcare claims included in accrued self-insurance liabilities, and income taxes. Actual results could differ from those estimates. Fair Value of Financial Instruments — The Company’s financial instruments consist principally of cash and cash equivalents, debt security investments, accounts receivable, insurance subsidiary deposits, accounts payable and borrowings. The Company believes all of the financial instruments’ recorded values approximate fair values because of their nature or respective short durations. Revenue Recognition — The Company recognizes revenue when the following four conditions have been met: (i) there is persuasive evidence that an arrangement exists; (ii) delivery has occurred or service has been rendered; (iii) the price is fixed or determinable; and (iv) collection is reasonably assured. The Company's revenue is derived primarily from providing healthcare services to patients and is recognized on the date services are provided at amounts billable to the individual. For reimbursement arrangements with third-party payors, including Medicaid, Medicare and private insurers, revenue is recorded based on contractually agreed-upon amounts on a per patient basis. Revenue from the Medicare and Medicaid programs accounted for 68.2% of the Company's revenue for both the three and six months ended June 30, 2017 , and 68.0% and 67.3% for the three and six months ended June 30, 2016 , respectively. The Company records revenue from these governmental and managed care programs as services are performed at their expected net realizable amounts under these programs. The Company’s revenue from governmental and managed care programs is subject to audit and retroactive adjustment by governmental and third-party agencies. Consistent with healthcare industry accounting practices, any changes to these governmental revenue estimates are recorded in the period the change or adjustment becomes known based on final settlement. The Company recorded adjustments to revenue which were not material to the Company's consolidated revenue for the three and six months ended June 30, 2017 and 2016 . The Company’s service specific revenue recognition policies are as follows: Skilled Nursing Revenue The Company’s revenue is derived primarily from providing long-term healthcare services to patients and is recognized on the date services are provided at amounts billable to individual patients. For patients under reimbursement arrangements with third-party payors, including Medicaid, Medicare and private insurers, revenue is recorded based on contractually agreed-upon amounts or rate on a per patient, daily basis or as services are performed. Assisted and Independent Living Revenue The Company's revenue is recorded when services are rendered on the date services are provided at amounts billable to individual residents and consists of fees for basic housing and assisted living care. Residency agreements are generally for a term of 30 days, with resident fees billed monthly in advance. For patients under reimbursement arrangements with Medicaid, revenue is recorded based on contractually agreed-upon amounts or rate on a per resident, daily basis or as services. Revenue for certain ancillary charges is recognized as services are provided, and such fees are billed monthly in arrears. Home Health Revenue Medicare Revenue Net service revenue is recorded under the Medicare prospective payment system based on a 60-day episode payment rate that is subject to adjustment based on certain variables including, but not limited to: (a) an outlier payment if patient care was unusually costly; (b) a low utilization payment adjustment if the number of visits was fewer than five; (c) a partial payment if the patient transferred to another provider or the Company received a patient from another provider before completing the episode; (d) a payment adjustment based upon the level of therapy services required; (e) the number of episodes of care provided to a patient, regardless of whether the same home health provider provided care for the entire series of episodes; (f) changes in the base episode payments established by the Medicare program; (g) adjustments to the base episode payments for case mix and geographic wages; and (h) recoveries of overpayments. The Company makes adjustments to Medicare revenue on completed episodes to reflect differences between estimated and actual payment amounts, an inability to obtain appropriate billing documentation or authorizations acceptable to the payor and other reasons unrelated to credit risk. Therefore, the Company believes that its reported net service revenue and patient accounts receivable will be the net amounts to be realized from Medicare for services rendered. In addition to revenue recognized on completed episodes, the Company also recognizes a portion of revenue associated with episodes in progress. Episodes in progress are 60-day episodes of care that begin during the reporting period, but were not completed as of the end of the period. As such, the Company estimates revenue and recognizes it on a daily basis. The primary factors underlying this estimate are the number of episodes in progress at the end of the reporting period, expected Medicare revenue per episode and its estimate of the average percentage complete based on visits performed. Non-Medicare Revenue Episodic Based Revenue - The Company recognizes revenue in a similar manner as it recognizes Medicare revenue for episodic-based rates that are paid by other insurance carriers, including Medicare Advantage programs; however, these rates can vary based upon the negotiated terms. Non-episodic Based Revenue - Revenue is recorded on an accrual basis based upon the date of service at amounts equal to its established or estimated per-visit rates, as applicable. Hospice Revenue Revenue is recorded on an accrual basis based upon the date of service at amounts equal to the estimated payment rates. The estimated payment rates are daily rates for each of the levels of care the Company delivers. The Company makes adjustments to revenue for an inability to obtain appropriate billing documentation or authorizations acceptable to the payor and other reasons unrelated to credit risk. Additionally, as Medicare hospice revenue is subject to an inpatient cap limit and an overall payment cap, the Company monitors its provider numbers and estimates amounts due back to Medicare if a cap has been exceeded. The Company records these adjustments as a reduction to revenue and increases other accrued liabilities. Accounts Receivable and Allowance for Doubtful Accounts — Accounts receivable consist primarily of amounts due from Medicare and Medicaid programs, other government programs, managed care health plans and private payor sources. Estimated provisions for doubtful accounts are recorded to the extent it is probable that a portion or all of a particular account will not be collected. In evaluating the collectability of accounts receivable, the Company considers a number of factors, including the age of the accounts, changes in collection patterns, the composition of patient accounts by payor type and the status of ongoing disputes with third-party payors. On an annual basis, the historical collection percentages are reviewed by payor and by state and are updated to reflect the recent collection experience of the Company. In order to determine the appropriate reserve rate percentages which ultimately establish the allowance, the Company analyzes historical cash collection patterns by payor and by state. The percentages applied to the aged receivable balances are based on the Company’s historical experience and time limits, if any, for managed care, Medicare, Medicaid and other payors. The Company periodically refines its estimates of the allowance for doubtful accounts based on experience with the estimation process and changes in circumstances. Property and Equipment — Property and equipment are initially recorded at their historical cost. Repairs and maintenance are expensed as incurred. Depreciation is computed using the straight-line method over the estimated useful lives of the depreciable assets (ranging from three to 59 years). Leasehold improvements are amortized on a straight-line basis over the shorter of their estimated useful lives or the remaining lease term. Impairment of Long-Lived Assets — The Company reviews the carrying value of long-lived assets that are held and used in the Company’s operating subsidiaries for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Recoverability of these assets is determined based upon expected undiscounted future net cash flows from the operating subsidiaries to which the assets relate, utilizing management’s best estimate, appropriate assumptions, and projections at the time. If the carrying value is determined to be unrecoverable from future operating cash flows, the asset is deemed impaired and an impairment loss would be recognized to the extent the carrying value exceeded the estimated fair value of the asset. The Company estimates the fair value of assets based on the estimated future discounted cash flows of the asset. Management has evaluated its long-lived assets and recorded an impairment charge of $111 and $137 related to the closure of facilities during the six months ended June 30, 2017 and 2016 , respectively. The Company did not identify any asset impairment during the three months ended June 30, 2017 and 2016 . Intangible Assets and Goodwill — Definite-lived intangible assets consist primarily of favorable leases, lease acquisition costs, patient base, facility trade names and customer relationships. Favorable leases and lease acquisition costs are amortized over the life of the lease of the facility. Patient base is amortized over a period of four to eight months, depending on the classification of the patients and the level of occupancy in a new acquisition on the acquisition date. Trade names at affiliated facilities are amortized over 30 years and customer relationships are amortized over a period of up to 20 years. The Company's indefinite-lived intangible assets consist of trade names and Medicare and Medicaid licenses. The Company tests indefinite-lived intangible assets for impairment on an annual basis or more frequently if events or changes in circumstances indicate that the carrying amount of the intangible asset may not be recoverable. Goodwill represents the excess of the purchase price over the fair value of identifiable net assets acquired in business combinations. Goodwill is subject to annual testing for impairment. In addition, goodwill is tested for impairment if events occur or circumstances change that would reduce the fair value of a reporting unit below its carrying amount. The Company performs its annual test for impairment during the fourth quarter of each year. See further discussion at Note 11, Goodwill and Other Indefinite-Lived Intangible Assets . Self-Insurance — The Company is partially self-insured for general and professional liability up to a base amount per claim (the self-insured retention) with an aggregate, one-time deductible above this limit. Losses beyond these amounts are insured through third-party policies with coverage limits per claim, per location and on an aggregate basis for the Company. Starting on January 1, 2017, the combined self-insured retention was $500 per claim, subject to an additional one-time deductible of $750 for California affiliated facilities and a separate, one-time, deductible of $1,000 for non-California facilities. For all affiliated facilities, except those located in Colorado, the third-party coverage above these limits was $1,000 per claim, $3,000 per facility, with a $5,000 blanket aggregate limit and an additional state-specific aggregate where required by state law. In Colorado, the third-party coverage above these limits was $1,000 per claim and $3,000 per facility for skilled nursing facilities, which is independent of the aforementioned blanket aggregate limits that apply outside of Colorado. The self-insured retention and deductible limits for general and professional liability and workers' compensation for all states (except Texas and Washington for workers' compensation) are self-insured through the Captive, the related assets and liabilities of which are included in the accompanying condensed consolidated balance sheets. The Captive is subject to certain statutory requirements as an insurance provider. These requirements include, but are not limited to, maintaining statutory capital. The Company’s policy is to accrue amounts equal to the actuarially estimated costs to settle open claims of insureds, as well as an estimate of the cost of insured claims that have been incurred but not reported. The Company develops information about the size of the ultimate claims based on historical experience, current industry information and actuarial analysis, and evaluates the estimates for claim loss exposure on a quarterly basis. Accrued general liability and professional malpractice liabilities on an undiscounted basis, net of anticipated insurance recoveries, were $37,676 and $34,735 as of June 30, 2017 and December 31, 2016 , respectively. The Company’s operating subsidiaries are self-insured for workers’ compensation in California. To protect itself against loss exposure in California with this policy, the Company has purchased individual specific excess insurance coverage that insures individual claims that exceed $500 per occurrence. In Texas, the operating subsidiaries have elected non-subscriber status for workers’ compensation claims and, effective February 1, 2011, the Company has purchased individual stop-loss coverage that insures individual claims that exceed $750 per occurrence. As of July 1, 2014, the Company’s operating subsidiaries in all other states, with the exception of Washington, are under a loss sensitive plan that insures individual claims that exceed $350 per occurrence. In Washington, the operating subsidiaries' coverage is financed through premiums paid by the employers and employees. The claims and pay benefits are managed through a state insurance pool. Outside of California, Texas and Washington, the Company has purchased insurance coverage that insures individual claims that exceed $350 per accident. In all states except Washington, the Company accrues amounts equal to the estimated costs to settle open claims, as well as an estimate of the cost of claims that have been incurred but not reported. The Company uses actuarial valuations to estimate the liability based on historical experience and industry information. Accrued workers’ compensation liabilities are recorded on an undiscounted basis in the accompanying condensed consolidated balance sheets and were $21,617 and $20,873 as of June 30, 2017 and December 31, 2016 , respectively. In addition, the Company has recorded an asset and equal liability of $4,662 and $4,104 at June 30, 2017 and December 31, 2016 , respectively, in order to present the ultimate costs of malpractice and workers' compensation claims and the anticipated insurance recoveries on a gross basis. See Note 12, Restricted and Other Assets. The Company self-funds medical (including prescription drugs) and dental healthcare benefits to the majority of its employees. The Company is fully liable for all financial and legal aspects of these benefit plans. To protect itself against loss exposure with this policy, the Company has purchased individual stop-loss insurance coverage that insures individual claims that exceed $300 for each covered person with an additional one-time aggregate individual stop loss deductible of $75 . Beginning 2016, the Company's policy does not include the additional one-time aggregate individual stop loss deductible of $75 . The Company’s accrued liability under these plans recorded on an undiscounted basis in the accompanying condensed consolidated balance sheets was $5,713 and $5,639 as of June 30, 2017 and December 31, 2016 , respectively. The Company believes that adequate provision has been made in the Interim Financial Statements for liabilities that may arise out of patient care, workers’ compensation, healthcare benefits and related services provided to date. The amount of the Company’s reserves was determined based on an estimation process that uses information obtained from both company-specific and industry data. This estimation process requires the Company to continuously monitor and evaluate the life cycle of the claims. Using data obtained from this monitoring and the Company’s assumptions about emerging trends, the Company, with the assistance of an independent actuary, develops information about the size of ultimate claims based on the Company’s historical experience and other available industry information. The most significant assumptions used in the estimation process include determining the trend in costs, the expected cost of claims incurred but not reported and the expected costs to settle or pay damage awards with respect to unpaid claims. The self-insured liabilities are based upon estimates, and while management believes that the estimates of loss are reasonable, the ultimate liability may be in excess of or less than the recorded amounts. Due to the inherent volatility of actuarially determined loss estimates, it is reasonably possible that the Company could experience changes in estimated losses that could be material to net income. If the Company’s actual liability exceeds its estimates of loss, its future earnings, cash flows and financial condition would be adversely affected. Income Taxes — Deferred tax assets and liabilities are established for temporary differences between the financial reporting basis and the tax basis of the Company’s assets and liabilities at tax rates in effect when such temporary differences are expected to reverse. The Company generally expects to fully utilize its deferred tax assets; however, when necessary, the Company records a valuation allowance to reduce its net deferred tax assets to the amount that is more likely than not to be realized. In determining the need for a valuation allowance or the need for and magnitude of liabilities for uncertain tax positions, the Company makes certain estimates and assumptions. These estimates and assumptions are based on, among other things, knowledge of operations, markets, historical trends and likely future changes and, when appropriate, the opinions of advisors with knowledge and expertise in certain fields. Due to certain risks associated with the Company’s estimates and assumptions, actual results could differ. Noncontrolling Interest — The noncontrolling interest in a subsidiary is initially recognized at estimated fair value on the acquisition date and is presented within total equity in the Company's condensed consolidated balance sheets. The Company presents the noncontrolling interest and the amount of consolidated net income attributable to The Ensign Group, Inc. in its condensed consolidated statements of income and net income per share is calculated based on net income attributable to The Ensign Group, Inc.'s stockholders. The carrying amount of the noncontrolling interest is adjusted based on an allocation of subsidiary earnings based on ownership interest. Share-Based Compensation — The Company measures and recognizes compensation expense for all share-based payment awards made to employees and directors including employee stock options based on estimated fair values, ratably over the requisite service period of the award. Net income has been reduced as a result of the recognition of the fair value of all stock options and restricted stock awards issued, the amount of which is contingent upon the number of future grants and other variables. Leases and Leasehold Improvements - At the inception of each lease, the Company performs an evaluation to determine whether the lease should be classified as an operating or capital lease. The Company records rent expense for operating leases that contain scheduled rent increases on a straight-line basis over the term of the lease. The lease term used for straight-line rent expense is calculated from the date the Company is given control of the leased premises through the end of the lease term. The lease term used for this evaluation also provides the basis for establishing depreciable lives for buildings subject to lease and leasehold improvements, as well as the period over which the Company records straight-line rent expense. Recent Accounting Pronouncements — Except for rules and interpretive releases of the Securities and Exchange Commission (SEC) under authority of federal securities laws and a limited number of grandfathered standards, the Financial Accounting Standards Board (FASB) Accounting Standards Codification (ASC) is the sole source of authoritative GAAP literature recognized by the FASB and applicable to the Company. For any new pronouncements announced, the Company considers whether the new pronouncements could alter previous generally accepted accounting principles and determines whether any new or modified principles will have a material impact on the Company's reported financial position or operations in the near term. The applicability of any standard is subject to the formal review of the Company's financial management and certain standards are under consideration. Recent Accounting Standards Adopted by the Company In March 2016, the FASB issued a new standard to simplify several aspects of the accounting for employee share-based payment transactions, which includes the accounting for income taxes, forfeitures, and statutory tax withholding requirements, as well as classification in the statement of cash flows. The new standard was effective for the Company in the first quarter of fiscal year 2017. Under the previous guidance, excess tax benefits and deficiencies from share-based compensation arrangements were recorded in equity when the awards vested or were settled. The new guidance requires prospective recognition of excess tax benefits and deficiencies in the income statement, resulting in the recognition of excess tax benefits in income tax expense, of $697 and $1,207 , rather than in paid-in-capital, for the three and six months ended June 30, 2017 , respectively. In addition, under the new guidance, excess income tax benefits from share-based compensation arrangements are classified as cash flow from operations, rather than as cash flow from financing activities. The Company has elected to apply the cash flow classification guidance prospectively, resulting in an increase to operating cash flow for the six months ended June 30, 2017 , and the prior year period has not been adjusted. The Company has also elected to continue to estimate the expected forfeitures rather than electing to account for forfeitures as they occur. Finally, the adoption of the guidance requires excess tax benefits and deficiencies to be prospectively excluded from assumed future proceeds in the calculation of diluted shares, resulting in an increase in diluted weighted average shares outstanding. Accounting Standards Recently Issued But Not Yet Adopted by the Company In May 2017, the FASB issued amended authoritative guidance to provide guidance on types of changes to the terms or conditions of share-based payments awards to which an entity would be required to apply modification accounting under Accounting Standard Codification (ASC) 718. This guidance is effective for annual and interim periods beginning after December 15, 2017, which will be the Company's fiscal year 2018, with early adoption permitted in certain cases. The adoption of this standard is not expected to have a material impact on the Company's consolidated financial statements. In January 2017, the FASB issued amended authoritative guidance to clarify the definition of a business and reduce diversity in practice related to the evaluation of whether transactions should be accounted for as acquisitions (or disposals) of assets or businesses. The new provisions provide the requirements needed for an integrated set of assets and activities (the set) to be a business and also establish a practical way to determine when a set is not a business. The more robust framework helps entities to narrow the definition of outputs created by the set and align it with how outputs are described in the new revenue standard. This guidance is effective for annual and interim periods beginning after December 15, 2017, which will be the Company's fiscal year 2018, with early adoption permitted in certain cases. The adoption of this standard is not expected to have a material impact on the Company's consolidated financial statements. In January 2017, the FASB issued amended authoritative guidance to simplify and reduce the cost and complexity of the goodwill impairment test. The new provisions eliminate step 2 from the goodwill impairment test and shifts the concept of impairment from a measure of loss when comparing the implied fair value of goodwill to its carrying amount to comparing the fair value of a reporting unit with its carrying amount. The Board also eliminated the requirements for any reporting unit with a zero or negative carrying amount to perform a qualitative assessment or step 2 of the goodwill impairment test. The new guidance does not amend the optional qualitative assessment of goodwill impairment. This guidance is effective for annual periods beginning after December 15, 2019, which will be the Company's fiscal year 2020, with early adoption permitted. The adoption of this standard is not expected to have a material impact on the Company's consolidated financial statements. In August 2016, the FASB issued amended authoritative guidance to reduce the diversity in practice related to the presentation and classification of certain cash receipts and cash payments in the statement of cash flows. The new provisions target cash flow issues related to (i) debt prepayment or debt extinguishment costs, (ii) settlement of debt instruments with coupon rates that are insignificant relative to effective interest rates, (iii) contingent consideration payments made after a business combination, (iv) proceeds from settlement of insurance claims, (v) proceeds from the settlement of corporate-owned life insurance and bank-owned life insurance policies, (vi) distributions received from equity method investees, (vii) beneficial interests in securitization transactions and (viii) separately identifiable cash flows and application of the predominance principle. This guidance will be effective for fiscal years beginning after December 15, 2017, which will be the Company's fiscal year 2018, with early adoption permitted. The adoption of this standard is not expected to have a material impact on the Company’s consolidated financial statements. In March 2016, the FASB issued its standard to amend the principal-versus-agent implementation guidance and illustrations in the Board’s new revenue standard, which includes accounting implication related to (1) determining the appropriate unit of account under the revenue standard’s principal-versus-agent guidance and (2) applying the indicators of whether an entity is a principal or an agent in accordance with the revenue standard’s control principle. The guidance will be effective for fiscal years beginning after December 15, 2017, which will be the Company's fiscal year 2018. The guidance has the same effective date as the new revenue standard and the Company is required to adopt the guidance by using the same transition method it would use to adopt the new revenue standard. The Company's evaluation of the adoption method and impact to the consolidated financial statements is ongoing and being performed concurrently with the new revenue standard. In February 2016, the FASB issued amended authoritative guidance on accounting for leases. The new provisions require that a lessee of operating leases recognize in the statement of financial position a liability to make lease payments (the lease liability) and a right-of-use asset representing its right to use the underlying asset for the lease term. The lease liability will be equal to the present value of lease payments, with the right-of-use asset based upon the lease liability. The classification criteria for distinguishing between finance (or capital) leases and operating leases are substantially similar to the previous lease guidance, but with no explicit bright lines. As such, operating leases will result in straight-line rent expense similar to current practice. For short term leases (term of 12 months or less), a lessee is permitted to make an accounting election not to recognize lease assets and lease liabilities, which would generally result in lease expense being recognized on a straight-line basis over the lease term. This guidance applies to all entities and is effective for annual periods beginning after December 15, 2018, which will be the Company's fiscal year 2019, with early adoption permitted. The Company is currently evaluating the impact this guidance will have on its consolidated financial statements but expects this adoption will result in a significant increase in the assets and liabilities on its consolidated balance sheet. In January 2016, the FASB issued amended authoritative guidance which makes targeted improvements for financial instruments. The new provisions impact certain aspects of recognition, measurement, presentation and disclosure requirements of financial instruments. Specifically, the guidance will (1) require equity investments to be measured at fair value with changes in fair value recognized in net income, (2) simplify the impairment assessment of equity investments without readily determinable fair values, (3) eliminate the requirement to disclose the method and assumptions used to estimate fair value for financial instruments measured at amortized cost, and (4) require separate presentation of financial assets and financial liabilities by measurement category. The guidance is effective for annual and interim periods beginning after December 15, 2017, which will be the Company's fiscal year 2018. Early adoption is not permitted. The adoption of this standard is not expected to have a material impact on the Company’s consolidated financial statements. In May 2014, the FASB and International Accounting Standards Board issued their final standard on revenue from contracts with customers that outlines a single comprehensive model for entities to use in accounting for revenue arising from contracts with customers. The new standard supersedes most current revenue recognition guidance, including industry-specific guidance, and may be applied retrospectively to each period presented (full retrospective method) or

Common Stock

Common Stock	6 Months Ended
	Jun. 30, 2017
Common Stock [Abstract]
Common stock offering [Text Block]	COMMON STOCK On February 8, 2017, the Company announced that its Board of Directors authorized a stock repurchase program, under which the Company may repurchase up to $30,000 of its common stock under the program for a period of 12 months . Under this program, the Company is authorized to repurchase its issued and outstanding common shares from time to time in open-market and privately negotiated transactions and block trades in accordance with federal securities laws. The stock repurchase program is scheduled to expire on February 8, 2018 . During the three and six months ended June 30, 2017 , the Company repurchased 69 and 412 shares of its common stock for a total of $1,220 and $7,288 , respectively. On November 4, 2015 and February 9, 2016, the Company announced that its Board of Directors authorized two stock repurchase programs, under which the Company may repurchase up to $15,000 of its common stock under each program for a period of 12 months . During the first quarter of 2016, the Company repurchased 1,452 shares of its common stock for a total of $30,000 and the repurchase programs expired upon the repurchase of the full authorized amount under the plans.

Computation of Net Income Per C

Computation of Net Income Per Common Share	6 Months Ended
	Jun. 30, 2017
COMPUTATION OF NET INCOME PER COMMON SHARE [Abstract]
Earnings Per Share [Text Block]	COMPUTATION OF NET INCOME PER COMMON SHARE Basic net income per share is computed by dividing income from continuing operations attributable to The Ensign Group, Inc. stockholders by the weighted average number of outstanding common shares for the period. The computation of diluted net income per share is similar to the computation of basic net income per share except that the denominator is increased to include the number of additional common shares that would have been outstanding if the dilutive potential common shares had been issued. The adoption of ASU No. 2016-09, Improvements to Employee Share-Based Payment Accounting: Topic 718 requires excess tax benefits and deficiencies to be prospectively excluded from assumed future proceeds in the calculation of diluted shares, resulting in an increase in diluted weighted average shares outstanding. A reconciliation of the numerator and denominator used in the calculation of basic net income per common share follows: Three Months Ended June 30, Six Months Ended June 30, 2017 2016 2017 2016 Numerator: Net income $ 12,380 $ 11,363 $ 15,337 $ 20,653 Less: net income attributable to noncontrolling interests 163 37 279 155 Net income attributable to The Ensign Group, Inc. $ 12,217 $ 11,326 $ 15,058 $ 20,498 Denominator: Weighted average shares outstanding for basic net income per share 50,705 50,274 50,736 50,476 Basic net income per common share attributable to The Ensign Group, Inc. $ 0.24 $ 0.23 $ 0.30 $ 0.41 A reconciliation of the numerator and denominator used in the calculation of diluted net income per common share follows: Three Months Ended June 30, Six Months Ended June 30, 2017 2016 2017 2016 Numerator: Net income $ 12,380 $ 11,363 $ 15,337 $ 20,653 Less: net income attributable to noncontrolling interests 163 37 279 155 Net income attributable to The Ensign Group, Inc. $ 12,217 $ 11,326 $ 15,058 $ 20,498 Denominator: Weighted average common shares outstanding 50,705 50,274 50,736 50,476 Plus: incremental shares from assumed conversion (1) 1,843 1,657 1,857 1,658 Adjusted weighted average common shares outstanding 52,548 51,931 52,593 52,134 Diluted net income per common share attributable to The Ensign Group, Inc. $ 0.23 $ 0.22 $ 0.29 $ 0.39 (1) Options outstanding which are anti-dilutive and therefore not factored into the weighted average common shares amount above were 1,378 and 1,312 for the three and six months ended June 30, 2017 , respectively and 850 and 774 for the three and six months ended June 30, 2016 respectively.

Fair Value Measurements

Fair Value Measurements	6 Months Ended
	Jun. 30, 2017
Fair Value Disclosures [Abstract]
Fair Value Disclosures [Text Block]	FAIR VALUE MEASUREMENTS Fair value measurements are based on a three-tier hierarchy that prioritizes the inputs used to measure fair value. These tiers include: Level 1, defined as observable inputs such as quoted market prices in active markets; Level 2, defined as inputs other than quoted prices included within Level 1 that are observable for the asset or liability, either directly or indirectly; and Level 3, defined as unobservable inputs for which little or no market data exists, therefore requiring an entity to develop its own assumptions. The following table summarizes the financial assets and liabilities measured at fair value on a recurring basis as of June 30, 2017 and December 31, 2016 : June 30, 2017 December 31, 2016 Level 1 Level 2 Level 3 Level 1 Level 2 Level 3 Cash and cash equivalents $ 33,476 $ — $ — $ 57,706 $ — $ — Our non-financial assets, which include long-lived assets, including goodwill, intangible assets and property and equipment, are not required to be measured at fair value on a recurring basis. However, on a periodic basis, or whenever events or changes in circumstances indicate that their carrying value may not be recoverable, we assess our long-lived assets for impairment. When impairment has occurred, such long-lived assets are written down to fair value. See Note 2, Summary of Significant Accounting Policies for further discussion of the Company's significant accounting policies. Debt Security Investments - Held to Maturity At June 30, 2017 and December 31, 2016 , the Company had approximately $39,542 and $35,184 , respectively, in debt security investments which were classified as held to maturity and carried at amortized cost. The carrying value of the debt securities approximates fair value. The Company has the intent and ability to hold these debt securities to maturity. Further, as of June 30, 2017 , the debt security investments were held in AA, A and BBB+ rated debt securities.

Revenue and Accounts Receivable

Revenue and Accounts Receivable	6 Months Ended
	Jun. 30, 2017
REVENUE AND ACCOUNTS RECEIVABLE [Abstract]
Revenue and Accounts receivable [Text Block]	REVENUE AND ACCOUNTS RECEIVABLE Revenue for the three and six months ended June 30, 2017 and 2016 is summarized in the following tables: Three Months Ended June 30, 2017 2016 Revenue % of Revenue Revenue % of Revenue Medicaid $ 152,637 34.0 % $ 139,226 33.9 % Medicare 128,151 28.6 119,443 29.1 Medicaid — skilled 24,913 5.6 20,661 5.0 Total Medicaid and Medicare 305,701 68.2 279,330 68.0 Managed care 74,925 16.7 65,178 15.9 Private and other payors (1) 67,653 15.1 66,009 16.1 Revenue $ 448,279 100.0 % $ 410,517 100.0 % (1) Private and other payors also includes revenue from all payors generated in other ancillary services for both the three months ended June 30, 2017 and 2016 and urgent care centers for the three months ended June 30, 2016 . Six Months Ended June 30, 2017 2016 Revenue % of Revenue Revenue % of Revenue Medicaid $ 300,908 33.8 % $ 262,867 33.1 % Medicare 258,072 29.0 229,721 28.9 Medicaid — skilled 47,930 5.4 42,327 5.3 Total Medicaid and Medicare 606,910 68.2 534,915 67.3 Managed care 150,486 16.9 129,721 16.4 Private and other payors (1) 132,623 14.9 129,114 16.3 Revenue $ 890,019 100.0 % $ 793,750 100.0 % (1) Private and other payors also includes revenue from all payors generated in other ancillary services for both the six months ended June 30, 2017 and 2016 and urgent care centers for the six months ended June 30, 2016 . Accounts receivable as of June 30, 2017 and December 31, 2016 is summarized in the following table: June 30, 2017 December 31, 2016 Medicaid $ 109,306 $ 111,031 Managed care 67,064 66,346 Medicare 50,270 55,500 Private and other payors 56,367 51,347 283,007 284,224 Less: allowance for doubtful accounts (39,759 ) (39,791 ) Accounts receivable, net $ 243,248 $ 244,433

Business Segments

Business Segments	6 Months Ended
	Jun. 30, 2017
Segment Reporting [Abstract]
Segment Reporting Disclosure [Text Block]	BUSINESS SEGMENTS The Company has three reportable operating segments: (1) transitional and skilled services, which includes the operation of skilled nursing facilities; (2) assisted and independent living services, which includes the operation of assisted and independent living facilities; and (3) home health and hospice services, which includes the Company's home health, home care and hospice businesses. The Company's Chief Executive Officer, who is our chief operating decision maker, or CODM, reviews financial information at the operating segment level. The Company also reports an “all other” category that includes revenue from its mobile diagnostics and other ancillary operations for both the three and six months ended June 30, 2017 and 2016 and urgent care centers for the three and six months ended June 30, 2016 . The Company completed the sale of its urgent care centers in the third and fourth quarter of 2016. These operations are neither significant individually nor in aggregate and therefore do not constitute a reportable segment. The reporting segments are business units that offer different services and are managed separately to provide greater visibility into those operations. The expansion of the Company's assisted and independent living services led it to separate the assisted and independent living services into a distinct reportable segment in the fourth quarter of 2016. Previously, the Company had two reportable segments: (1) transitional, skilled and assisted living services (TSA services), which includes the operation of skilled nursing facilities and assisted living facilities; and (2) home health and hospice services. The Company has presented the financial information for the three and six months ended June 30, 2016 on a comparative basis to conform with the current year segment presentation. Certain revenues by payor source were reclassified between Medicaid and "Private and other" to conform with the current year presentation. See also Note 11, Goodwill and Other Indefinite-Lived Intangible Assets for comparative information on changes in the carrying amount of goodwill by segment. As of June 30, 2017 , transitional and skilled services included 155 wholly-owned affiliated skilled nursing facilities and 21 campuses that provide skilled nursing and rehabilitative care services. The Company provided room and board and social services through 46 wholly-owned affiliated assisted and independent living facilities and 21 campuses. Home health, home care and hospice services were provided to patients through 41 affiliated agencies. As of June 30, 2017 , the Company held majority membership interests in other ancillary operations, which operating results are included in the "all other" category. The Company evaluates performance and allocates capital resources to each segment based on an operating model that is designed to maximize the quality of care provided and profitability. General and administrative expenses are not allocated to any segment for purposes of determining segment profit or loss, and are included in the "all other" category in the selected segment financial data that follows. The accounting policies of the reporting segments are the same as those described in Note 2 , Summary of Significant Accounting Policies. The Company's CODM does not review assets by segment in his resource allocation and therefore assets by segment are not disclosed below. Segment revenues by major payor source were as follows: Three Months Ended June 30, 2017 Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Total Revenue Revenue % Medicaid $ 142,833 $ 7,203 $ 2,601 $ — $ 152,637 34.0 % Medicare 104,450 — 23,701 — 128,151 28.6 Medicaid-skilled 24,913 — — — 24,913 5.6 Subtotal 272,196 7,203 26,302 — 305,701 68.2 Managed care 69,265 — 5,660 — 74,925 16.7 Private and other 33,756 25,806 2,659 5,432 (1) 67,653 15.1 Total revenue $ 375,217 $ 33,009 $ 34,621 $ 5,432 $ 448,279 100.0 % (1) Private and other payors also includes revenue from all payors generated in other ancillary services for the three months ended June 30, 2017. Three Months Ended June 30, 2016 Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Total Revenue Revenue % Medicaid $ 129,860 $ 6,655 $ 2,711 $ — $ 139,226 33.9 % Medicare 99,184 — 20,259 — 119,443 29.1 Medicaid-skilled 20,661 — — — 20,661 5.0 Subtotal 249,705 6,655 22,970 — 279,330 68.0 Managed care 61,121 — 4,057 — 65,178 15.9 Private and other 29,591 24,053 1,466 10,899 (1) 66,009 16.1 Total revenue $ 340,417 $ 30,708 $ 28,493 $ 10,899 $ 410,517 100.0 % (1) Private and other payors also includes revenue from all payors generated in other ancillary services and urgent care centers for the three months ended June 30, 2016. Six Months Ended June 30, 2017 Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Total Revenue Revenue % Medicaid $ 281,658 $ 14,239 $ 5,011 $ — $ 300,908 33.8 % Medicare 212,379 — 45,693 — 258,072 29.0 Medicaid-skilled 47,930 — — — 47,930 5.4 Subtotal 541,967 14,239 50,704 — 606,910 68.2 Managed care 139,621 — 10,865 — 150,486 16.9 Private and other 65,968 51,116 5,185 10,354 (1) 132,623 14.9 Total revenue $ 747,556 $ 65,355 $ 66,754 $ 10,354 $ 890,019 100.0 % (1) Private and other payors also includes revenue from all payors generated in other ancillary services for the six months ended June 30, 2017. Six Months Ended June 30, 2016 Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Total Revenue Revenue % Medicaid $ 244,682 $ 12,899 $ 5,286 $ — $ 262,867 33.1 % Medicare 190,828 — 38,893 — 229,721 28.9 Medicaid-skilled 42,327 — — — 42,327 5.3 Subtotal 477,837 12,899 44,179 — 534,915 67.3 Managed care 121,660 — 8,061 — 129,721 16.4 Private and other 56,134 47,978 2,919 22,083 (1) 129,114 16.3 Total revenue $ 655,631 $ 60,877 $ 55,159 $ 22,083 $ 793,750 100.0 % (1) Private and other payors also includes revenue from all payors generated in other ancillary services and urgent care centers for the six months ended June 30, 2016. The following table sets forth selected financial data consolidated by business segment: Three Months Ended June 30, 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 $ 375,217 $ 33,009 $ 34,621 $ 5,432 $ — $ 448,279 Intersegment revenue (1) 631 — — 729 (1,360 ) — Total revenue $ 375,848 $ 33,009 $ 34,621 $ 6,161 $ (1,360 ) $ 448,279 Segment income (loss) (2) $ 31,704 $ 3,657 $ 4,923 $ (18,253 ) $ — $ 22,031 Interest expense, net of interest income $ (2,765 ) Income before provision for income taxes $ 19,266 Depreciation and amortization $ 7,204 $ 1,492 $ 230 $ 1,824 $ — $ 10,750 (1) Intersegment revenue represents services provided at the Company's skilled nursing facilities and other ancillary operations to the Company's other operating subsidiaries. (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 "All Other" category. (3) The Company's campuses represents facilities that offer both 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. Three Months Ended June 30, 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 $ 340,417 $ 30,708 $ 28,493 $ 10,899 $ — $ 410,517 Intersegment revenue (1) 781 — — 694 (1,475 ) — Total revenue $ 341,198 $ 30,708 $ 28,493 $ 11,593 $ (1,475 ) $ 410,517 Segment income (loss) (2) $ 32,835 $ 3,263 $ 4,349 $ (20,638 ) $ — $ 19,809 Interest expense, net of interest income $ (1,168 ) Income before provision for income taxes $ 18,641 Depreciation and amortization $ 6,792 $ 983 $ 229 $ 1,768 $ — $ 9,772 (1) Intersegment revenue represents services provided at the Company's skilled nursing facilities, urgent care centers and other ancillary operations to the Company's other operating subsidiaries. (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 "All Other" category. (3) The Company's campuses represents facilities that offer both 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. Six Months Ended June 30, 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 $ 747,556 $ 65,355 $ 66,754 $ 10,354 $ — $ 890,019 Intersegment revenue (1) 1,375 — — 1,613 (2,988 ) — Total revenue $ 748,931 $ 65,355 $ 66,754 $ 11,967 $ (2,988 ) $ 890,019 Segment income (loss) (2) $ 63,494 $ 8,096 $ 9,217 $ (51,224 ) $ — $ 29,583 Interest expense, net of interest income $ (5,920 ) Income before provision for income taxes $ 23,663 Depreciation and amortization $ 14,157 $ 3,115 $ 466 $ 3,526 $ — $ 21,264 (1) Intersegment revenue represents services provided at the Company's skilled nursing facilities and other ancillary operations to the Company's other operating subsidiaries. (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 "All Other" category. (3) The Company's campuses represents facilities that offer both 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. Six Months Ended June 30, 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 $ 655,631 $ 60,877 $ 55,159 $ 22,083 $ — $ 793,750 Intersegment revenue (1) 1,491 — — 965 (2,456 ) — Total revenue $ 657,122 $ 60,877 $ 55,159 $ 23,048 $ (2,456 ) $ 793,750 Segment income (loss) (2) $ 60,431 $ 6,523 $ 7,525 $ (38,356 ) $ — $ 36,123 Interest expense, net of interest income $ (2,303 ) Income before provision for income taxes $ 33,820 Depreciation and amortization $ 12,031 $ 2,046 $ 496 $ 3,496 $ — $ 18,069 (1) Intersegment revenue represents services provided at the Company's skilled nursing facilities, urgent care centers and other ancillary operations to the Company's other operating subsidiaries. (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 "All Other" category. (3) The Company's campuses represents facilities that offer both 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. The Company's transitional and skilled services segment income for the six months ended June 30, 2017 and 2016 included continued obligations under the lease related to closed operations, lease termination costs and related closing expenses of $4,017 and $7,935 , respectively. These amounts included the value of the present value of future rental payments of approximately $2,715 and $6,512 and long-lived assets impairment of $111 and $137 for the six months ended June 30, 2017 and 2016 , respectively. See Note 17, Leases for further detail. Included in the three months ended June 30, 2017 is the loss recovery of $1,286 related to a facility that was closed in the prior year.

Acquisitions

Acquisitions	6 Months Ended
	Jun. 30, 2017
Business Combinations [Abstract]
Business Combination Disclosure [Text Block]	ACQUISITIONS The Company’s acquisition focus is to purchase or lease operating subsidiaries that are complementary to the Company’s current affiliated operations, accretive to the Company's business or otherwise advance the Company's strategy. The results of all the Company’s operating subsidiaries are included in the accompanying Interim Financial Statements subsequent to the date of acquisition. Acquisitions are accounted for using the acquisition method of accounting. The Company also enters into long-term leases that may include options to purchase the affiliated facilities. As a result, from time to time, the Company will acquire affiliated facilities that the Company has been operating under third-party leases. During the six months ended June 30, 2017 , the Company expanded its operations with the addition of four stand-alone skilled nursing operations, six stand-alone assisted living operations, one campus operation, one home health agency and one hospice agency through a combination of long-term leases and purchases. The Company did not acquire any material assets or assume any liabilities other than the tenant's post-assumption rights and obligations under the long-term leases. The Company has also invested in new ancillary services that are complementary to its existing transitional and skilled services, assisted and independent living services, and home health and hospice businesses. The aggregate purchase price for these acquisitions for the six months ended June 30, 2017 was $41,763 . The addition of these operations added 508 operational skilled nursing beds and 239 assisted living units operated by the Company's operating subsidiaries. The Company entered into a separate operations transfer agreement with the prior operator as part of each transaction. The Company's operating subsidiaries also opened three newly constructed stand-alone skilled nursing operations under long-term lease agreements, which added 385 operational skilled nursing beds. The table below presents the allocation of the purchase price for the operations acquired in business combinations during the six months ended June 30, 2017 and 2016 . As of the date of this filing, the preliminary allocation of the purchase price for the acquisitions in the second quarter was not completed as necessary valuation information was not yet available. Six Months Ended June 30, 2017 2016 Land $ 3,595 $ 866 Building and improvements 24,527 16,056 Equipment, furniture, and fixtures 2,298 7,998 Assembled occupancy 410 1,220 Definite-lived intangible assets — 363 Goodwill 6,059 28,790 Favorable leases — 393 Other indefinite-lived intangible assets 4,548 600 Other assets acquired, net of liabilities assumed 326 6 Total acquisitions $ 41,763 $ 56,292 In addition to the business combinations above, the Company acquired Medicare and Medicaid licenses for additional hospice and skilled nursing beds to add to existing operations for an aggregate purchase price of $310 . Subsequent to June 30, 2017 , the Company acquired two stand-alone skilled nursing operations and three assisted and independent living operations for an aggregate purchase price of $22,830 , which included real estate. The addition of these operations added 194 operational skilled nursing beds and 361 operational assisted and independent living units operated by the Company's operating subsidiaries. The Company’s acquisition strategy has been focused on identifying both opportunistic and strategic acquisitions within its target markets that offer strong opportunities for return on invested capital. The operating subsidiaries acquired by the Company are frequently underperforming financially and can have regulatory and clinical challenges to overcome. Financial information, especially with underperforming operating subsidiaries, is often inadequate, inaccurate or unavailable. Consequently, the Company believes that prior operating results are not a meaningful, representation of the Company’s current operating results or indicative of the integration potential of its newly acquired operating subsidiaries. The businesses acquired during the three and six months ended June 30, 2017 were not material acquisitions to the Company individually or in the aggregate. Accordingly, pro forma financial information is not presented. These acquisitions have been included in the June 30, 2017 condensed consolidated balance sheet of the Company, and the operating results have been included in the condensed consolidated statements of operations of the Company since the dates the Company gained effective control.

Property and Equipment

Property and Equipment	6 Months Ended
	Jun. 30, 2017
Property, Plant and Equipment [Abstract]
Property, Plant and Equipment Disclosure [Text Block]	PROPERTY AND EQUIPMENT— Net Property and equipment, net consist of the following: June 30, 2017 December 31, 2016 Land $ 44,301 $ 47,565 Buildings and improvements 310,620 304,263 Equipment 167,660 153,170 Furniture and fixtures 5,425 6,931 Leasehold improvements 86,340 80,164 Construction in progress 2,803 2,441 617,149 594,534 Less: accumulated depreciation (126,763 ) (110,036 ) Property and equipment, net $ 490,386 $ 484,498 The Company disposed of $24,847 of land, building and equipments as part of the sale-leaseback transaction in the three months ended June 30, 2017 . See Note 17, Leases for information on the sale-leaseback transaction. See also Note 8, Acquisitions for information on acquisitions during the six months ended June 30, 2017 .

Intangible Assets - Net

Intangible Assets - Net	6 Months Ended
	Jun. 30, 2017
Intangible Assets, Net (Excluding Goodwill) [Abstract]
Intangible Assets Disclosure [Text Block]	INTANGIBLE ASSETS — Net Weighted Average Life (Years) June 30, 2017 December 31, 2016 Gross Carrying Amount Accumulated Amortization Gross Carrying Amount Accumulated Amortization Intangible Assets Net Net Lease acquisition costs 23.2 $ 483 $ (89 ) $ 394 $ 483 $ (78 ) $ 405 Favorable leases 32.5 35,116 (5,579 ) 29,537 35,116 (4,589 ) 30,527 Assembled occupancy 0.5 2,307 (2,048 ) 259 1,897 (1,897 ) — Facility trade name 30.0 733 (281 ) 452 733 (269 ) 464 Customer relationships 18.6 4,933 (1,391 ) 3,542 4,933 (1,253 ) 3,680 Total $ 43,572 $ (9,388 ) $ 34,184 $ 43,162 $ (8,086 ) $ 35,076 Amortization expense was $690 and $1,302 for the three and six months ended June 30, 2017 , respectively, and $1,410 and $2,497 for the three and six months ended June 30, 2016 , respectively. Estimated amortization expense for each of the years ending December 31 is as follows: Year Amount 2017 (remainder) $ 1,388 2018 2,321 2019 2,301 2020 2,301 2021 2,270 2022 2,244 Thereafter 21,359 $ 34,184

Goodwill and Other Indefinite-L

Goodwill and Other Indefinite-Lived Intangible Assets	6 Months Ended
	Jun. 30, 2017
Indefinite-Lived Intangible Assets (Including Goodwill) [Abstract]
Goodwill and Other Indefinite-Lived Intangibles [Text Block]	GOODWILL AND OTHER INDEFINITE-LIVED INTANGIBLE ASSETS The Company tests goodwill during the fourth quarter of each year or more often if events or circumstances indicate there may be impairment. The Company performs its analysis for each reporting unit that constitutes a business for which discrete financial information is produced and reviewed by operating segment management and provides services that are distinct from the other components of the operating segment, in accordance with the provisions of Accounting Standards Codification topic 350, Intangibles—Goodwill and Other (ASC 350). This guidance provides the option to first assess qualitative factors to determine whether it is more likely than not that the fair value of a reporting unit is less than its carrying value, a "Step 0" analysis. If, based on a review of qualitative factors, it is more likely than not that the fair value of a reporting unit is less than its carrying value, the Company performs "Step 1" of the traditional two-step goodwill impairment test by comparing the net assets of each reporting unit to their respective fair values. The Company determines the estimated fair value of each reporting unit using a discounted cash flow analysis. In the event a unit's net assets exceed its fair value, an implied fair value of goodwill must be determined by assigning the unit's fair value to each asset and liability of the unit. The excess of the fair value of the reporting unit over the amounts assigned to its assets and liabilities is the implied fair value of goodwill. An impairment loss is measured by the difference between the goodwill carrying value and the implied fair value. The following table represents activity in goodwill by segment as of and for the six months ended June 30, 2017 : Goodwill Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Total January 1, 2017 $ 40,636 $ 3,538 $ 17,901 $ 5,025 $ 67,100 Additions 3,980 — 1,826 253 6,059 June 30, 2017 $ 44,616 $ 3,538 $ 19,727 $ 5,278 $ 73,159 The Company anticipates that total goodwill recognized will be fully deductible for tax purposes as of June 30, 2017 . See further discussion of goodwill acquired at Note 8, Acquisitions . During the six months ended June 30, 2017 , the Company recorded $4,823 in Medicare and Medicaid licenses and $35 in trade name indefinite-lived intangible assets as part of its acquisitions. Other indefinite-lived intangible assets consists of the following: June 30, 2017 December 31, 2016 Trade name $ 1,181 $ 1,146 Medicare and Medicaid licenses 23,263 18,440 $ 24,444 $ 19,586

Restricted and Other Assets

Restricted and Other Assets	6 Months Ended
	Jun. 30, 2017
Other Assets [Abstract]
Other Assets Disclosure [Text Block]	RESTRICTED AND OTHER ASSETS Restricted and other assets consist of the following: June 30, 2017 December 31, 2016 Debt issuance costs, net $ 3,169 $ 3,611 Long-term insurance losses recoverable asset 4,662 4,104 Deposits with landlords 4,708 3,526 Capital improvement reserves with landlords and lenders 790 673 Note receivable from sale of urgent care centers — 700 Restricted and other assets $ 13,329 $ 12,614 Included in restricted and other assets as of June 30, 2017 are anticipated insurance recoveries related to the Company's workers' compensation, general and professional liability claims that are recorded on a gross rather than net basis in accordance with an Accounting Standards Update issued by the FASB. Note receivable from sale of urgent centers was reclassed to current assets from restricted and other assets as the Company is anticipating to receive the receivable within the 12 months period.

Other Accrued Liabilities

Other Accrued Liabilities	6 Months Ended
	Jun. 30, 2017
Accrued Liabilities [Abstract]
Other Liabilities Disclosure [Text Block]	OTHER ACCRUED LIABILITIES Other accrued liabilities consist of the following: June 30, 2017 December 31, 2016 Quality assurance fee $ 6,989 $ 4,604 Refunds payable 20,015 18,368 Deferred revenue 4,608 6,994 Cash held in trust for patients 2,460 2,373 Resident deposits 6,210 6,099 Dividends payable 2,182 2,186 Property taxes 8,058 9,130 Income tax payable — 1,182 Operational closure liability 962 1,972 Other 7,303 5,855 Other accrued liabilities $ 58,787 $ 58,763 Quality assurance fee represents amounts payable to Arizona, California, Colorado, Idaho, Iowa, Kansas, Nebraska, Nevada, Utah, Washington and Wisconsin as a result of a mandated fee based on patient days or licensed beds. Refunds payable includes payables related to overpayments and duplicate payments from various payor sources. Deferred revenue occurs when the Company receives payments in advance of services provided. Resident deposits include refundable deposits to patients. Cash held in trust for patients reflects monies received from, or on behalf of, patients. Maintaining a trust account for patients is a regulatory requirement and, while the trust assets offset the liabilities, the Company assumes a fiduciary responsibility for these funds. The cash balance related to this liability is included in other current assets in the accompanying condensed consolidated balance sheets. Operational closure liability includes short-term portion of the closing costs that are payable within the next 12 months. The remaining long-term portion is included in other long-term liabilities in the accompanying condensed consolidated balance sheets.

Income Taxes

Income Taxes	6 Months Ended
	Jun. 30, 2017
Income Tax Disclosure [Abstract]
Income Tax Disclosure [Text Block]	INCOME TAXES The Company is not currently under examination by any major income tax jurisdiction. During 2017, the statutes of limitations will lapse on the Company's 2013 Federal tax year and certain 2012 and 2013 state tax years. The Company does not believe the Federal or state statute lapses or any other event will significantly impact the balance of unrecognized tax benefits in the next twelve months. The net balance of unrecognized tax benefits was not material to the Interim Financial Statements for the six months ended June 30, 2017 or 2016. For the six months ended June 30, 2017 and 2016 , the Company recorded total pre-tax charges related to lease terminations and closing expenses in connection with the closure of operations of $2,731 and $7,935 , respectively. The Company recorded estimated tax benefits of $ 1,049 and $ 3,065 for the six months ended June 30, 2017 and 2016 related to the losses. See Note 17, Leases . The Company recorded a loss of $11,000 related to class action lawsuit and an estimated tax benefits of $4,220 during the six months ended June 30, 2017 . There were no similar charges during the six months ended June 30, 2016 . See Note 18, Commitments and Contingencies .

Debt

Debt	6 Months Ended
	Jun. 30, 2017
Debt Disclosure [Abstract]
Debt Disclosure [Text Block]	DEBT Long-term debt consists of the following: June 30, 2017 December 31, 2016 Term loan with SunTrust, interest payable quarterly $ 144,375 $ 148,125 Credit facility with SunTrust 135,000 122,000 Mortgage loans and promissory note, principal and interest payable monthly, interest at fixed rate 13,731 14,032 293,106 284,157 Less: current maturities (8,165 ) (8,129 ) Less: debt issuance costs (476 ) (542 ) $ 284,465 $ 275,486 Credit Facility with a Lending Consortium Arranged by SunTrust The Company maintains a credit facility with a lending consortium arranged by SunTrust (as amended to date, the Credit Facility). On July 19, 2016, the Company entered into the second amendment to the credit facility (Second Amended Credit Facility), which amended the existing credit agreement to increase the aggregate principal amount up to $450,000 . The Second Amended Credit Facility comprised of a $300,000 revolving credit facility and a $150,000 term loan. Borrowings under the term loan portion of the Second Amended Credit Facility mature on February 5, 2021 and amortize in equal quarterly installments, in an aggregate annual amount equal to 5.0% per annum of the original principal amount. The interest rates and commitment fee applicable to the Second Amended Credit Facility are similar to the Amended Credit Facility discussed below. Except as set forth in the Second Amended Credit Facility, all other terms and conditions of the Amended Credit Facility remained in full force and effect as described below. On February 5, 2016, the Company amended its existing revolving credit facility to increase its aggregate principal amount available to $250,000 (the Amended Credit Facility). Under the credit facility, the Company may seek to obtain incremental revolving or term loans in an aggregate amount not to exceed $150,000 . The interest rates applicable to loans under the credit facility are, at the Company's option, equal to either a base rate plus a margin ranging from 0.75% to 1.75% per annum or LIBOR plus a margin ranging from 1.75% to 2.75% per annum, based on the Consolidated Total Net Debt to Consolidated EBITDA ratio (as defined in the agreement). In addition, the Company will pay a commitment fee on the unused portion of the commitments under the credit facility that will range from 0.30% to 0.50% per annum, depending on the Consolidated Total Net Debt to Consolidated EBITDA ratio of the Company and its subsidiaries. The Company is permitted to prepay all or any portion of the loans under the credit facility prior to maturity without premium or penalty, subject to reimbursement of any LIBOR breakage costs of the lenders. The Credit Facility is secured by a pledge of stock of the Company's material operating subsidiaries as well as a first lien on substantially all of its personal property. The credit facility contains customary covenants that, among other things, restrict, subject to certain exceptions, the ability of the Company and its operating subsidiaries to grant liens on their assets, incur indebtedness, sell assets, make investments, engage in acquisitions, mergers or consolidations, amend certain material agreements and pay certain dividends and other restricted payments. Under the Credit Facility, the Company must comply with financial maintenance covenants to be tested quarterly, consisting of a maximum Consolidated Total Net Debt to consolidated EBITDA ratio (which shall be increased to 3.50 : 1.00 for the first fiscal quarter and the immediate following three fiscal quarters), and a minimum interest/rent coverage ratio (which cannot be below 1.50 : 1.00 ). The majority of lenders can require that the Company and its operating subsidiaries mortgage certain of its real property assets to secure the Amended Credit Facility if an event of default occurs, the Consolidated Total Net Debt to consolidated EBITDA ratio is above 2.75 : 1.00 for two consecutive fiscal quarters, or its liquidity is equal or less than 10% of the Aggregate Revolving Commitment Amount (as defined in the agreement) for ten consecutive business days, provided that such mortgages will no longer be required if the event of default is cured, the Consolidated Total Net Debt to consolidated EBITDA ratio is below 2.75 : 1.00 for two consecutive fiscal quarters, or its liquidity is above 10% of the Aggregate Revolving Commitment Amount (as defined in the agreement) or ninety consecutive days, as applicable. As of June 30, 2017 , the Company's operating subsidiaries had $279,375 outstanding under the Credit Facility. The outstanding balance on the term loan was $144,375 , of which $7,500 is classified as short-term and the remaining $136,875 is classified as long-term. The outstanding balance on the revolving Credit Facility was $135,000 , which is classified as long-term. The Company was in compliance with all loan covenants as of June 30, 2017 . As of August 1, 2017 , there was approximately $279,375 outstanding under the Credit Facility. Mortgage Loans and Promissory Note The Company had outstanding indebtedness under mortgage loans and a promissory note issued in connection with various acquisitions. The mortgage loans are insured with the U.S. Department of Housing and Urban Development (HUD), which subjects the Company's operating subsidiaries to HUD oversight and periodic inspections. The mortgage loans and note bear fixed interest rates between 2.6% and 5.3% per annum. Amounts borrowed under the mortgage loans may be prepaid starting after the second anniversary of the notes subject to prepayment fees of the principal balance on the date of prepayment. These prepayment fees are reduced by 1.0% per year for years three through eleven of the loan. There is no prepayment penalty after year eleven . The term of the mortgage loans and the note is between 12 and 33 years . The mortgage loans and note are secured by the real property comprising the facilities and the rents, issues and profits thereof, as well as all personal property used in the operation of the facilities. As of June 30, 2017 , the Company's operating subsidiaries had $13,731 outstanding under the mortgage loans and note, of which $665 is classified as short-term and the remaining $13,066 is classified as long-term. The Company was in compliance with all loan covenants as of June 30, 2017 . Based on Level 2, the carrying value of the Company's long-term debt is considered to approximate the fair value of such debt for all periods presented based upon the interest rates that the Company believes it can currently obtain for similar debt. Off-Balance Sheet Arrangements During the second quarter of 2016, the Company increased the letters of credit by $450 . As of June 30, 2017 , the Company had approximately $2,760 on the credit facility of borrowing capacity pledged as collateral to secure outstanding letters of credit.

Options and Awards

Options and Awards	6 Months Ended
	Jun. 30, 2017
Options and Awards [Abstract]
Disclosure of Compensation Related Costs, Share-based Payments [Text Block]	OPTIONS AND AWARDS Stock-based compensation expense consists of share-based payment awards made to employees and directors, including employee stock options and restricted stock awards, based on estimated fair values. As stock-based compensation expense recognized in the Company’s condensed consolidated statements of income for the three and six months ended June 30, 2017 and 2016 was based on awards ultimately expected to vest, it has been reduced for estimated forfeitures. The Company estimates forfeitures at the time of grant and, if necessary, revises the estimate in subsequent periods if actual forfeitures differ. The Company has four option plans, the 2001 Stock Option, Deferred Stock and Restricted Stock Plan (2001 Plan), the 2005 Stock Incentive Plan (2005 Plan), the 2007 Omnibus Incentive Plan (2007 Plan) and the 2017 Omnibus Incentive Plan (2017 Plan), all of which have been approved by the Company's stockholders. The total number of shares available under all of the Company’s stock incentive plans was 6,662 as of June 30, 2017 . 2017 Omnibus Incentive Plan - During the second quarter of 2017, the Company's shareholders approved the 2017 Omnibus Incentive Plan (the 2017 Plan). The 2017 Plan provides for the issuance of 6,881 shares of common stock. The number of shares available to be issued under the 2017 Plan will be reduced by (i) one share for each share that relates to an option or stock appreciation right award and (ii) 2.5 shares for each share which relates to an award other than a stock option or stock appreciation right award (a full-value award). Granted non-employee director options vest and become exercisable in three equal annual installments, or the length of the term if less than three years, on the completion of each year of service measured from the grant date. All other options generally vest over five years at 20% per year on the anniversary of the grant date. Options expire 10 years from the date of grant. At June 30, 2017 , there were 6,662 unissued shares of common stock available for issuance under this plan. The Company also retired the 2001 Plan, 2005 Plan and the 2007 Plan as a result of the approval of the 2017 Plan. The Company uses the Black-Scholes option-pricing model to recognize the value of stock-based compensation expense for all share-based payment awards. Determining the appropriate fair-value model and calculating the fair value of stock-based awards at the grant date requires considerable judgment, including estimating stock price volatility, expected option life and forfeiture rates. The Company develops estimates based on historical data and market information, which can change significantly over time. The Company granted 280 options and 99 restricted stock awards from the 2007 and 2017 Plans during the six months ended June 30, 2017 . Stock Options The Company used the following assumptions for stock options granted during the three months ended June 30, 2017 and 2016 : Grant Year Options Granted Weighted Average Risk-Free Rate Expected Life Weighted Average Volatility Weighted Average Dividend Yield 2017 124 1.90% 6.3 years 35.8% 0.89% 2016 121 1.49% 6.5 years 41.1% 0.79% The Company used the following assumptions for stock options granted during the six months ended June 30, 2017 and 2016 : Grant Year Options Granted Weighted Average Risk-Free Rate Expected Life Weighted Average Volatility Weighted Average Dividend Yield 2017 280 1.96% 6.3 years 35.8% 0.84% 2016 288 1.40% 6.5 years 39.2% 0.78% For the six months ended June 30, 2017 and 2016 , the following represents the exercise price and fair value displayed at grant date for stock option grants: Grant Year Granted Weighted Average Exercise Price Weighted Average Fair Value of Options 2017 280 $ 19.55 $ 6.84 2016 288 $ 19.76 $ 7.42 The weighted average exercise price equaled the weighted average fair value of common stock on the grant date for all options granted during the periods ended June 30, 2017 and 2016 and therefore, the intrinsic value was $0 at date of grant. The following table represents the employee stock option activity during the six months ended June 30, 2017 : Number of Options Outstanding Weighted Average Exercise Price Number of Options Vested Weighted Average Exercise Price of Options Vested January 1, 2017 5,176 $ 11.62 2,704 $ 8.18 Granted 280 19.55 Forfeited (103 ) 13.50 Exercised (295 ) 7.13 June 30, 2017 5,058 $ 12.28 2,957 $ 9.17 The following summary information reflects stock options outstanding, vested and related details as of June 30, 2017 : Stock Options Vested Stock Options Outstanding Number Outstanding Black-Scholes Fair Value Remaining Contractual Life (Years) Vested and Exercisable Year of Grant Exercise Price 2008 2.56 - 4.06 332 $ 492 1 332 2009 4.06 - 4.56 504 1,081 2 504 2010 4.77 - 4.96 132 321 3 132 2011 5.90 - 7.99 155 528 4 155 2012 6.56 - 7.96 474 1,750 5 387 2013 7.98 - 11.49 567 2,763 6 382 2014 10.55 - 18.94 1,565 8,880 7 844 2015 21.47 - 25.24 578 5,260 8 168 2016 18.79 - 19.89 471 3,293 9 53 2017 18.64 - 20.28 280 1,911 10 — Total 5,058 $ 26,279 2,957 Restricted Stock Awards The Company granted 46 and 99 restricted stock awards during the three and six months ended June 30, 2017 , respectively. The Company granted 52 and 214 restricted stock awards during the three and six months ended June 30, 2016 , respectively. All awards were granted at an exercise price of $0 and generally vest over five years . The fair value per share of restricted awards granted during the six months ended June 30, 2017 and 2016 ranged from $18.47 to $20.68 and $19.58 to $23.23 , respectively. The fair value per share includes quarterly stock awards to non-employee directors. A summary of the status of the Company's non-vested restricted stock awards as of June 30, 2017 and changes during the six months ended June 30, 2017 is presented below: Non-Vested Restricted Awards Weighted Average Grant Date Fair Value Nonvested at January 1, 2017 429 $ 20.42 Granted 99 19.40 Vested (75 ) 18.79 Forfeited (7 ) 18.97 Nonvested at June 30, 2017 446 $ 20.49 During the three and six months ended June 30, 2017 , the Company granted 8 and 15 automatic quarterly stock awards to non-employee directors for their service on the Company's board of directors. The fair value per share of these stock awards ranged from $18.47 to $20.68 based on the market price on the grant date. Share-based compensation expense recognized for the Omnibus Incentive Plan for the three and six months ended June 30, 2017 and 2016 was as follows: Three Months Ended June 30, Six Months Ended June 30, 2017 2016 2017 2016 Share-based compensation expense related to stock options $ 1,319 $ 1,319 $ 2,526 $ 2,503 Share-based compensation expense related to restricted stock awards 588 652 1,140 1,200 Share-based compensation expense related to stock awards to non-employee directors 132 166 264 319 Total $ 2,039 $ 2,137 $ 3,930 $ 4,022 In future periods, the Company expects to recognize approximately $12,304 and $7,814 in share-based compensation expense for unvested options and unvested restricted stock awards, respectively, that were outstanding as of June 30, 2017 . Future share-based compensation expense will be recognized over 3.0 and 3.4 weighted average years for unvested options and restricted stock awards, respectively. There were 2,101 unvested and outstanding options at June 30, 2017 , of which 1,998 are expected to vest. The weighted average contractual life for options outstanding, vested and expected to vest at June 30, 2017 was 5.9 years. The aggregate intrinsic value of options outstanding, vested, expected to vest and exercised as of and for the six months ended June 30, 2017 and as of and for the twelve months ended December 31, 2016 is as follows: Options June 30, 2017 December 31, 2016 Outstanding $ 48,939 $ 55,610 Vested 37,505 38,101 Expected to vest 10,493 15,983 Exercisable 3,739 9,199 The intrinsic value is calculated as the difference between the market value of the underlying common stock and the exercise price of the options. Equity Instrument Denominated in the Shares of a Subsidiary On May 26, 2016, the Company implemented a management equity plan and granted stock options and restricted stock awards of a subsidiary of the Company to employees and management of that subsidiary (Subsidiary Equity Plan). These awards generally vest over a period of five years or upon the occurrence of certain prescribed events. The value of the stock options and restricted stock awards is tied to the value of the common stock of the subsidiary. The awards can be put to the Company at various prescribed dates, which in no event is earlier than six months after vesting of the restricted awards or exercise of the stock options. The Company can also call the awards, generally upon employee termination. The grant-date fair value of the awards is recognized as compensation expense over the relevant vesting periods, with a corresponding adjustment to noncontrolling interests. The grant value was determined based on an independent valuation of the subsidiary shares. For the three and six months ended June 30, 2017 , the Company expensed $337 and $670 , respectively, in share-based compensation related to the Subsidiary Equity Plan. For the three and six months ended June 30, 2016 , the Company expensed $643 in share-based compensation related to the Subsidiary Equity Plan. The aggregate number of the Company's common shares that would be required to settle these awards at current estimated fair values, including vested and unvested awards, at June 30, 2017 and 2016 is 269 and 226 , respectively.

Leases

Leases	6 Months Ended
	Jun. 30, 2017
Leases [Abstract]
Leases of Lessee Disclosure [Text Block]	LEASES The Company leases from CareTrust REIT, Inc. (CareTrust) real property associated with 93 affiliated skilled nursing, assisted living and independent living facilities used in the Company’s operations under eight “triple-net” master lease agreements (collectively, the Master Leases), which range in terms from 12 to 19 years. At the Company’s option, the Master Leases may be extended for two or three five-year renewal terms beyond the initial term, on the same terms and conditions. The extension of the term of any of the Master Leases is subject to the following conditions: (1) no event of default under any of the Master Leases having occurred and being continuing; and (2) the tenants providing timely notice of their intent to renew. The term of the Master Leases is subject to termination prior to the expiration of the then current term upon default by the tenants in their obligations, if not cured within any applicable cure periods set forth in the Master Leases. The Company does not have the ability to terminate the obligations under a Master Lease prior to its expiration without CareTrust’s consent. If a Master Lease is terminated prior to its expiration other than with CareTrust’s consent, the Company may be liable for damages and incur charges such as continued payment of rent through the end of the lease term and maintenance and repair costs for the leased property. Commencing the third year, the rent structure under the Master Leases includes a fixed component, subject to annual escalation equal to the lesser of (1) the percentage change in the Consumer Price Index (but not less than zero) or (2) 2.5% . In addition to rent, the Company is required to pay the following: (1) all impositions and taxes levied on or with respect to the leased properties (other than taxes on the income of the lessor); (2) all utilities and other services necessary or appropriate for the leased properties and the business conducted on the leased properties; (3) all insurance required in connection with the leased properties and the business conducted on the leased properties; (4) all facility maintenance and repair costs; and (5) all fees in connection with any licenses or authorizations necessary or appropriate for the leased properties and the business conducted on the leased properties. Total rent expense under the Master Leases was approximately $14,217 and $28,333 for the three and six months ended June 30, 2017 , respectively, and $14,039 and $28,039 for the three and six months ended June 30, 2016 , respectively. At the Company's option, the Master Leases may be extended for two or three five-year renewal terms beyond the initial term, on the same terms and conditions. If the Company elects to renew the term of a Master Lease, the renewal will be effective as to all, but not less than all, of the leased property then subject to the Master Lease. Among other things, under the Master Leases, the Company must maintain compliance with specified financial covenants measured on a quarterly basis, including a portfolio coverage ratio and a minimum rent coverage ratio. The Master Leases also include certain reporting, legal and authorization requirements. The Company is not aware of any defaults as of June 30, 2017 . In March 2017, the Company voluntarily discontinued operations at one of its skilled nursing facilities after determining that the facility cannot competitively operate in the marketplace without substantial investment renovating the building. After careful consideration, the Company determined that the costs to renovate the facility could outweigh the future returns from the operation. As part of this closure, the Company entered into an agreement with its landlord allowing for the closure of the property, as well as other provisions, to allow its landlord to transfer the property and the licenses free and clear of the applicable master lease. This arrangement does not impact the rent expense to be paid in 2017, or expected to be paid in future periods, and has no material impact on the Company's lease coverage ratios under the Master Leases. The Company recorded a continued obligation liability under the lease and related closing expenses of $2,830 , including the present value of rental payments of approximately $2,715 , which was recognized in the first quarter of 2017. Residents of the affected facility were transferred to local skilled nursing facilities. During the first quarter of 2016, the Company voluntarily discontinued operations at one of its skilled nursing facilities in order to preserve the overall ability to serve the residents in surrounding counties after careful consideration and some clinical survey challenges. As part of this closure, the Company entered into an agreement with its landlord allowing for the closure of the property as well as other provisions to allow its landlord to transfer the property and the licenses free and clear of the applicable master lease. This arrangement does not impact the rental payments and has no material impact on the Company's lease coverage ratios under the Master Leases. The Company recorded a continued obligation liability under the lease and related closing expenses of $7,935 , including the present value of rental payments of approximately $6,512 , which was recognized in the first quarter of 2016. Residents of the affected facility were transferred to local skilled nursing facilities. In the second quarter of 2017, the Company recovered $1,286 of certain losses that were recorded in 2016 related to the closure of the operation. The loss recovery is recorded as a gain in the current period. The Company also leases certain affiliated operations and its administrative offices under non-cancelable operating leases, most of which have initial lease terms ranging from five to 20 years . The Company has entered into multiple lease agreements with various landlords to operate newly constructed state-of-the-art, full-service healthcare resorts upon completion of construction. The term of each lease is 15 years with two five -year renewal options and is subject to annual escalation equal to the percentage change in the Consumer Price Index with a stated cap percentage. In addition, the Company leases certain of its equipment under non-cancelable operating leases with initial terms ranging from three to five years . Most of these leases contain renewal options, certain of which involve rent increases. Total rent expense, inclusive of straight-line rent adjustments and rent associated with the Master Leases noted above, was $32,851 and $64,843 for the three and six months ended June 30, 2017 and $30,916 and $58,051 for the three and six months ended June 30, 2016 , respectively. Future minimum lease payments for all leases as of June 30, 2017 are as follows: Year Amount 2017 (remainder) 82,757 2018 132,331 2019 131,633 2020 131,149 2021 130,408 2022 128,449 Thereafter 994,990 $ 1,731,717 Twenty-five of the Company’s affiliated facilities, excluding the facilities that are operated under the Master Leases with CareTrust, are operated under six separate master lease arrangements. Under these master leases, a breach at a single facility could subject one or more of the other facilities covered by the same master lease to the same default risk. Failure to comply with Medicare and Medicaid provider requirements is a default under several of the Company’s leases, master lease agreements and debt financing instruments. In addition, other potential defaults related to an individual facility may cause a default of an entire master lease portfolio and could trigger cross-default provisions in the Company’s outstanding debt arrangements and other leases. With an indivisible lease, it is difficult to restructure the composition of the portfolio or economic terms of the lease without the consent of the landlord. In March 2017, the Company entered into definitive agreements to sell the properties of two skilled nursing facilities and one assisted living community. The transaction closed in the second quarter of 2017. Upon closing the transaction, the Company leased the properties under a triple-net master lease with an initial 20 -year term, with three 5 -year optional extensions, at CPI-based annual escalators. The Company received $38,000 in proceeds. The carrying value for the sale was $24,847 . Under applicable accounting guidance, the master lease was classified as an operating lease. The Company recognized a deferred gain on the transaction of $13,153 that will be amortized over the life of the lease. During the first quarter of 2017, the Company terminated its lease obligations on four transitional care facilities that are currently under development and one newly constructed stand-alone skilled nursing operation. The Company recorded $1,187 in lease termination costs and long-lived asset impairment.

Commitments and Contingencies

Commitments and Contingencies	6 Months Ended
	Jun. 30, 2017
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies Disclosure [Text Block]	COMMITMENTS AND CONTINGENCIES Regulatory Matters — Laws and regulations governing Medicare and Medicaid programs are complex and subject to interpretation. Compliance with such laws and regulations can be subject to future governmental review and interpretation, as well as significant regulatory action including fines, penalties, and exclusion from certain governmental programs. Included in these laws and regulations is the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which requires healthcare providers (among other things) to safeguard and keep confidential protected health information. In late December of 2016, the Company learned of a potential issue at one of its independent operating entities in Arizona which involved the limited and inadvertent disclosure of certain confidential information. The issue has been internally investigated, addressed and disclosed as per the HIPAA obligations. The Company believes that it is presently in compliance in all material respects with all applicable laws and regulations. Cost-Containment Measures — Both government and private pay sources have instituted cost-containment measures designed to limit payments made to providers of healthcare services, and there can be no assurance that future measures designed to limit payments made to providers will not adversely affect the Company. Indemnities — From time to time, the Company enters into certain types of contracts that contingently require the Company to indemnify parties against third-party claims. These contracts primarily include (i) certain real estate leases, under which the Company may be required to indemnify property owners or prior facility operators for post-transfer environmental or other liabilities and other claims arising from the Company’s use of the applicable premises, (ii) operations transfer agreements, in which the Company agrees to indemnify past operators of facilities the Company acquires against certain liabilities arising from the transfer of the operation and/or the operation thereof after the transfer, (iii) certain lending agreements, under which the Company may be required to indemnify the lender against various claims and liabilities, and (iv) certain agreements with the Company’s officers, directors and employees, under which the Company may be required to indemnify such persons for liabilities arising out of their employment relationships. The terms of such obligations vary by contract and, in most instances, a specific or maximum dollar amount is not explicitly stated therein. Generally, amounts under these contracts cannot be reasonably estimated until a specific claim is asserted. Consequently, because no claims have been asserted, no liabilities have been recorded for these obligations on the Company’s balance sheets for any of the periods presented. Litigation — The skilled nursing business involves a significant risk of liability given the age and health of the patients and residents served by the Company's operating subsidiaries. The Company, its operating subsidiaries, and others in the industry are subject to an increasing number of claims and lawsuits, including professional liability claims, alleging that services provided have resulted in personal injury, elder abuse, wrongful death or other related claims. The defense of these lawsuits may result in significant legal costs, regardless of the outcome, and can result in large settlement amounts or damage awards. In addition to the potential lawsuits and claims described above, the Company is also subject to potential lawsuits under the Federal False Claims Act and comparable state laws alleging submission of fraudulent claims for services to any healthcare program (such as Medicare) or payor. A violation may provide the basis for exclusion from federally-funded healthcare programs. Such exclusions could have a correlative negative impact on the Company’s financial performance. Some states, including California, Arizona and Texas, have enacted similar whistleblower and false claims laws and regulations. In addition, the Deficit Reduction Act of 2005 created incentives for states to enact anti-fraud legislation modeled on the Federal False Claims Act. As such, the Company could face increased scrutiny, potential liability and legal expenses and costs based on claims under state false claims acts in markets in which it does business. In May 2009, Congress passed the Fraud Enforcement and Recovery Act (FERA) of 2009 which made significant changes to the Federal False Claims Act (FCA), expanding the types of activities subject to prosecution and whistleblower liability. Following changes by FERA, health care providers face significant penalties for the knowing retention of government overpayments, even if no false claim was involved. Health care providers can now be liable for knowingly and improperly avoiding or decreasing an obligation to pay money or property to the government. This includes the retention of any government overpayment. The government can argue, therefore, that a FCA violation can occur without any affirmative fraudulent action or statement, as long as it is knowingly improper. In addition, FERA extended protections against retaliation for whistleblowers, including protections not only for employees, but also contractors and agents. Thus, there is generally no need for an employment relationship in order to qualify for protection against retaliation for whistleblowing. Healthcare litigation (including class action litigation) is common and is filed based upon a wide variety of claims and theories, and the Company is routinely subjected to varying types of claims. One particular type of suit arises from alleged violations of state-established minimum staffing requirements for skilled nursing facilities. Failure to meet these requirements can, among other things, jeopardize a facility's compliance with conditions of participation under certain state and federal healthcare programs; it may also subject the facility to a notice of deficiency, a citation, a civil money penalty, or litigation. These class-action “staffing” suits have the potential to result in large jury verdicts and settlements. The Company expects the plaintiff's bar to continue to be aggressive in their pursuit of these staffing and similar claims. The Company has in the past been subject to class action litigation involving claims of alleged violations of regulatory requirements related to staffing. While the Company has been able to settle these claims without a material ongoing adverse effect on its business, future claims could be brought that may materially affect its business, financial condition and results of operations. Other claims and suits, including class actions, continue to be filed against the Company and other companies in its industry. If there were a significant increase in the number of these claims or an increase in amounts owing should plaintiffs be successful in their prosecution of these claims, this could materially adversely affect the Company’s business, financial condition, results of operations and cash flows. The Company and its operating subsidiaries have been, and continue to be, subject to claims and legal actions that arise in the ordinary course of business, including potential claims related to patient care and treatment as well as employment related claims. Since 2011, the Company has been involved in a class action litigation claim alleging violations of state and federal wage and hour laws. In January 2017, the Company participated in an initial mediation session with plaintiffs' counsel. As a result of this discussion and due to (i) the fact no class had been certified (ii) the lack of specificity as to legal theories put forth by the plaintiffs, (iii) the nature of the remedies sought and (iv) the lack of any basis on which to compute estimated compensatory and/or exemplary damages, the Company could not predict what the outcome of the pending purported class action lawsuit would be, what the timing of the ultimate resolution of this lawsuit would be, or an estimate and/or range of possible loss related to it. In light of the inherent uncertainties involved in the pending class action lawsuit, the Company determined that we were not able to estimate the related costs or range of costs for the year ended December 31, 2016. In March 2017, the Company was invited to engage in further mediation discussions to determine whether settlement in advance of a decision on class certification was possible. In April 2017, the Company reached an agreement in principle to settle the subject class action litigation, without any admission of liability and subject to approval by the California Superior Court. Based upon the recent change in case status, the Company recorded an accrual for estimated probable losses of $11,000 , exclusive of legal fees, in the first quarter of 2017. The settlement remains subject to final documentation following notice to affected class members, and further approval of the California Superior Court. Other claims and suits continue to be filed against the Company and other companies in its industry. By way of recent example, a general/premises liability lawsuit was filed against one of the Company’s independent operating entities in San Luis Obispo, California, in connection with an alleged injury to a non-employee/contractor. Further, another one of the Company’s independent operating entities was sued on allegations of professional negligence, which claim was recently settled. The Company does not expect that there will be any material ongoing adverse effect on the Company's business, financial condition or results of operations in connection with the resolution of these matters. The Company cannot predict or provide any assurance as to the possible outcome of any litigation. If any litigation were to proceed, and the Company and its operating subsidiaries are subjected to, alleged to be liable for, or agrees to a settlement of, claims or obligations under Federal Medicare statutes, the Federal False Claims Act, or similar State and Federal statutes and related regulations, the Company's business, financial condition and results of operations and cash flows could be materially and adversely affected and its stock price could be adversely impacted. Among other things, any settlement or litigation could involve the payment of substantial sums to settle any alleged civil violations, and may also include the assumption of specific procedural and financial obligations by the Company or its subsidiaries going forward under a corporate integrity agreement and/or other arrangement with the government. Medicare Revenue Recoupments — The Company is subject to reviews relating to Medicare services, billings and potential overpayments. As of June 30, 2017 , five of the Company's operating subsidiaries had probes scheduled and in process, both pre- and post-payment. The Company anticipates that these probe reviews will increase in frequency in the future. If a facility fails a probe review and subsequent re-probes, the facility could then be subject to extended pre-pay review or extrapolation of the identified error rate to all billing in the same time period. None of the Company's operating subsidiaries are currently on extended prepayment review or subject to extrapolation, although that may occur in the future. U.S. Government Inquiry — In October 2013, the Company completed and executed a settlement agreement (the Settlement Agreement) with the DOJ, which received the final approval of the Office of Inspector General-HHS and the United States District Court for the Central District of California. Pursuant to the Settlement Agreement, the Company made a single lump-sum remittance to the government in the amount of $48,000 in October 2013. The Company has denied engaging in any illegal conduct and has agreed to the settlement amount without any admission of wrongdoing in order to resolve the allegations and to avoid the uncertainty and expense of protracted litigation. In connection with the settlement and effective as of October 1, 2013, the Company entered into a five-year corporate integrity agreement (the CIA) with the Office of Inspector General-HHS. The CIA acknowledges the existence of the Company’s current compliance program, which is in accord with the Office of the Inspector General (OIG)’s guidance related to an effective compliance program, and requires that the Company continue during the term of the CIA to maintain a program designed to promote compliance with the statutes, regulations, and written directives of Medicare, Medicaid, and all other Federal health care programs. The Company is also required to notify the Office of Inspector General-HHS in writing, of, among other things: (i) any ongoing government investigation or legal proceeding involving an allegation that the Company has committed a crime or has engaged in fraudulent activities; (ii) any other matter that a reasonable person would consider a probable violation of applicable criminal, civil, or administrative laws related to compliance with federal healthcare programs; and (iii) any change in location, sale, closing, purchase, or establishment of a new business unit or location related to items or services that may be reimbursed by federal health care programs. The Company is also required to retain an Independent Review Organization (IRO) to review certain clinical documentation annually for the term of the CIA. The Company has met the requirements of its third year under the Settlement Agreement and passed its IRO audits. Participation in federal healthcare programs by the Company is not affected by the Settlement Agreement or the CIA. In the event of an uncured material breach of the CIA, the Company could be excluded from participation in federal healthcare programs and/or subject to prosecution. Concentrations Credit Risk — The Company has significant accounts receivable balances, the collectability of which is dependent on the availability of funds from certain governmental programs, primarily Medicare and Medicaid. These receivables represent the only significant concentration of credit risk for the Company. The Company does not believe there are significant credit risks associated with these governmental programs. The Company believes that an appropriate allowance has been recorded for the possibility of these receivables proving uncollectible, and continually monitors and adjusts these allowances as necessary. The Company’s receivables from Medicare and Medicaid payor programs accounted for approximately 56.4% and 58.6% of its total accounts receivable as of June 30, 2017 and December 31, 2016 , respectively. Revenue from reimbursement under the Medicare and Medicaid programs accounted for 68.2% of the Company's revenue for both the three and six months ended June 30, 2017 , respectively, and 68.0% and 67.3% for the three and six months ended June 30, 2016 , respectively. Cash in Excess of FDIC Limits — The Company currently has bank deposits with financial institutions in the U.S. that exceed FDIC insurance limits. FDIC insurance provides protection for bank deposits up to $250 . In addition, the Company has uninsured bank deposits with a financial institution outside the U.S. As of August 1, 2017 , the Company had approximately $136 in uninsured cash deposits. All uninsured bank deposits are held at high quality credit institutions.

Significant Accounting Polici24

Significant Accounting Policies Level 2 (Policies)	6 Months Ended
	Jun. 30, 2017
Accounting Policies [Abstract]
Basis of Accounting, Policy [Policy Text Block]	Basis of Presentation — The accompanying Interim Financial Statements have been prepared in accordance with accounting principles generally accepted in the United States (GAAP). The Company is the sole member or shareholder of various consolidated limited liability companies and corporations established to operate various acquired skilled nursing and assisted living operations, home health, hospice and home care operations, and related ancillary services. All intercompany transactions and balances have been eliminated in consolidation. The condensed consolidated financial statements include the accounts of all entities controlled by the Company through its ownership of a majority voting interest. The Company presents noncontrolling interest within the equity section of its condensed consolidated balance sheets. The Company presents the amount of condensed consolidated net income that is attributable to The Ensign Group, Inc. and the noncontrolling interest in its condensed consolidated statements of income.
Use of Estimates, Policy [Policy Text Block]	Estimates and Assumptions — The preparation of Interim Financial Statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenue and expenses during the reporting periods. The most significant estimates in the Company’s Interim Financial Statements relate to revenue, allowance for doubtful accounts, intangible assets and goodwill, impairment of long-lived assets, general and professional liability, workers' compensation and healthcare claims included in accrued self-insurance liabilities, and income taxes. Actual results could differ from those estimates.
Fair Value of Financial Instruments, Policy [Policy Text Block]	Fair Value of Financial Instruments — The Company’s financial instruments consist principally of cash and cash equivalents, debt security investments, accounts receivable, insurance subsidiary deposits, accounts payable and borrowings. The Company believes all of the financial instruments’ recorded values approximate fair values because of their nature or respective short durations.
Revenue Recognition, Sales of Services [Policy Text Block]	Revenue Recognition — The Company recognizes revenue when the following four conditions have been met: (i) there is persuasive evidence that an arrangement exists; (ii) delivery has occurred or service has been rendered; (iii) the price is fixed or determinable; and (iv) collection is reasonably assured. The Company's revenue is derived primarily from providing healthcare services to patients and is recognized on the date services are provided at amounts billable to the individual. For reimbursement arrangements with third-party payors, including Medicaid, Medicare and private insurers, revenue is recorded based on contractually agreed-upon amounts on a per patient basis. Revenue from the Medicare and Medicaid programs accounted for 68.2% of the Company's revenue for both the three and six months ended June 30, 2017 , and 68.0% and 67.3% for the three and six months ended June 30, 2016 , respectively. The Company records revenue from these governmental and managed care programs as services are performed at their expected net realizable amounts under these programs. The Company’s revenue from governmental and managed care programs is subject to audit and retroactive adjustment by governmental and third-party agencies. Consistent with healthcare industry accounting practices, any changes to these governmental revenue estimates are recorded in the period the change or adjustment becomes known based on final settlement. The Company recorded adjustments to revenue which were not material to the Company's consolidated revenue for the three and six months ended June 30, 2017 and 2016 . The Company’s service specific revenue recognition policies are as follows: Skilled Nursing Revenue The Company’s revenue is derived primarily from providing long-term healthcare services to patients and is recognized on the date services are provided at amounts billable to individual patients. For patients under reimbursement arrangements with third-party payors, including Medicaid, Medicare and private insurers, revenue is recorded based on contractually agreed-upon amounts or rate on a per patient, daily basis or as services are performed. Assisted and Independent Living Revenue The Company's revenue is recorded when services are rendered on the date services are provided at amounts billable to individual residents and consists of fees for basic housing and assisted living care. Residency agreements are generally for a term of 30 days, with resident fees billed monthly in advance. For patients under reimbursement arrangements with Medicaid, revenue is recorded based on contractually agreed-upon amounts or rate on a per resident, daily basis or as services. Revenue for certain ancillary charges is recognized as services are provided, and such fees are billed monthly in arrears. Home Health Revenue Medicare Revenue Net service revenue is recorded under the Medicare prospective payment system based on a 60-day episode payment rate that is subject to adjustment based on certain variables including, but not limited to: (a) an outlier payment if patient care was unusually costly; (b) a low utilization payment adjustment if the number of visits was fewer than five; (c) a partial payment if the patient transferred to another provider or the Company received a patient from another provider before completing the episode; (d) a payment adjustment based upon the level of therapy services required; (e) the number of episodes of care provided to a patient, regardless of whether the same home health provider provided care for the entire series of episodes; (f) changes in the base episode payments established by the Medicare program; (g) adjustments to the base episode payments for case mix and geographic wages; and (h) recoveries of overpayments. The Company makes adjustments to Medicare revenue on completed episodes to reflect differences between estimated and actual payment amounts, an inability to obtain appropriate billing documentation or authorizations acceptable to the payor and other reasons unrelated to credit risk. Therefore, the Company believes that its reported net service revenue and patient accounts receivable will be the net amounts to be realized from Medicare for services rendered. In addition to revenue recognized on completed episodes, the Company also recognizes a portion of revenue associated with episodes in progress. Episodes in progress are 60-day episodes of care that begin during the reporting period, but were not completed as of the end of the period. As such, the Company estimates revenue and recognizes it on a daily basis. The primary factors underlying this estimate are the number of episodes in progress at the end of the reporting period, expected Medicare revenue per episode and its estimate of the average percentage complete based on visits performed. Non-Medicare Revenue Episodic Based Revenue - The Company recognizes revenue in a similar manner as it recognizes Medicare revenue for episodic-based rates that are paid by other insurance carriers, including Medicare Advantage programs; however, these rates can vary based upon the negotiated terms. Non-episodic Based Revenue - Revenue is recorded on an accrual basis based upon the date of service at amounts equal to its established or estimated per-visit rates, as applicable. Hospice Revenue Revenue is recorded on an accrual basis based upon the date of service at amounts equal to the estimated payment rates. The estimated payment rates are daily rates for each of the levels of care the Company delivers. The Company makes adjustments to revenue for an inability to obtain appropriate billing documentation or authorizations acceptable to the payor and other reasons unrelated to credit risk. Additionally, as Medicare hospice revenue is subject to an inpatient cap limit and an overall payment cap, the Company monitors its provider numbers and estimates amounts due back to Medicare if a cap has been exceeded. The Company records these adjustments as a reduction to revenue and increases other accrued liabilities.
Trade and Other Accounts Receivable, Policy [Policy Text Block]	Accounts Receivable and Allowance for Doubtful Accounts — Accounts receivable consist primarily of amounts due from Medicare and Medicaid programs, other government programs, managed care health plans and private payor sources. Estimated provisions for doubtful accounts are recorded to the extent it is probable that a portion or all of a particular account will not be collected. In evaluating the collectability of accounts receivable, the Company considers a number of factors, including the age of the accounts, changes in collection patterns, the composition of patient accounts by payor type and the status of ongoing disputes with third-party payors. On an annual basis, the historical collection percentages are reviewed by payor and by state and are updated to reflect the recent collection experience of the Company. In order to determine the appropriate reserve rate percentages which ultimately establish the allowance, the Company analyzes historical cash collection patterns by payor and by state. The percentages applied to the aged receivable balances are based on the Company’s historical experience and time limits, if any, for managed care, Medicare, Medicaid and other payors. The Company periodically refines its estimates of the allowance for doubtful accounts based on experience with the estimation process and changes in circumstances.
Property, Plant and Equipment, Policy [Policy Text Block]	Property and Equipment — Property and equipment are initially recorded at their historical cost. Repairs and maintenance are expensed as incurred. Depreciation is computed using the straight-line method over the estimated useful lives of the depreciable assets (ranging from three to 59 years). Leasehold improvements are amortized on a straight-line basis over the shorter of their estimated useful lives or the remaining lease term.
Impairment or Disposal of Long-Lived Assets, Policy [Policy Text Block]	Impairment of Long-Lived Assets — The Company reviews the carrying value of long-lived assets that are held and used in the Company’s operating subsidiaries for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Recoverability of these assets is determined based upon expected undiscounted future net cash flows from the operating subsidiaries to which the assets relate, utilizing management’s best estimate, appropriate assumptions, and projections at the time. If the carrying value is determined to be unrecoverable from future operating cash flows, the asset is deemed impaired and an impairment loss would be recognized to the extent the carrying value exceeded the estimated fair value of the asset. The Company estimates the fair value of assets based on the estimated future discounted cash flows of the asset. Management has evaluated its long-lived assets and recorded an impairment charge of $111 and $137 related to the closure of facilities during the six months ended June 30, 2017 and 2016 , respectively. The Company did not identify any asset impairment during the three months ended June 30, 2017 and 2016 .
Goodwill and Intangible Assets, Policy [Policy Text Block]	Intangible Assets and Goodwill — Definite-lived intangible assets consist primarily of favorable leases, lease acquisition costs, patient base, facility trade names and customer relationships. Favorable leases and lease acquisition costs are amortized over the life of the lease of the facility. Patient base is amortized over a period of four to eight months, depending on the classification of the patients and the level of occupancy in a new acquisition on the acquisition date. Trade names at affiliated facilities are amortized over 30 years and customer relationships are amortized over a period of up to 20 years. The Company's indefinite-lived intangible assets consist of trade names and Medicare and Medicaid licenses. The Company tests indefinite-lived intangible assets for impairment on an annual basis or more frequently if events or changes in circumstances indicate that the carrying amount of the intangible asset may not be recoverable. Goodwill represents the excess of the purchase price over the fair value of identifiable net assets acquired in business combinations. Goodwill is subject to annual testing for impairment. In addition, goodwill is tested for impairment if events occur or circumstances change that would reduce the fair value of a reporting unit below its carrying amount. The Company performs its annual test for impairment during the fourth quarter of each year. See further discussion at Note 11, Goodwill and Other Indefinite-Lived Intangible Assets .
Liability Reserve Estimate, Policy [Policy Text Block]	Self-Insurance — The Company is partially self-insured for general and professional liability up to a base amount per claim (the self-insured retention) with an aggregate, one-time deductible above this limit. Losses beyond these amounts are insured through third-party policies with coverage limits per claim, per location and on an aggregate basis for the Company. Starting on January 1, 2017, the combined self-insured retention was $500 per claim, subject to an additional one-time deductible of $750 for California affiliated facilities and a separate, one-time, deductible of $1,000 for non-California facilities. For all affiliated facilities, except those located in Colorado, the third-party coverage above these limits was $1,000 per claim, $3,000 per facility, with a $5,000 blanket aggregate limit and an additional state-specific aggregate where required by state law. In Colorado, the third-party coverage above these limits was $1,000 per claim and $3,000 per facility for skilled nursing facilities, which is independent of the aforementioned blanket aggregate limits that apply outside of Colorado. The self-insured retention and deductible limits for general and professional liability and workers' compensation for all states (except Texas and Washington for workers' compensation) are self-insured through the Captive, the related assets and liabilities of which are included in the accompanying condensed consolidated balance sheets. The Captive is subject to certain statutory requirements as an insurance provider. These requirements include, but are not limited to, maintaining statutory capital. The Company’s policy is to accrue amounts equal to the actuarially estimated costs to settle open claims of insureds, as well as an estimate of the cost of insured claims that have been incurred but not reported. The Company develops information about the size of the ultimate claims based on historical experience, current industry information and actuarial analysis, and evaluates the estimates for claim loss exposure on a quarterly basis. Accrued general liability and professional malpractice liabilities on an undiscounted basis, net of anticipated insurance recoveries, were $37,676 and $34,735 as of June 30, 2017 and December 31, 2016 , respectively. The Company’s operating subsidiaries are self-insured for workers’ compensation in California. To protect itself against loss exposure in California with this policy, the Company has purchased individual specific excess insurance coverage that insures individual claims that exceed $500 per occurrence. In Texas, the operating subsidiaries have elected non-subscriber status for workers’ compensation claims and, effective February 1, 2011, the Company has purchased individual stop-loss coverage that insures individual claims that exceed $750 per occurrence. As of July 1, 2014, the Company’s operating subsidiaries in all other states, with the exception of Washington, are under a loss sensitive plan that insures individual claims that exceed $350 per occurrence. In Washington, the operating subsidiaries' coverage is financed through premiums paid by the employers and employees. The claims and pay benefits are managed through a state insurance pool. Outside of California, Texas and Washington, the Company has purchased insurance coverage that insures individual claims that exceed $350 per accident. In all states except Washington, the Company accrues amounts equal to the estimated costs to settle open claims, as well as an estimate of the cost of claims that have been incurred but not reported. The Company uses actuarial valuations to estimate the liability based on historical experience and industry information. Accrued workers’ compensation liabilities are recorded on an undiscounted basis in the accompanying condensed consolidated balance sheets and were $21,617 and $20,873 as of June 30, 2017 and December 31, 2016 , respectively. In addition, the Company has recorded an asset and equal liability of $4,662 and $4,104 at June 30, 2017 and December 31, 2016 , respectively, in order to present the ultimate costs of malpractice and workers' compensation claims and the anticipated insurance recoveries on a gross basis. See Note 12, Restricted and Other Assets. The Company self-funds medical (including prescription drugs) and dental healthcare benefits to the majority of its employees. The Company is fully liable for all financial and legal aspects of these benefit plans. To protect itself against loss exposure with this policy, the Company has purchased individual stop-loss insurance coverage that insures individual claims that exceed $300 for each covered person with an additional one-time aggregate individual stop loss deductible of $75 . Beginning 2016, the Company's policy does not include the additional one-time aggregate individual stop loss deductible of $75 . The Company’s accrued liability under these plans recorded on an undiscounted basis in the accompanying condensed consolidated balance sheets was $5,713 and $5,639 as of June 30, 2017 and December 31, 2016 , respectively. The Company believes that adequate provision has been made in the Interim Financial Statements for liabilities that may arise out of patient care, workers’ compensation, healthcare benefits and related services provided to date. The amount of the Company’s reserves was determined based on an estimation process that uses information obtained from both company-specific and industry data. This estimation process requires the Company to continuously monitor and evaluate the life cycle of the claims. Using data obtained from this monitoring and the Company’s assumptions about emerging trends, the Company, with the assistance of an independent actuary, develops information about the size of ultimate claims based on the Company’s historical experience and other available industry information. The most significant assumptions used in the estimation process include determining the trend in costs, the expected cost of claims incurred but not reported and the expected costs to settle or pay damage awards with respect to unpaid claims. The self-insured liabilities are based upon estimates, and while management believes that the estimates of loss are reasonable, the ultimate liability may be in excess of or less than the recorded amounts. Due to the inherent volatility of actuarially determined loss estimates, it is reasonably possible that the Company could experience changes in estimated losses that could be material to net income. If the Company’s actual liability exceeds its estimates of loss, its future earnings, cash flows and financial condition would be adversely affected.
Income Tax, Policy [Policy Text Block]	Income Taxes — Deferred tax assets and liabilities are established for temporary differences between the financial reporting basis and the tax basis of the Company’s assets and liabilities at tax rates in effect when such temporary differences are expected to reverse. The Company generally expects to fully utilize its deferred tax assets; however, when necessary, the Company records a valuation allowance to reduce its net deferred tax assets to the amount that is more likely than not to be realized. In determining the need for a valuation allowance or the need for and magnitude of liabilities for uncertain tax positions, the Company makes certain estimates and assumptions. These estimates and assumptions are based on, among other things, knowledge of operations, markets, historical trends and likely future changes and, when appropriate, the opinions of advisors with knowledge and expertise in certain fields. Due to certain risks associated with the Company’s estimates and assumptions, actual results could differ.
Noncontrolling Interest [Policy Text Block]	Noncontrolling Interest — The noncontrolling interest in a subsidiary is initially recognized at estimated fair value on the acquisition date and is presented within total equity in the Company's condensed consolidated balance sheets. The Company presents the noncontrolling interest and the amount of consolidated net income attributable to The Ensign Group, Inc. in its condensed consolidated statements of income and net income per share is calculated based on net income attributable to The Ensign Group, Inc.'s stockholders. The carrying amount of the noncontrolling interest is adjusted based on an allocation of subsidiary earnings based on ownership interest.
Share-based Compensation, Option and Incentive Plans Policy [Policy Text Block]	Share-Based Compensation — The Company measures and recognizes compensation expense for all share-based payment awards made to employees and directors including employee stock options based on estimated fair values, ratably over the requisite service period of the award. Net income has been reduced as a result of the recognition of the fair value of all stock options and restricted stock awards issued, the amount of which is contingent upon the number of future grants and other variables.
Lease, Policy [Policy Text Block]	Leases and Leasehold Improvements - At the inception of each lease, the Company performs an evaluation to determine whether the lease should be classified as an operating or capital lease. The Company records rent expense for operating leases that contain scheduled rent increases on a straight-line basis over the term of the lease. The lease term used for straight-line rent expense is calculated from the date the Company is given control of the leased premises through the end of the lease term. The lease term used for this evaluation also provides the basis for establishing depreciable lives for buildings subject to lease and leasehold improvements, as well as the period over which the Company records straight-line rent expense.
New Accounting Pronouncements, Policy [Policy Text Block]	Recent Accounting Pronouncements — Except for rules and interpretive releases of the Securities and Exchange Commission (SEC) under authority of federal securities laws and a limited number of grandfathered standards, the Financial Accounting Standards Board (FASB) Accounting Standards Codification (ASC) is the sole source of authoritative GAAP literature recognized by the FASB and applicable to the Company. For any new pronouncements announced, the Company considers whether the new pronouncements could alter previous generally accepted accounting principles and determines whether any new or modified principles will have a material impact on the Company's reported financial position or operations in the near term. The applicability of any standard is subject to the formal review of the Company's financial management and certain standards are under consideration. Recent Accounting Standards Adopted by the Company In March 2016, the FASB issued a new standard to simplify several aspects of the accounting for employee share-based payment transactions, which includes the accounting for income taxes, forfeitures, and statutory tax withholding requirements, as well as classification in the statement of cash flows. The new standard was effective for the Company in the first quarter of fiscal year 2017. Under the previous guidance, excess tax benefits and deficiencies from share-based compensation arrangements were recorded in equity when the awards vested or were settled. The new guidance requires prospective recognition of excess tax benefits and deficiencies in the income statement, resulting in the recognition of excess tax benefits in income tax expense, of $697 and $1,207 , rather than in paid-in-capital, for the three and six months ended June 30, 2017 , respectively. In addition, under the new guidance, excess income tax benefits from share-based compensation arrangements are classified as cash flow from operations, rather than as cash flow from financing activities. The Company has elected to apply the cash flow classification guidance prospectively, resulting in an increase to operating cash flow for the six months ended June 30, 2017 , and the prior year period has not been adjusted. The Company has also elected to continue to estimate the expected forfeitures rather than electing to account for forfeitures as they occur. Finally, the adoption of the guidance requires excess tax benefits and deficiencies to be prospectively excluded from assumed future proceeds in the calculation of diluted shares, resulting in an increase in diluted weighted average shares outstanding. Accounting Standards Recently Issued But Not Yet Adopted by the Company In May 2017, the FASB issued amended authoritative guidance to provide guidance on types of changes to the terms or conditions of share-based payments awards to which an entity would be required to apply modification accounting under Accounting Standard Codification (ASC) 718. This guidance is effective for annual and interim periods beginning after December 15, 2017, which will be the Company's fiscal year 2018, with early adoption permitted in certain cases. The adoption of this standard is not expected to have a material impact on the Company's consolidated financial statements. In January 2017, the FASB issued amended authoritative guidance to clarify the definition of a business and reduce diversity in practice related to the evaluation of whether transactions should be accounted for as acquisitions (or disposals) of assets or businesses. The new provisions provide the requirements needed for an integrated set of assets and activities (the set) to be a business and also establish a practical way to determine when a set is not a business. The more robust framework helps entities to narrow the definition of outputs created by the set and align it with how outputs are described in the new revenue standard. This guidance is effective for annual and interim periods beginning after December 15, 2017, which will be the Company's fiscal year 2018, with early adoption permitted in certain cases. The adoption of this standard is not expected to have a material impact on the Company's consolidated financial statements. In January 2017, the FASB issued amended authoritative guidance to simplify and reduce the cost and complexity of the goodwill impairment test. The new provisions eliminate step 2 from the goodwill impairment test and shifts the concept of impairment from a measure of loss when comparing the implied fair value of goodwill to its carrying amount to comparing the fair value of a reporting unit with its carrying amount. The Board also eliminated the requirements for any reporting unit with a zero or negative carrying amount to perform a qualitative assessment or step 2 of the goodwill impairment test. The new guidance does not amend the optional qualitative assessment of goodwill impairment. This guidance is effective for annual periods beginning after December 15, 2019, which will be the Company's fiscal year 2020, with early adoption permitted. The adoption of this standard is not expected to have a material impact on the Company's consolidated financial statements. In August 2016, the FASB issued amended authoritative guidance to reduce the diversity in practice related to the presentation and classification of certain cash receipts and cash payments in the statement of cash flows. The new provisions target cash flow issues related to (i) debt prepayment or debt extinguishment costs, (ii) settlement of debt instruments with coupon rates that are insignificant relative to effective interest rates, (iii) contingent consideration payments made after a business combination, (iv) proceeds from settlement of insurance claims, (v) proceeds from the settlement of corporate-owned life insurance and bank-owned life insurance policies, (vi) distributions received from equity method investees, (vii) beneficial interests in securitization transactions and (viii) separately identifiable cash flows and application of the predominance principle. This guidance will be effective for fiscal years beginning after December 15, 2017, which will be the Company's fiscal year 2018, with early adoption permitted. The adoption of this standard is not expected to have a material impact on the Company’s consolidated financial statements. In March 2016, the FASB issued its standard to amend the principal-versus-agent implementation guidance and illustrations in the Board’s new revenue standard, which includes accounting implication related to (1) determining the appropriate unit of account under the revenue standard’s principal-versus-agent guidance and (2) applying the indicators of whether an entity is a principal or an agent in accordance with the revenue standard’s control principle. The guidance will be effective for fiscal years beginning after December 15, 2017, which will be the Company's fiscal year 2018. The guidance has the same effective date as the new revenue standard and the Company is required to adopt the guidance by using the same transition method it would use to adopt the new revenue standard. The Company's evaluation of the adoption method and impact to the consolidated financial statements is ongoing and being performed concurrently with the new revenue standard. In February 2016, the FASB issued amended authoritative guidance on accounting for leases. The new provisions require that a lessee of operating leases recognize in the statement of financial position a liability to make lease payments (the lease liability) and a right-of-use asset representing its right to use the underlying asset for the lease term. The lease liability will be equal to the present value of lease payments, with the right-of-use asset based upon the lease liability. The classification criteria for distinguishing between finance (or capital) leases and operating leases are substantially similar to the previous lease guidance, but with no explicit bright lines. As such, operating leases will result in straight-line rent expense similar to current practice. For short term leases (term of 12 months or less), a lessee is permitted to make an accounting election not to recognize lease assets and lease liabilities, which would generally result in lease expense being recognized on a straight-line basis over the lease term. This guidance applies to all entities and is effective for annual periods beginning after December 15, 2018, which will be the Company's fiscal year 2019, with early adoption permitted. The Company is currently evaluating the impact this guidance will have on its consolidated financial statements but expects this adoption will result in a significant increase in the assets and liabilities on its consolidated balance sheet. In January 2016, the FASB issued amended authoritative guidance which makes targeted improvements for financial instruments. The new provisions impact certain aspects of recognition, measurement, presentation and disclosure requirements of financial instruments. Specifically, the guidance will (1) require equity investments to be measured at fair value with changes in fair value recognized in net income, (2) simplify the impairment assessment of equity investments without readily determinable fair values, (3) eliminate the requirement to disclose the method and assumptions used to estimate fair value for financial instruments measured at amortized cost, and (4) require separate presentation of financial assets and financial liabilities by measurement category. The guidance is effective for annual and interim periods beginning after December 15, 2017, which will be the Company's fiscal year 2018. Early adoption is not permitted. The adoption of this standard is not expected to have a material impact on the Company’s consolidated financial statements. In May 2014, the FASB and International Accounting Standards Board issued their final standard on revenue from contracts with customers that outlines a single comprehensive model for entities to use in accounting for revenue arising from contracts with customers. The new standard supersedes most current revenue recognition guidance, including industry-specific guidance, and may be applied retrospectively to each period presented (full retrospective method) or retrospectively with the cumulative effect recognized in beginning retained earnings as of the date of adoption (modified retrospective method). In July 2015, the FASB formally deferred for one year the effective date of the new revenue standard and decided to permit entities to early adopt the standard. In December 2016, the FASB made certain technical corrections to further clarify the core revenue recognition principles, primarily in response to feedback from several sources, including the FASB/IASB Transition Resource Group. The guidance will be effective for fiscal years beginning after December 15, 2017, which will be the Company's fiscal year 2018. The Company initiated an adoption plan in fiscal year 2015, beginning with preliminary evaluation of the standard, and will continue by performing additional analysis of revenue streams and transactions for which the accounting may change under the new standard. For example, the Company is currently performing analysis regarding the application of the portfolio approach as a practical expedient to group patient contracts with similar characteristics. The adoption plan, which also includes evaluation of the adoption method and the impact to the consolidated financial statements, is ongoing and will be completed by the end of fiscal year 2017. The new guidance requires enhanced disclosures, including revenue recognition policies to identify performance obligations and significant judgments in measurement and recognition. The FASB has issued and may issue in the future, interpretive guidance, which may impact its evaluation, however the Company currently anticipates adopting the standard as of January 1, 2018, using the modified retrospective method.

Computation of Net Income Per25

Computation of Net Income Per Common Share (Tables)	6 Months Ended
	Jun. 30, 2017
COMPUTATION OF NET INCOME PER COMMON SHARE [Abstract]
Schedule of Earnings Per Share, Basic, by Common Class, Including Two Class Method [Table Text Block]	Three Months Ended June 30, Six Months Ended June 30, 2017 2016 2017 2016 Numerator: Net income $ 12,380 $ 11,363 $ 15,337 $ 20,653 Less: net income attributable to noncontrolling interests 163 37 279 155 Net income attributable to The Ensign Group, Inc. $ 12,217 $ 11,326 $ 15,058 $ 20,498 Denominator: Weighted average shares outstanding for basic net income per share 50,705 50,274 50,736 50,476 Basic net income per common share attributable to The Ensign Group, Inc. $ 0.24 $ 0.23 $ 0.30 $ 0.41
Schedule of Earnings Per Share, Diluted, by Common Class, Including Two Class Method [Table Text Block]	Three Months Ended June 30, Six Months Ended June 30, 2017 2016 2017 2016 Numerator: Net income $ 12,380 $ 11,363 $ 15,337 $ 20,653 Less: net income attributable to noncontrolling interests 163 37 279 155 Net income attributable to The Ensign Group, Inc. $ 12,217 $ 11,326 $ 15,058 $ 20,498 Denominator: Weighted average common shares outstanding 50,705 50,274 50,736 50,476 Plus: incremental shares from assumed conversion (1) 1,843 1,657 1,857 1,658 Adjusted weighted average common shares outstanding 52,548 51,931 52,593 52,134 Diluted net income per common share attributable to The Ensign Group, Inc. $ 0.23 $ 0.22 $ 0.29 $ 0.39 (1) Options outstanding which are anti-dilutive and therefore not factored into the weighted average common shares amount above were 1,378 and 1,312 for the three and six months ended June 30, 2017 , respectively and 850 and 774 for the three and six months ended June 30, 2016 respectively.

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	6 Months Ended
	Jun. 30, 2017
Fair Value Disclosures [Abstract]
Fair Value, Assets Measured on Recurring Basis [Table Text Block]	June 30, 2017 December 31, 2016 Level 1 Level 2 Level 3 Level 1 Level 2 Level 3 Cash and cash equivalents $ 33,476 $ — $ — $ 57,706 $ — $ —

Revenue and Accounts Receivab27

Revenue and Accounts Receivable (Tables)	6 Months Ended
	Jun. 30, 2017
REVENUE AND ACCOUNTS RECEIVABLE [Abstract]
Schedule of Revenue Sources, Health Care Organization [Table Text Block]	Three Months Ended June 30, 2017 2016 Revenue % of Revenue Revenue % of Revenue Medicaid $ 152,637 34.0 % $ 139,226 33.9 % Medicare 128,151 28.6 119,443 29.1 Medicaid — skilled 24,913 5.6 20,661 5.0 Total Medicaid and Medicare 305,701 68.2 279,330 68.0 Managed care 74,925 16.7 65,178 15.9 Private and other payors (1) 67,653 15.1 66,009 16.1 Revenue $ 448,279 100.0 % $ 410,517 100.0 % (1) Private and other payors also includes revenue from all payors generated in other ancillary services for both the three months ended June 30, 2017 and 2016 and urgent care centers for the three months ended June 30, 2016 . Six Months Ended June 30, 2017 2016 Revenue % of Revenue Revenue % of Revenue Medicaid $ 300,908 33.8 % $ 262,867 33.1 % Medicare 258,072 29.0 229,721 28.9 Medicaid — skilled 47,930 5.4 42,327 5.3 Total Medicaid and Medicare 606,910 68.2 534,915 67.3 Managed care 150,486 16.9 129,721 16.4 Private and other payors (1) 132,623 14.9 129,114 16.3 Revenue $ 890,019 100.0 % $ 793,750 100.0 % (1) Private and other payors also includes revenue from all payors generated in other ancillary services for both the six months ended June 30, 2017 and 2016 and urgent care centers for the six months ended June 30, 2016 .
Schedule of Accounts, Notes, Loans and Financing Receivable [Table Text Block]	Accounts receivable as of June 30, 2017 and December 31, 2016 is summarized in the following table: June 30, 2017 December 31, 2016 Medicaid $ 109,306 $ 111,031 Managed care 67,064 66,346 Medicare 50,270 55,500 Private and other payors 56,367 51,347 283,007 284,224 Less: allowance for doubtful accounts (39,759 ) (39,791 ) Accounts receivable, net $ 243,248 $ 244,433

Business Segments (Tables)

Business Segments (Tables)	6 Months Ended
	Jun. 30, 2017
Segment Reporting [Abstract]
Reconciliation of Revenue from Segments to Consolidated [Table Text Block]	Three Months Ended June 30, 2017 Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Total Revenue Revenue % Medicaid $ 142,833 $ 7,203 $ 2,601 $ — $ 152,637 34.0 % Medicare 104,450 — 23,701 — 128,151 28.6 Medicaid-skilled 24,913 — — — 24,913 5.6 Subtotal 272,196 7,203 26,302 — 305,701 68.2 Managed care 69,265 — 5,660 — 74,925 16.7 Private and other 33,756 25,806 2,659 5,432 (1) 67,653 15.1 Total revenue $ 375,217 $ 33,009 $ 34,621 $ 5,432 $ 448,279 100.0 % (1) Private and other payors also includes revenue from all payors generated in other ancillary services for the three months ended June 30, 2017. Three Months Ended June 30, 2016 Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Total Revenue Revenue % Medicaid $ 129,860 $ 6,655 $ 2,711 $ — $ 139,226 33.9 % Medicare 99,184 — 20,259 — 119,443 29.1 Medicaid-skilled 20,661 — — — 20,661 5.0 Subtotal 249,705 6,655 22,970 — 279,330 68.0 Managed care 61,121 — 4,057 — 65,178 15.9 Private and other 29,591 24,053 1,466 10,899 (1) 66,009 16.1 Total revenue $ 340,417 $ 30,708 $ 28,493 $ 10,899 $ 410,517 100.0 % (1) Private and other payors also includes revenue from all payors generated in other ancillary services and urgent care centers for the three months ended June 30, 2016. Six Months Ended June 30, 2017 Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Total Revenue Revenue % Medicaid $ 281,658 $ 14,239 $ 5,011 $ — $ 300,908 33.8 % Medicare 212,379 — 45,693 — 258,072 29.0 Medicaid-skilled 47,930 — — — 47,930 5.4 Subtotal 541,967 14,239 50,704 — 606,910 68.2 Managed care 139,621 — 10,865 — 150,486 16.9 Private and other 65,968 51,116 5,185 10,354 (1) 132,623 14.9 Total revenue $ 747,556 $ 65,355 $ 66,754 $ 10,354 $ 890,019 100.0 % (1) Private and other payors also includes revenue from all payors generated in other ancillary services for the six months ended June 30, 2017. Six Months Ended June 30, 2016 Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Total Revenue Revenue % Medicaid $ 244,682 $ 12,899 $ 5,286 $ — $ 262,867 33.1 % Medicare 190,828 — 38,893 — 229,721 28.9 Medicaid-skilled 42,327 — — — 42,327 5.3 Subtotal 477,837 12,899 44,179 — 534,915 67.3 Managed care 121,660 — 8,061 — 129,721 16.4 Private and other 56,134 47,978 2,919 22,083 (1) 129,114 16.3 Total revenue $ 655,631 $ 60,877 $ 55,159 $ 22,083 $ 793,750 100.0 % (1) Private and other payors also includes revenue from all payors generated in other ancillary services and urgent care centers for the six months ended June 30, 2016.
Schedule of Segment Reporting Information, by Segment [Table Text Block]	The following table sets forth selected financial data consolidated by business segment: Three Months Ended June 30, 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 $ 375,217 $ 33,009 $ 34,621 $ 5,432 $ — $ 448,279 Intersegment revenue (1) 631 — — 729 (1,360 ) — Total revenue $ 375,848 $ 33,009 $ 34,621 $ 6,161 $ (1,360 ) $ 448,279 Segment income (loss) (2) $ 31,704 $ 3,657 $ 4,923 $ (18,253 ) $ — $ 22,031 Interest expense, net of interest income $ (2,765 ) Income before provision for income taxes $ 19,266 Depreciation and amortization $ 7,204 $ 1,492 $ 230 $ 1,824 $ — $ 10,750 (1) Intersegment revenue represents services provided at the Company's skilled nursing facilities and other ancillary operations to the Company's other operating subsidiaries. (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 "All Other" category. (3) The Company's campuses represents facilities that offer both 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. Three Months Ended June 30, 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 $ 340,417 $ 30,708 $ 28,493 $ 10,899 $ — $ 410,517 Intersegment revenue (1) 781 — — 694 (1,475 ) — Total revenue $ 341,198 $ 30,708 $ 28,493 $ 11,593 $ (1,475 ) $ 410,517 Segment income (loss) (2) $ 32,835 $ 3,263 $ 4,349 $ (20,638 ) $ — $ 19,809 Interest expense, net of interest income $ (1,168 ) Income before provision for income taxes $ 18,641 Depreciation and amortization $ 6,792 $ 983 $ 229 $ 1,768 $ — $ 9,772 (1) Intersegment revenue represents services provided at the Company's skilled nursing facilities, urgent care centers and other ancillary operations to the Company's other operating subsidiaries. (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 "All Other" category. (3) The Company's campuses represents facilities that offer both 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. Six Months Ended June 30, 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 $ 747,556 $ 65,355 $ 66,754 $ 10,354 $ — $ 890,019 Intersegment revenue (1) 1,375 — — 1,613 (2,988 ) — Total revenue $ 748,931 $ 65,355 $ 66,754 $ 11,967 $ (2,988 ) $ 890,019 Segment income (loss) (2) $ 63,494 $ 8,096 $ 9,217 $ (51,224 ) $ — $ 29,583 Interest expense, net of interest income $ (5,920 ) Income before provision for income taxes $ 23,663 Depreciation and amortization $ 14,157 $ 3,115 $ 466 $ 3,526 $ — $ 21,264 (1) Intersegment revenue represents services provided at the Company's skilled nursing facilities and other ancillary operations to the Company's other operating subsidiaries. (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 "All Other" category. (3) The Company's campuses represents facilities that offer both 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. Six Months Ended June 30, 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 $ 655,631 $ 60,877 $ 55,159 $ 22,083 $ — $ 793,750 Intersegment revenue (1) 1,491 — — 965 (2,456 ) — Total revenue $ 657,122 $ 60,877 $ 55,159 $ 23,048 $ (2,456 ) $ 793,750 Segment income (loss) (2) $ 60,431 $ 6,523 $ 7,525 $ (38,356 ) $ — $ 36,123 Interest expense, net of interest income $ (2,303 ) Income before provision for income taxes $ 33,820 Depreciation and amortization $ 12,031 $ 2,046 $ 496 $ 3,496 $ — $ 18,069 (1) Intersegment revenue represents services provided at the Company's skilled nursing facilities, urgent care centers and other ancillary operations to the Company's other operating subsidiaries. (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 "All Other" category. (3) The Company's campuses represents facilities that offer both 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.

Acquisitions (Tables)

Acquisitions (Tables)	6 Months Ended
	Jun. 30, 2017
Business Combinations [Abstract]
Schedule of Business Acquisitions, by Acquisition [Table Text Block]	Six Months Ended June 30, 2017 2016 Land $ 3,595 $ 866 Building and improvements 24,527 16,056 Equipment, furniture, and fixtures 2,298 7,998 Assembled occupancy 410 1,220 Definite-lived intangible assets — 363 Goodwill 6,059 28,790 Favorable leases — 393 Other indefinite-lived intangible assets 4,548 600 Other assets acquired, net of liabilities assumed 326 6 Total acquisitions $ 41,763 $ 56,292

Property and Equipment (Tables)

Property and Equipment (Tables)	6 Months Ended
	Jun. 30, 2017
Property, Plant and Equipment [Abstract]
Property, Plant and Equipment [Table Text Block]	June 30, 2017 December 31, 2016 Land $ 44,301 $ 47,565 Buildings and improvements 310,620 304,263 Equipment 167,660 153,170 Furniture and fixtures 5,425 6,931 Leasehold improvements 86,340 80,164 Construction in progress 2,803 2,441 617,149 594,534 Less: accumulated depreciation (126,763 ) (110,036 ) Property and equipment, net $ 490,386 $ 484,498

Intangible Assets - Net (Tables

Intangible Assets - Net (Tables)	6 Months Ended
	Jun. 30, 2017
Intangible Assets, Net (Excluding Goodwill) [Abstract]
Schedule of Finite-Lived Intangible Assets [Table Text Block]	Weighted Average Life (Years) June 30, 2017 December 31, 2016 Gross Carrying Amount Accumulated Amortization Gross Carrying Amount Accumulated Amortization Intangible Assets Net Net Lease acquisition costs 23.2 $ 483 $ (89 ) $ 394 $ 483 $ (78 ) $ 405 Favorable leases 32.5 35,116 (5,579 ) 29,537 35,116 (4,589 ) 30,527 Assembled occupancy 0.5 2,307 (2,048 ) 259 1,897 (1,897 ) — Facility trade name 30.0 733 (281 ) 452 733 (269 ) 464 Customer relationships 18.6 4,933 (1,391 ) 3,542 4,933 (1,253 ) 3,680 Total $ 43,572 $ (9,388 ) $ 34,184 $ 43,162 $ (8,086 ) $ 35,076
Schedule of Finite-Lived Intangible Assets, Future Amortization Expense [Table Text Block]	Year Amount 2017 (remainder) $ 1,388 2018 2,321 2019 2,301 2020 2,301 2021 2,270 2022 2,244 Thereafter 21,359 $ 34,184

Goodwill and Other Indefinite32

Goodwill and Other Indefinite-Lived Intangible Assets (Tables)	6 Months Ended
	Jun. 30, 2017
Indefinite-Lived Intangible Assets (Including Goodwill) [Abstract]
Schedule of Goodwill [Table Text Block]	Goodwill Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Total January 1, 2017 $ 40,636 $ 3,538 $ 17,901 $ 5,025 $ 67,100 Additions 3,980 — 1,826 253 6,059 June 30, 2017 $ 44,616 $ 3,538 $ 19,727 $ 5,278 $ 73,159
Schedule of Acquired Indefinite-lived Intangible Assets by Major Class [Table Text Block]	June 30, 2017 December 31, 2016 Trade name $ 1,181 $ 1,146 Medicare and Medicaid licenses 23,263 18,440 $ 24,444 $ 19,586

Restricted and Other Assets (Ta

Restricted and Other Assets (Tables)	6 Months Ended
	Jun. 30, 2017
Other Assets [Abstract]
Schedule of Other Assets [Table Text Block]	June 30, 2017 December 31, 2016 Debt issuance costs, net $ 3,169 $ 3,611 Long-term insurance losses recoverable asset 4,662 4,104 Deposits with landlords 4,708 3,526 Capital improvement reserves with landlords and lenders 790 673 Note receivable from sale of urgent care centers — 700 Restricted and other assets $ 13,329 $ 12,614

Other Accrued Liabilities (Tabl

Other Accrued Liabilities (Tables)	6 Months Ended
	Jun. 30, 2017
Accrued Liabilities [Abstract]
Schedule of Accrued Liabilities [Table Text Block]	June 30, 2017 December 31, 2016 Quality assurance fee $ 6,989 $ 4,604 Refunds payable 20,015 18,368 Deferred revenue 4,608 6,994 Cash held in trust for patients 2,460 2,373 Resident deposits 6,210 6,099 Dividends payable 2,182 2,186 Property taxes 8,058 9,130 Income tax payable — 1,182 Operational closure liability 962 1,972 Other 7,303 5,855 Other accrued liabilities $ 58,787 $ 58,763

Debt (Tables)

Debt (Tables)	6 Months Ended
	Jun. 30, 2017
Debt Disclosure [Abstract]
Schedule of Long-term Debt Instruments [Table Text Block]	June 30, 2017 December 31, 2016 Term loan with SunTrust, interest payable quarterly $ 144,375 $ 148,125 Credit facility with SunTrust 135,000 122,000 Mortgage loans and promissory note, principal and interest payable monthly, interest at fixed rate 13,731 14,032 293,106 284,157 Less: current maturities (8,165 ) (8,129 ) Less: debt issuance costs (476 ) (542 ) $ 284,465 $ 275,486

Options and Awards (Tables)

Options and Awards (Tables)	6 Months Ended
	Jun. 30, 2017
Options and Awards [Abstract]
Schedule of Share-based Payment Award, Stock Options, Valuation Assumptions [Table Text Block]	The Company used the following assumptions for stock options granted during the three months ended June 30, 2017 and 2016 : Grant Year Options Granted Weighted Average Risk-Free Rate Expected Life Weighted Average Volatility Weighted Average Dividend Yield 2017 124 1.90% 6.3 years 35.8% 0.89% 2016 121 1.49% 6.5 years 41.1% 0.79% The Company used the following assumptions for stock options granted during the six months ended June 30, 2017 and 2016 : Grant Year Options Granted Weighted Average Risk-Free Rate Expected Life Weighted Average Volatility Weighted Average Dividend Yield 2017 280 1.96% 6.3 years 35.8% 0.84% 2016 288 1.40% 6.5 years 39.2% 0.78%
Share-based Compensation Arrangement by Share-based Payment Award, Options, Grants in Period, Weighted Average Grant Date Fair Value [Table Text Block]	Grant Year Granted Weighted Average Exercise Price Weighted Average Fair Value of Options 2017 280 $ 19.55 $ 6.84 2016 288 $ 19.76 $ 7.42
Schedule of Common Stock Outstanding Roll Forward [Table Text Block]	Number of Options Outstanding Weighted Average Exercise Price Number of Options Vested Weighted Average Exercise Price of Options Vested January 1, 2017 5,176 $ 11.62 2,704 $ 8.18 Granted 280 19.55 Forfeited (103 ) 13.50 Exercised (295 ) 7.13 June 30, 2017 5,058 $ 12.28 2,957 $ 9.17
Schedule of Share-based Compensation, Shares Authorized under Stock Option Plans, by Exercise Price Range [Table Text Block]	Stock Options Vested Stock Options Outstanding Number Outstanding Black-Scholes Fair Value Remaining Contractual Life (Years) Vested and Exercisable Year of Grant Exercise Price 2008 2.56 - 4.06 332 $ 492 1 332 2009 4.06 - 4.56 504 1,081 2 504 2010 4.77 - 4.96 132 321 3 132 2011 5.90 - 7.99 155 528 4 155 2012 6.56 - 7.96 474 1,750 5 387 2013 7.98 - 11.49 567 2,763 6 382 2014 10.55 - 18.94 1,565 8,880 7 844 2015 21.47 - 25.24 578 5,260 8 168 2016 18.79 - 19.89 471 3,293 9 53 2017 18.64 - 20.28 280 1,911 10 — Total 5,058 $ 26,279 2,957
Schedule of Nonvested Restricted Stock Units Activity [Table Text Block]	Non-Vested Restricted Awards Weighted Average Grant Date Fair Value Nonvested at January 1, 2017 429 $ 20.42 Granted 99 19.40 Vested (75 ) 18.79 Forfeited (7 ) 18.97 Nonvested at June 30, 2017 446 $ 20.49
Schedule of Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Table Text Block]	Three Months Ended June 30, Six Months Ended June 30, 2017 2016 2017 2016 Share-based compensation expense related to stock options $ 1,319 $ 1,319 $ 2,526 $ 2,503 Share-based compensation expense related to restricted stock awards 588 652 1,140 1,200 Share-based compensation expense related to stock awards to non-employee directors 132 166 264 319 Total $ 2,039 $ 2,137 $ 3,930 $ 4,022
Share-based Compensation, Schedule of Intrisice Values by Option Category [Table Text Block]	Options June 30, 2017 December 31, 2016 Outstanding $ 48,939 $ 55,610 Vested 37,505 38,101 Expected to vest 10,493 15,983 Exercisable 3,739 9,199

Leases (Tables)

Leases (Tables)	6 Months Ended
	Jun. 30, 2017
Leases [Abstract]
Schedule of Future Minimum Rental Payments for Operating Leases [Table Text Block]	Year Amount 2017 (remainder) 82,757 2018 132,331 2019 131,633 2020 131,149 2021 130,408 2022 128,449 Thereafter 994,990 $ 1,731,717

Description of Business (Detail

Description of Business (Details)	Jun. 30, 2017businessBedsfacilities	Dec. 31, 2016facilities
Skilled nursing, assisted living and independent living facilities [Abstract]
Number of Real Estate Properties	56	50
Number of Real Estate Properties Leased	166	160
Number of Real Estate Properties Leased with an Option to Purchase	10	9
Number of Real Estate Properties Operated	222	210
Home Health, Hospice and Home Care Operations | business	41
Operational Skilled Nursing Beds | Beds	18,400
Operational Skilled Nursing, Assisted Living and Independent Living Beds [Abstract]
Operational Skilled Nursing, Assisted Living and Independent Living Beds | Beds	4,700

Significant Accounting Polici39

Significant Accounting Policies Revenue and Accounts Receivable (Details)	3 Months Ended		6 Months Ended
	Jun. 30, 2017Rate	Jun. 30, 2016Rate	Jun. 30, 2017Rate	Jun. 30, 2016Rate
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
% of Revenue	100.00%	100.00%	100.00%	100.00%
Total Medicaid and Medicare
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
% of Revenue	68.20%	68.00%	68.20%	67.30%

Significant Accounting Polici40

Significant Accounting Policies Impairment (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2017	Jun. 30, 2016
Accounting Policies [Abstract]
Impairment of Long-Lived Assets to be Disposed of	$ 111	$ 137

Significant Accounting Polici41

Significant Accounting Policies Self-Insurance General and Professional (Details) - General and Professional Liability Insurance [Member] - USD ($) $ in Thousands	Jun. 30, 2017	Dec. 31, 2016
Liability for Claims and Claims Adjustment Expense [Line Items]
Self Insurance Reserve	$ 37,676	$ 34,735
Self-insurance retention per claim [Member] | Parent Company [Member]
Liability for Claims and Claims Adjustment Expense [Line Items]
Self Insurance Reserve	500
Aggregate Deductible [Member] | Parent Company [Member] | CALIFORNIA
Liability for Claims and Claims Adjustment Expense [Line Items]
Self Insurance Reserve	750
Aggregate Deductible [Member] | Parent Company [Member] | Non-California [Domain]
Liability for Claims and Claims Adjustment Expense [Line Items]
Self Insurance Reserve	1,000
Blanket Aggregate [Member] | Third-Party Payor [Member] | All States Except Colorado [Domain]
Liability for Claims and Claims Adjustment Expense [Line Items]
Self Insurance Reserve	5,000
Per Facility [Member] | Third-Party Payor [Member] | All States Except Colorado [Domain]
Liability for Claims and Claims Adjustment Expense [Line Items]
Self Insurance Reserve	3,000
Per Facility [Member] | Third-Party Payor [Member] | COLORADO
Liability for Claims and Claims Adjustment Expense [Line Items]
Self Insurance Reserve	3,000
Per Occurence [Member] | Third-Party Payor [Member] | All States Except Colorado [Domain]
Liability for Claims and Claims Adjustment Expense [Line Items]
Self Insurance Reserve	1,000
Per Occurence [Member] | Third-Party Payor [Member] | COLORADO
Liability for Claims and Claims Adjustment Expense [Line Items]
Self Insurance Reserve	$ 1,000

Significant Accounting Polici42

Significant Accounting Policies Self-Insurance Workers' Compensation (Details) - Workers' Compensation [Member] - USD ($) $ in Thousands	Jun. 30, 2017	Dec. 31, 2016
Liability for Claims and Claims Adjustment Expense [Line Items]
Self Insurance Reserve	$ 21,617	$ 20,873
Stop-Loss Insurance limit per claim [Member]
Liability for Claims and Claims Adjustment Expense [Line Items]
Self Insurance Reserve	500
Stop-Loss Insurance limit per claim [Member] | TEXAS
Liability for Claims and Claims Adjustment Expense [Line Items]
Self Insurance Reserve	750
Loss-Sensitive limit per claim [Member] [Member] | Other states, except California, Texas and Washington [Domain]
Liability for Claims and Claims Adjustment Expense [Line Items]
Self Insurance Reserve	$ 350

Significant Accounting Polici43

Significant Accounting Policies Self Insurance Recoveries (Details) - USD ($) $ in Thousands	Jun. 30, 2017	Dec. 31, 2016
Accounting Policies [Abstract]
Long-term insurance losses recoverable asset	$ 4,662	$ 4,104

Significant Accounting Polici44

Significant Accounting Policies Self-Insurance Health Insurance (Details) - Health Liability Insurance [Member] - USD ($) $ in Thousands	Jun. 30, 2017	Dec. 31, 2016
Liability for Claims and Claims Adjustment Expense [Line Items]
Self Insurance Reserve	$ 5,713	$ 5,639
Stop-Loss Insurance limit per claim [Member]
Liability for Claims and Claims Adjustment Expense [Line Items]
Self Insurance Reserve	300
Stop Loss Deductible [Member]
Liability for Claims and Claims Adjustment Expense [Line Items]
Self Insurance Reserve	$ 75

Significant Accounting Polici45

Significant Accounting Policies Recent Accounting Standards Adopted (Details) - USD ($) $ in Thousands	3 Months Ended	6 Months Ended
	Jun. 30, 2017	Jun. 30, 2017
Accounting Policies [Abstract]
Income Tax Effects Allocated Directly to Equity, Employee Stock Options	$ 697	$ 1,207

Common Stock (Details)

Common Stock (Details) shares in Thousands, $ in Thousands	Feb. 08, 2017USD ($)	Nov. 04, 2015USD ($)Agreements	Jun. 30, 2017USD ($)shares	Jun. 30, 2016USD ($)shares	Jun. 30, 2017USD ($)shares	Jun. 30, 2016USD ($)
Common Stock Transactions [Line Items]
Stock Repurchase Program, Period in Force	12 months	12 months
Stock Repurchase Program Expiration Date	Feb. 8, 2018
Repurchase of shares of common stock (Note 3)					$ (7,288)	$ (30,000)
Number of Stock Repurchase Programs | Agreements		2
Common Stock [Member]
Common Stock Transactions [Line Items]
Stock Repurchase Program, Authorized Amount	$ 30,000	$ 15,000
Stock Repurchased During Period, Shares | shares			69	1,452	412
Repurchase of shares of common stock (Note 3)			$ (1,220)	$ (30,000)	$ (7,288)

Computation of Net Income Per47

Computation of Net Income Per Common Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2017	Jun. 30, 2016	Jun. 30, 2017	Jun. 30, 2016
Numerator:
Net income	$ 12,380	$ 11,363	$ 15,337	$ 20,653
Less: net income attributable to noncontrolling interests	163	37	279	155
Net income attributable to The Ensign Group, Inc.	$ 12,217	$ 11,326	$ 15,058	$ 20,498
Denominator:
Weighted average shares outstanding for basic net income per share	50,705	50,274	50,736	50,476
Basic net income (loss) per common share:
Basic net income per common share attributable to The Ensign Group, Inc.	$ 0.24	$ 0.23	$ 0.30	$ 0.41
Common Class A [Member]
Denominator:
Weighted average shares outstanding for basic net income per share	50,705	50,274	50,736	50,476

Computation of Net Income Per48

Computation of Net Income Per Common Share Dilutive Table (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands		3 Months Ended		6 Months Ended
		Jun. 30, 2017	Jun. 30, 2016	Jun. 30, 2017	Jun. 30, 2016
Numerator:
Net income		$ 12,380	$ 11,363	$ 15,337	$ 20,653
Less: net income attributable to noncontrolling interests		163	37	279	155
Net income attributable to The Ensign Group, Inc.		$ 12,217	$ 11,326	$ 15,058	$ 20,498
Denominator:
Basic		50,705	50,274	50,736	50,476
Adjusted weighted average common shares outstanding		52,548	51,931	52,593	52,134
Diluted net (loss) income per common share:
Diluted net income per common share attributable to The Ensign Group, Inc.		$ 0.23	$ 0.22	$ 0.29	$ 0.39
Common Class A [Member]
Denominator:
Basic		50,705	50,274	50,736	50,476
Plus: incremental shares from assumed conversion (1)	[1]	1,843	1,657	1,857	1,658
[1]	(1) Options outstanding which are anti-dilutive and therefore not factored into the weighted average common shares amount above were 1,378 and 1,312 for the three and six months ended June 30, 2017, respectively and 850 and 774 for the three and six months ended June 30, 2016 respectively.

Computation of Net Income Per49

Computation of Net Income Per Common Share Antidilutive Shares (Details) - shares shares in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2017	Jun. 30, 2016	Jun. 30, 2017	Jun. 30, 2016
Earnings Per Share, Diluted, Other Disclosures [Abstract]
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount	1,378	850	1,312	774

Fair Value Measurements (Detail

Fair Value Measurements (Details) - Cash and cash equivalents - USD ($) $ in Thousands	Jun. 30, 2017	Dec. 31, 2016
Level 1
Cash and cash equivalents	$ 33,476	$ 57,706
Level 2
Cash and cash equivalents	0	0
Level 3
Cash and cash equivalents	$ 0	$ 0

Fair Value Measurements Investm

Fair Value Measurements Investments (Details) - USD ($) $ in Thousands	Jun. 30, 2017	Dec. 31, 2016
Domestic Corporate Debt Securities [Member]
Schedule of Held-to-maturity Securities [Line Items]
Held-to-maturity Securities	$ 39,542	$ 35,184

Revenue and Accounts Receivab52

Revenue and Accounts Receivable Revenue (Details) - USD ($) $ in Thousands	3 Months Ended				6 Months Ended
	Jun. 30, 2017		Jun. 30, 2016		Jun. 30, 2017		Jun. 30, 2016
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Revenue	$ 448,279		$ 410,517		$ 890,019		$ 793,750
Revenue by payor as a percent of total revenue	100.00%		100.00%		100.00%		100.00%
Medicaid
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Revenue	$ 152,637		$ 139,226		$ 300,908		$ 262,867
Revenue by payor as a percent of total revenue	34.00%		33.90%		33.80%		33.10%
Medicare
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Revenue	$ 128,151		$ 119,443		$ 258,072		$ 229,721
Revenue by payor as a percent of total revenue	28.60%		29.10%		29.00%		28.90%
Medicaid — skilled
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Revenue	$ 24,913		$ 20,661		$ 47,930		$ 42,327
Revenue by payor as a percent of total revenue	5.60%		5.00%		5.40%		5.30%
Total Medicaid and Medicare
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Revenue	$ 305,701		$ 279,330		$ 606,910		$ 534,915
Revenue by payor as a percent of total revenue	68.20%		68.00%		68.20%		67.30%
Managed care
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Revenue	$ 74,925		$ 65,178		$ 150,486		$ 129,721
Revenue by payor as a percent of total revenue	16.70%		15.90%		16.90%		16.40%
Private and other payors(1)
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Revenue	$ 67,653	[1]	$ 66,009	[1]	$ 132,623	[2]	$ 129,114	[2]
Revenue by payor as a percent of total revenue	15.10%		16.10%		14.90%		16.30%
[1]	(1) Private and other payors also includes revenue from all payors generated in other ancillary services for both the three months ended June 30, 2017 and 2016 and urgent care centers for the three months ended June 30, 2016.
[2]	(1) Private and other payors also includes revenue from all payors generated in other ancillary services for both the six months ended June 30, 2017 and 2016 and urgent care centers for the six months ended June 30, 2016.

Revenue and Accounts Receivab53

Revenue and Accounts Receivable Accounts Receivable (Details) - USD ($) $ in Thousands	Jun. 30, 2017	Dec. 31, 2016
Accounts, Notes, Loans and Financing Receivable [Line Items]
Accounts Receivable, Gross	$ 283,007	$ 284,224
Less: allowance for doubtful accounts	(39,759)	(39,791)
Accounts receivable, net	243,248	244,433
Medicaid
Accounts, Notes, Loans and Financing Receivable [Line Items]
Accounts Receivable, Gross	109,306	111,031
Managed care
Accounts, Notes, Loans and Financing Receivable [Line Items]
Accounts Receivable, Gross	67,064	66,346
Medicare
Accounts, Notes, Loans and Financing Receivable [Line Items]
Accounts Receivable, Gross	50,270	55,500
Private and other payors
Accounts, Notes, Loans and Financing Receivable [Line Items]
Accounts Receivable, Gross	$ 56,367	$ 51,347

Business Segments (Details)

Business Segments (Details) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2017USD ($)businessfacilities	Jun. 30, 2016USD ($)	Jun. 30, 2017USD ($)Segmentsbusinessfacilities	Jun. 30, 2016USD ($)Segments
Segment Reporting Information [Line Items]
Number of Reportable Segments | Segments			3	2
Transitional and Skilled Service Facilities | facilities	155		155
Transitional and Skilled Services and Assistant and Independent Living Campuses | facilities	21		21
Assisted and Independent Living Facilities | facilities	46		46
Home Health, Hospice and Home Care Operations | business	41		41
(Gain)/losses related to operational closures (Note 7 and 17)	$ (1,286)	$ 0	$ 2,731	$ 7,935
Gain (Loss) on Contract Termination			2,715	6,512
Impairment of Long-Lived Assets to be Disposed of			111	$ 137
Contract Termination and Facility Closing [Member]
Segment Reporting Information [Line Items]
(Gain)/losses related to operational closures (Note 7 and 17)			$ 4,017

Business Segments Revenue by Se

Business Segments Revenue by Segment (Details) - USD ($) $ in Thousands	3 Months Ended				6 Months Ended
	Jun. 30, 2017		Jun. 30, 2016		Jun. 30, 2017		Jun. 30, 2016
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	$ 448,279		$ 410,517		$ 890,019		$ 793,750
Revenue by payor as a percent of total revenue	100.00%		100.00%		100.00%		100.00%
TSA Services
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	$ 375,217		$ 340,417		$ 747,556		$ 655,631
Assisted and Independent Living Services Segment [Member]
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	33,009		30,708		65,355		60,877
Home Health and Hospice Services
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	34,621		28,493		66,754		55,159
Other Segments [Member]
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	5,432		10,899		10,354		22,083
Medicaid
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	$ 152,637		$ 139,226		$ 300,908		$ 262,867
Revenue by payor as a percent of total revenue	34.00%		33.90%		33.80%		33.10%
Medicaid | TSA Services
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	$ 142,833		$ 129,860		$ 281,658		$ 244,682
Medicaid | Assisted and Independent Living Services Segment [Member]
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	7,203		6,655		14,239		12,899
Medicaid | Home Health and Hospice Services
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	2,601		2,711		5,011		5,286
Medicaid | Other Segments [Member]
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	0		0		0		0
Medicare
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	$ 128,151		$ 119,443		$ 258,072		$ 229,721
Revenue by payor as a percent of total revenue	28.60%		29.10%		29.00%		28.90%
Medicare | TSA Services
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	$ 104,450		$ 99,184		$ 212,379		$ 190,828
Medicare | Assisted and Independent Living Services Segment [Member]
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	0		0		0		0
Medicare | Home Health and Hospice Services
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	23,701		20,259		45,693		38,893
Medicare | Other Segments [Member]
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	0		0		0		0
Medicaid — skilled
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	$ 24,913		$ 20,661		$ 47,930		$ 42,327
Revenue by payor as a percent of total revenue	5.60%		5.00%		5.40%		5.30%
Medicaid — skilled | TSA Services
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	$ 24,913		$ 20,661		$ 47,930		$ 42,327
Medicaid — skilled | Assisted and Independent Living Services Segment [Member]
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	0		0		0		0
Medicaid — skilled | Home Health and Hospice Services
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	0		0		0		0
Medicaid — skilled | Other Segments [Member]
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	0		0		0		0
Total Medicaid and Medicare
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	$ 305,701		$ 279,330		$ 606,910		$ 534,915
Revenue by payor as a percent of total revenue	68.20%		68.00%		68.20%		67.30%
Total Medicaid and Medicare | TSA Services
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	$ 272,196		$ 249,705		$ 541,967		$ 477,837
Total Medicaid and Medicare | Assisted and Independent Living Services Segment [Member]
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	7,203		6,655		14,239		12,899
Total Medicaid and Medicare | Home Health and Hospice Services
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	26,302		22,970		50,704		44,179
Total Medicaid and Medicare | Other Segments [Member]
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	0		0		0		0
Managed care
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	$ 74,925		$ 65,178		$ 150,486		$ 129,721
Revenue by payor as a percent of total revenue	16.70%		15.90%		16.90%		16.40%
Managed care | TSA Services
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	$ 69,265		$ 61,121		$ 139,621		$ 121,660
Managed care | Assisted and Independent Living Services Segment [Member]
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	0		0		0		0
Managed care | Home Health and Hospice Services
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	5,660		4,057		10,865		8,061
Managed care | Other Segments [Member]
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	0		0		0		0
Private and other payors
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	$ 67,653	[1]	$ 66,009	[1]	$ 132,623	[2]	$ 129,114	[2]
Revenue by payor as a percent of total revenue	15.10%		16.10%		14.90%		16.30%
Private and other payors | TSA Services
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	$ 33,756		$ 29,591		$ 65,968		$ 56,134
Private and other payors | Assisted and Independent Living Services Segment [Member]
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	25,806		24,053		51,116		47,978
Private and other payors | Home Health and Hospice Services
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	2,659		1,466		5,185		2,919
Private and other payors | Other Segments [Member]
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	$ 5,432		$ 10,899		$ 10,354		$ 22,083
[1]	(1) Private and other payors also includes revenue from all payors generated in other ancillary services for both the three months ended June 30, 2017 and 2016 and urgent care centers for the three months ended June 30, 2016.
[2]	(1) Private and other payors also includes revenue from all payors generated in other ancillary services for both the six months ended June 30, 2017 and 2016 and urgent care centers for the six months ended June 30, 2016.

Business Segments Schedule of S

Business Segments Schedule of Segment Reporting Information, by Segment (Details) - USD ($) $ in Thousands	3 Months Ended			6 Months Ended
	Jun. 30, 2017		Jun. 30, 2016	Jun. 30, 2017		Jun. 30, 2016
Segment Reporting Information [Line Items]
Revenue	$ 448,279		$ 410,517	$ 890,019		$ 793,750
Intersegment revenue (1)	0		0	0		0
Revenue including intersegment revenue	448,279		410,517	890,019		793,750
Segment income (loss) (2)	22,031		19,809	29,583		36,123
Interest expense, net of interest income	(2,765)		(1,168)	(5,920)		(2,303)
Income before provision for income taxes	19,266		18,641	23,663		33,820
Depreciation and amortization	10,750		9,772	21,264		18,069
TSA Services
Segment Reporting Information [Line Items]
Revenue	375,217		340,417	747,556		655,631
Intersegment revenue (1)	631		781	1,375		1,491	[1]
Revenue including intersegment revenue	375,848		341,198	748,931		657,122
Segment income (loss) (2)	31,704		32,835	63,494		60,431
Depreciation and amortization	7,204		6,792	14,157		12,031
Assisted and Independent Living Services Segment [Member]
Segment Reporting Information [Line Items]
Revenue	33,009		30,708	65,355		60,877
Intersegment revenue (1)	0		0	0		0	[1]
Revenue including intersegment revenue	33,009		30,708	65,355		60,877
Segment income (loss) (2)	3,657		3,263	8,096		6,523
Depreciation and amortization	1,492		983	3,115		2,046
Home Health and Hospice Services
Segment Reporting Information [Line Items]
Revenue	34,621		28,493	66,754		55,159
Intersegment revenue (1)	0		0	0		0	[1]
Revenue including intersegment revenue	34,621		28,493	66,754		55,159
Segment income (loss) (2)	4,923		4,349	9,217		7,525
Depreciation and amortization	230		229	466		496
Other Segments [Member]
Segment Reporting Information [Line Items]
Revenue	5,432		10,899	10,354		22,083
Intersegment revenue (1)	729		694	1,613		965	[1]
Revenue including intersegment revenue	6,161		11,593	11,967		23,048
Segment income (loss) (2)	(18,253)		(20,638)	(51,224)		(38,356)
Depreciation and amortization	1,824		1,768	3,526		3,496
Elimination
Segment Reporting Information [Line Items]
Intersegment revenue (1)	(1,360)		(1,475)	(2,988)		(2,456)	[1]
Revenue including intersegment revenue	(1,360)		(1,475)	(2,988)		(2,456)
Segment income (loss) (2)	0	[2]	0	0	[2]	0	[2]
Depreciation and amortization	$ 0		$ 0	$ 0		$ 0
[1]	(1) Intersegment revenue represents services provided at the Company's skilled nursing facilities, urgent care centers and other ancillary operations to the Company's other operating subsidiaries.
[2]	(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 "All Other" category.

Acquisitions Acquisition Summar

Acquisitions Acquisition Summary (Details) $ in Thousands	Jul. 01, 2017BedsOperations	Aug. 01, 2017USD ($)Operations	Jun. 30, 2017USD ($)BedsOperations	Jun. 30, 2016USD ($)
Business Acquisition [Line Items]
Payments to Acquire Intangible Assets | $			$ 310
Payments to Acquire Businesses, Net of Cash Acquired | $			$ 41,645	$ 56,081
Operational Skilled Nursing Beds | Beds			18,400
Operational Assisted Living Units | Beds			4,700
Transitional and Skilled Services and Assisted and Independent Campuses [Member]
Business Acquisition [Line Items]
Number of Businesses Acquired			1
Home Health Agency [Member]
Business Acquisition [Line Items]
Number of Businesses Acquired			1
Hospice Agency [Member]
Business Acquisition [Line Items]
Number of Businesses Acquired			1
Assisted Living Facility [Member]
Business Acquisition [Line Items]
Number of Businesses Acquired			6
Operational Assisted Living Units | Beds			239
8051 Services, Skilled Nursing Care Facilities [Member]
Business Acquisition [Line Items]
Number of Businesses Acquired			4
Operational Skilled Nursing Beds | Beds			508
Skilled Nursing Care Facilities, Assisted Living Operations, Home Health and Hospice Agencies [Member] [Domain]
Business Acquisition [Line Items]
Payments to Acquire Businesses, Net of Cash Acquired | $			$ 41,763
8051 Services, Skilled Nursing Care Facilities [Member] | 8051 Services, Skilled Nursing Care Facilities [Member]
Business Acquisition [Line Items]
Number of Businesses Acquired			3
Operational Skilled Nursing Beds | Beds			385
Subsequent Event [Member] | Assisted Living and Independent Living Facility [Member] [Member]
Business Acquisition [Line Items]
Number of Businesses Acquired		3
Operational Skilled Nursing Beds | Beds	361
Subsequent Event [Member] | 8051 Services, Skilled Nursing Care Facilities [Member]
Business Acquisition [Line Items]
Number of Businesses Acquired	2
Operational Skilled Nursing Beds | Beds	194
Subsequent Event [Member] | Skilled Nursing, Assisted Living and Independent Living Facilities [Member]
Business Acquisition [Line Items]
Payments to Acquire Businesses, Net of Cash Acquired | $		$ 22,830

Acquisitions (Details)

Acquisitions (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2017	Jun. 30, 2016
Business Acquisition [Line Items]
Payments to Acquire Businesses, Gross	$ 41,763	$ 56,292
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Net	326	6
Land
Business Acquisition [Line Items]
Payments to Acquire Businesses, Gross	3,595	866
Building and improvements
Business Acquisition [Line Items]
Payments to Acquire Businesses, Gross	24,527	16,056
Equipment, furniture, and fixtures
Business Acquisition [Line Items]
Payments to Acquire Businesses, Gross	2,298	7,998
Assembled occupancy
Business Acquisition [Line Items]
Payments to Acquire Businesses, Gross	410	1,220
Definite-lived intangible assets
Business Acquisition [Line Items]
Payments to Acquire Businesses, Gross	0	363
Favorable leases
Business Acquisition [Line Items]
Payments to Acquire Businesses, Gross	0	393
Goodwill
Business Acquisition [Line Items]
Payments to Acquire Businesses, Gross	6,059	28,790
Other indefinite-lived intangible assets
Business Acquisition [Line Items]
Payments to Acquire Businesses, Gross	$ 4,548	$ 600

Property and Equipment (Details

Property and Equipment (Details) - USD ($) $ in Thousands	Jun. 30, 2017	Dec. 31, 2016
Property, Plant and Equipment [Line Items]
Property and equipment	$ 617,149	$ 594,534
Less: accumulated depreciation	(126,763)	(110,036)
Property and equipment, net	490,386	484,498
Land
Property, Plant and Equipment [Line Items]
Property and equipment	44,301	47,565
Building and improvements
Property, Plant and Equipment [Line Items]
Property and equipment	310,620	304,263
Equipment
Property, Plant and Equipment [Line Items]
Property and equipment	167,660	153,170
Furniture and fixtures
Property, Plant and Equipment [Line Items]
Property and equipment	5,425	6,931
Leasehold improvements
Property, Plant and Equipment [Line Items]
Property and equipment	86,340	80,164
Construction in progress
Property, Plant and Equipment [Line Items]
Property and equipment	$ 2,803	$ 2,441

Property and Equipment Addition

Property and Equipment Additional Disclosures (Details) $ in Thousands	Jun. 30, 2017USD ($)
Property, Plant and Equipment, Type [Abstract]
Sale Leaseback Transaction, Historical Cost	$ 24,847

Intangible Assets - Net (Detail

Intangible Assets - Net (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2017	Dec. 31, 2016
Acquired Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	$ 43,572	$ 43,162
Accumulated Amortization	(9,388)	(8,086)
Net	$ 34,184	35,076
Lease acquisition costs
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life (Years)	23 years 2 months
Gross Carrying Amount	$ 483	483
Accumulated Amortization	(89)	(78)
Net	$ 394	405
Favorable leases
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life (Years)	32 years 5 months 15 days
Gross Carrying Amount	$ 35,116	35,116
Accumulated Amortization	(5,579)	(4,589)
Net	$ 29,537	30,527
Assembled occupancy
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life (Years)	5 months 15 days
Gross Carrying Amount	$ 2,307	1,897
Accumulated Amortization	(2,048)	(1,897)
Net	$ 259	0
Trade name
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life (Years)	30 years
Gross Carrying Amount	$ 733	733
Accumulated Amortization	(281)	(269)
Net	$ 452	464
Customer relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life (Years)	18 years 6 months 20 days
Gross Carrying Amount	$ 4,933	4,933
Accumulated Amortization	(1,391)	(1,253)
Net	$ 3,542	$ 3,680

Intangible Assets - Net Additio

Intangible Assets - Net Additional Disclosures (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2017	Jun. 30, 2016	Jun. 30, 2017	Jun. 30, 2016
Finite-Lived Intangible Assets [Line Items]
Amortization of Intangible Assets	$ 690	$ 1,410	$ 1,302	$ 2,497

Intangible Assets - Net Future

Intangible Assets - Net Future Amortization (Details) - USD ($) $ in Thousands	Jun. 30, 2017	Dec. 31, 2016
Finite-Lived Intangible Assets, Net, Amortization Expense, Fiscal Year Maturity [Abstract]
2017 (remainder)	$ 1,388
2,018	2,321
2,019	2,301
2,020	2,301
2,021	2,270
2,022	2,244
Thereafter	21,359
Finite-Lived Intangible Assets, Net	$ 34,184	$ 35,076

Goodwill and Other Indefinite64

Goodwill and Other Indefinite-Lived Intangible Assets Goodwill Rollforward (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2017USD ($)
Goodwill [Line Items]
January 1, 2017	$ 67,100
Additions	6,059
June 30, 2017	73,159
Transitional and Skilled Services Segment [Member]
Goodwill [Line Items]
January 1, 2017	40,636
Additions	3,980
June 30, 2017	44,616
Assisted and Independent Living Services Segment [Member]
Goodwill [Line Items]
January 1, 2017	3,538
Additions	0
June 30, 2017	3,538
Home Health and Hospice Services
Goodwill [Line Items]
January 1, 2017	17,901
Additions	1,826
June 30, 2017	19,727
Other Segments [Member]
Goodwill [Line Items]
January 1, 2017	5,025
Additions	253
June 30, 2017	$ 5,278

Goodwill and Other Indefinite65

Goodwill and Other Indefinite-Lived Intangible Assets Indefinite-lived intangble assets (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2017	Dec. 31, 2016
Indefinite-lived Intangible Assets [Line Items]
Other indefinite-lived intangibles	$ 24,444	$ 19,586
Home Health and Hospice Services | Trade name
Indefinite-lived Intangible Assets [Line Items]
Other indefinite-lived intangibles	1,181	1,146
Home Health and Hospice Services | Medicare and Medicaid licenses
Indefinite-lived Intangible Assets [Line Items]
Other indefinite-lived intangibles	23,263	$ 18,440
Indefinite-lived Intangible Assets Acquired	4,823
Trade name | Medicare and Medicaid licenses
Indefinite-lived Intangible Assets [Line Items]
Indefinite-lived Intangible Assets Acquired	$ 35

Restricted and Other Assets (De

Restricted and Other Assets (Details) - USD ($) $ in Thousands	Jun. 30, 2017	Dec. 31, 2016
Other Assets [Abstract]
Debt issuance costs, net	$ 3,169	$ 3,611
Long-term insurance losses recoverable asset	4,662	4,104
Deposits with landlords	4,708	3,526
Capital improvement reserves with landlords and lenders	790	673
Note receivable from sale of urgent care centers	0	700
Restricted and other assets	$ 13,329	$ 12,614

Other Accrued Liabilities (Deta

Other Accrued Liabilities (Details) - USD ($) $ in Thousands	Jun. 30, 2017	Dec. 31, 2016
Accrued Liabilities [Abstract]
Quality assurance fee	$ 6,989	$ 4,604
Refunds payable	20,015	18,368
Deferred revenue	4,608	6,994
Cash held in trust for patients	2,460	2,373
Resident deposits	6,210	6,099
Dividends payable	2,182	2,186
Property taxes	8,058	9,130
Income tax payable	0	1,182
Operational closure liability	962	1,972
Other	7,303	5,855
Other accrued liabilities	$ 58,787	$ 58,763

Income Taxes Income Tax Other D

Income Taxes Income Tax Other Disclosures (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2017	Jun. 30, 2016	Jun. 30, 2017	Jun. 30, 2016
Operating Loss Carryforwards [Line Items]
(Gain)/losses related to operational closures (Note 7 and 17)	$ (1,286)	$ 0	$ 2,731	$ 7,935
Discontinued Operation, Tax Effect of Discontinued Operation			1,049	3,065
Litigation Settlement, Amount			11,000	0
Litigation Settlement, Tax Benefit			$ 4,220	$ 0

Debt (Details)

Debt (Details) - USD ($) $ in Thousands	Jun. 30, 2017	Dec. 31, 2016
Debt Instrument [Line Items]
Long-term Debt, Gross	$ 293,106	$ 284,157
Current maturities of long-term debt	(8,165)	(8,129)
Long Term Debt, net of Current Maturities and Debt Discount	284,465	275,486
SunTrust Bank [Member] | Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Credit facility with SunTrust	135,000	122,000
Second Amended Credit Facility [Member] | SunTrust Bank [Member] | Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Term loan with SunTrust, interest payable quarterly	144,375	148,125
Less: debt issuance costs	(476)	(542)
Collateralized Debt Obligations [Member] | Notes Payable, Other Payables [Member]
Debt Instrument [Line Items]
Mortgage loans and promissory note, principal and interest payable monthly, interest at fixed rate	$ 13,731	$ 14,032

Debt Additional Disclosures (De

Debt Additional Disclosures (Details) $ in Thousands	Feb. 05, 2016USD ($)Rate	Dec. 31, 2014Rate	Aug. 01, 2017USD ($)	Jun. 30, 2017USD ($)	Dec. 31, 2016USD ($)	Jul. 19, 2016USD ($)Rate
Collateralized Debt Obligations [Member] | Notes Payable, Other Payables [Member]
Long-Term Debt Additional Disclosures [Line Items]
Notes Payable				$ 13,731	$ 14,032
Notes Payable, Current				665
Notes Payable, Noncurrent				13,066
Collateralized Debt Obligations [Member] | Mortgage Loans on Real Estate [Member]
Long-Term Debt Additional Disclosures [Line Items]
Prepayment penalty reduced rate | Rate		1.00%
Secured Debt [Member] | Senior Debt Obligations [Member]
Long-Term Debt Additional Disclosures [Line Items]
Increase in Letters of Credit				450
Pledged Financial Instruments, Not Separately Reported, Securities for Letter of Credit Facilities				2,760
Minimum [Member] | Collateralized Debt Obligations [Member] | Notes Payable to Banks [Member]
Long-Term Debt Additional Disclosures [Line Items]
Debt Instrument, Interest Rate, Stated Percentage | Rate		2.60%
Minimum [Member] | Collateralized Debt Obligations [Member] | Mortgage Loans on Real Estate [Member]
Long-Term Debt Additional Disclosures [Line Items]
Debt Instrument, pre-payment fee reduction, term		3 years
Debt Instrument, Term		12 years
Maximum [Member] | Collateralized Debt Obligations [Member] | Notes Payable to Banks [Member]
Long-Term Debt Additional Disclosures [Line Items]
Debt Instrument, Interest Rate, Stated Percentage | Rate		5.30%
Maximum [Member] | Collateralized Debt Obligations [Member] | Mortgage Loans on Real Estate [Member]
Long-Term Debt Additional Disclosures [Line Items]
Debt Instrument, pre-payment fee reduction, term		11 years
Debt Instrument, Term		33 years
SunTrust Bank [Member] | Revolving Credit Facility [Member]
Long-Term Debt Additional Disclosures [Line Items]
Credit facility with SunTrust				135,000	122,000
Line of Credit Facility, Current Borrowing Capacity	$ 250,000
Line of Credit Facility, Maximum Borrowing Capacity	$ 150,000
Total Net Debt Ratio, Maximum	3.50
EBITDA Ratio, Maximum	1
Total Net Debt Ratio, Minimum	1.50
EBITDA Ratio, Minimum	1
Total Net Debt Ratio, Default	2.75
EBITDA Ratio, Default	1
Aggregate Revolving Commitment Percentage | Rate	10.00%
Total Net Debt Ratio, Cured	2.75
EBITDA Ratio, Cured	1
SunTrust Bank [Member] | Revolving Credit Facility [Member] | Second Amended Credit Facility [Member]
Long-Term Debt Additional Disclosures [Line Items]
Term Loan, Amount Outstanding, Current				7,500
Term Loan, Amount Outstanding, Noncurrent				136,875
Line of Credit Facility, Current Borrowing Capacity						$ 450,000
Long-term Line of Credit						300,000
Term Loan, Borrowing Capacity						$ 150,000
Line of Credit Facility, Interest Rate at Period End | Rate						5.00%
Term Loan and Line of Credit Facility, Amount Outstanding				279,375
Term loan with SunTrust, interest payable quarterly				$ 144,375	$ 148,125
SunTrust Bank [Member] | Revolving Credit Facility [Member] | Subsequent Event [Member] | Second Amended Credit Facility [Member]
Long-Term Debt Additional Disclosures [Line Items]
Term Loan and Line of Credit Facility, Amount Outstanding			$ 279,375
SunTrust Bank [Member] | Revolving Credit Facility [Member] | Minimum [Member]
Long-Term Debt Additional Disclosures [Line Items]
Line of Credit Facility, Interest Rate, Additional Margin | Rate	0.75%
Line of Credit Facility, Interest Rate, LIBOR | Rate	1.75%
Line of Credit Facility, Unused Capacity, Commitment Fee Percentage | Rate	0.30%
SunTrust Bank [Member] | Revolving Credit Facility [Member] | Maximum [Member]
Long-Term Debt Additional Disclosures [Line Items]
Line of Credit Facility, Interest Rate, Additional Margin | Rate	1.75%
Line of Credit Facility, Interest Rate, LIBOR | Rate	2.75%
Line of Credit Facility, Unused Capacity, Commitment Fee Percentage | Rate	0.50%

Options and Awards Lead Paragra

Options and Awards Lead Paragraphs (Details) shares in Thousands	Jun. 30, 2017Agreementsshares
Stock Options granted [Line Items]
Number of Option Plans | Agreements	4
Stock Issued or Granted During Period, Share-based Compensation [Abstract]
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Available for Grant	6,662
2017 Plan [Member] [Member]
Stock Issued or Granted During Period, Share-based Compensation [Abstract]
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Available for Grant	6,662
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Authorized	6,881

Options and Awards Valuation As

Options and Awards Valuation Assumptions (Details) - shares shares in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2017	Jun. 30, 2016	Jun. 30, 2017	Jun. 30, 2016
Fair Value Assumptions and Methodology
Issuance of restricted stock to employees	46	52	99	214
Options Granted	124	121	280	288
Weighted Average Risk-Free Rate	1.90%	1.49%	1.96%	1.40%
Expected Life	6 years 2 months 35 days	6 years 5 months 35 days	6 years 2 months 35 days	6 years 5 months 35 days
Weighted Average Volatility	35.80%	41.10%	35.80%	39.20%
Weighted Average Dividend Yield	0.89%	0.79%	0.84%	0.78%

Options and Awards Exercise Pri

Options and Awards Exercise Price and Fair Value (Details) - $ / shares shares in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2017	Jun. 30, 2016	Jun. 30, 2017	Jun. 30, 2016
Share-based Compensation Arrangement by Share-based Payment Award, Options, Grants in Period, Net of Forfeitures [Abstract]
Options Granted	124	121	280	288
Weighted Average Exercise Price			$ 19.55	$ 19.76
Weighted Average Fair Value of Options			6.84	7.42
Intrinsic Value of Options Granted on Grant Date [Abstract]
Share-based Compensation Arrangement by Share-based Payment Award, Options, Grants in Period, Grant Date Intrinsic Value			$ 0	$ 0

Options and Awards Options Outs

Options and Awards Options Outstanding Rollforward (Details) - $ / shares shares in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2017	Jun. 30, 2016	Jun. 30, 2017	Jun. 30, 2016
Options outstanding January 1, 2017			5,176
Weighted average exercise price January 1, 2017			$ 11.62
Options vested January 1, 2017			2,704
Weighted Average Exercise Price of Options Vested January 1, 2017			$ 8.18
Options Granted	124	121	280	288
Weighted Average Exercise Price, Options Granted			$ 19.55	$ 19.76
Options Forfeited in Period			(103)
Weighted Average Exercise Price, Options Forfeited in Period			$ 13.50
Options Exercised in Period			(295)
Weighted Average Exercise Price, Options Exercised in Period			$ 7.13
Options outstanding June 30, 2017	5,058		5,058
Weighted average exercise price June 30, 2017	$ 12.28		$ 12.28
Options vested June 30, 2017	2,957		2,957
Weighted Average Exercise Price of Options Vested June 30, 2017	$ 9.17		$ 9.17

Options and Awards Options Ou75

Options and Awards Options Outstanding by Exercise Price (Details) $ / shares in Units, shares in Thousands, $ in Thousands	6 Months Ended
	Jun. 30, 2017USD ($)$ / sharesshares
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Number of Outstanding Options	5,058
Black-Scholes Fair Value | $	$ 26,279
Stock Options Vested and Exercisable	2,957
2,008
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Exercise Price, Lower Range Limit | $ / shares	$ 2.56
Exercise Price, Upper Range Limit | $ / shares	$ 4.06
Number of Outstanding Options	332
Black-Scholes Fair Value | $	$ 492
Remaining Contractual Life (Years)	1 year
Stock Options Vested and Exercisable	332
2,009
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Exercise Price, Lower Range Limit | $ / shares	$ 4.06
Exercise Price, Upper Range Limit | $ / shares	$ 4.56
Number of Outstanding Options	504
Black-Scholes Fair Value | $	$ 1,081
Remaining Contractual Life (Years)	2 years
Stock Options Vested and Exercisable	504
2,010
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Exercise Price, Lower Range Limit | $ / shares	$ 4.77
Exercise Price, Upper Range Limit | $ / shares	$ 4.96
Number of Outstanding Options	132
Black-Scholes Fair Value | $	$ 321
Remaining Contractual Life (Years)	3 years
Stock Options Vested and Exercisable	132
2,011
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Exercise Price, Lower Range Limit | $ / shares	$ 5.90
Exercise Price, Upper Range Limit | $ / shares	$ 7.99
Number of Outstanding Options	155
Black-Scholes Fair Value | $	$ 528
Remaining Contractual Life (Years)	4 years
Stock Options Vested and Exercisable	155
2,012
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Exercise Price, Lower Range Limit | $ / shares	$ 6.56
Exercise Price, Upper Range Limit | $ / shares	$ 7.96
Number of Outstanding Options	474
Black-Scholes Fair Value | $	$ 1,750
Remaining Contractual Life (Years)	5 years
Stock Options Vested and Exercisable	387
2,013
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Exercise Price, Lower Range Limit | $ / shares	$ 7.98
Exercise Price, Upper Range Limit | $ / shares	$ 11.49
Number of Outstanding Options	567
Black-Scholes Fair Value | $	$ 2,763
Remaining Contractual Life (Years)	6 years
Stock Options Vested and Exercisable	382
2,014
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Exercise Price, Lower Range Limit | $ / shares	$ 10.55
Exercise Price, Upper Range Limit | $ / shares	$ 18.94
Number of Outstanding Options	1,565
Black-Scholes Fair Value | $	$ 8,880
Remaining Contractual Life (Years)	7 years
Stock Options Vested and Exercisable	844
2,015
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Exercise Price, Lower Range Limit | $ / shares	$ 21.47
Exercise Price, Upper Range Limit | $ / shares	$ 25.24
Number of Outstanding Options	578
Black-Scholes Fair Value | $	$ 5,260
Remaining Contractual Life (Years)	8 years
Stock Options Vested and Exercisable	168
2,016
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Exercise Price, Lower Range Limit | $ / shares	$ 18.79
Exercise Price, Upper Range Limit | $ / shares	$ 19.89
Number of Outstanding Options	471
Black-Scholes Fair Value | $	$ 3,293
Remaining Contractual Life (Years)	9 years
Stock Options Vested and Exercisable	53
2,017
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Exercise Price, Lower Range Limit | $ / shares	$ 18.64
Exercise Price, Upper Range Limit | $ / shares	$ 20.28
Number of Outstanding Options	280
Black-Scholes Fair Value | $	$ 1,911
Remaining Contractual Life (Years)	10 years
Stock Options Vested and Exercisable	0

Options and Awards Restricted A

Options and Awards Restricted Awards Granted (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2017	Jun. 30, 2016	Jun. 30, 2017	Jun. 30, 2016
Restricted awards granted [Line Items]
Restricted Awards Grant Date Fair Value Range, Minimum			$ 18.47	$ 19.58
Restricted Awards Grant Date Fair Value Range, Maximum			$ 20.68	$ 23.23
Share-based Compensation, Restricted Awards, Exercise Price			$ 0
Issuance of restricted stock to employees	46	52	99	214
Share-based Compensation Arrangement by Share-based Payment Award, Award Vesting Period			5 years
Director [Member]
Restricted awards granted [Line Items]
Restricted Awards Grant Date Fair Value Range, Minimum			$ 18.47
Restricted Awards Grant Date Fair Value Range, Maximum			$ 20.68
Options Granted to Non-employee Directors	8		15

Options and Awards Restricted77

Options and Awards Restricted Award Rollforward (Details) - $ / shares shares in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2017	Jun. 30, 2016	Jun. 30, 2017	Jun. 30, 2016
Restricted Stock Rollforward [Line Items]
Nonvested Restricted Awards, Nonvested at January 1, 2017			429
Weighted Average Grant Date Fair Value, Nonvested at January 1, 2017			$ 20.42
Issuance of restricted stock to employees	46	52	99	214
Weighted Average Grant Date Fair Value, Restricted Awards Granted in the Period			$ 19.40
Nonvested Restricted Awards, Vested in the Period			(75)
Weighted Average Grant Date Fair Value, Restricted Awards Vested in the Period			$ 18.79
Nonvested Restricted Awards, Forfeited in the Period			(7)
Weighted Average Grant Date Fair Value, Restricted Awards Forfeited in the Period			$ 18.97
Nonvested Restricted Awards, Nonvested at June 30, 2017	446		446
Weighted Average Grant Date Fair Value, Nonvested at June 30, 2017	$ 20.49		$ 20.49

Options and Awards Compensation

Options and Awards Compensation Expense (Details) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2017	Jun. 30, 2016	Jun. 30, 2017	Jun. 30, 2016
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Share-based compensation expense	$ 2,039	$ 2,137	$ 3,930	$ 4,022
Employee Service Share-based Compensation, Nonvested Awards, Total Compensation Cost Not yet Recognized [Abstract]
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding, Weighted Average Remaining Contractual Term			5 years 9 months 40 days
Stock Options
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Share-based compensation expense	1,319	1,319	$ 2,526	2,503
Employee Service Share-based Compensation, Nonvested Awards, Total Compensation Cost Not yet Recognized [Abstract]
Employee Service Share-based Compensation, Nonvested Awards, Total Compensation Cost Not yet Recognized	$ 12,304		$ 12,304
Employee Service Share-based Compensation, Nonvested Awards, Total Compensation Cost Not yet Recognized, Period for Recognition			3 years
Employee Service Share-based Compensation, Nonvested Awards	2,101		2,101
Share-based Compensation Arrangement by Share-based Payment Award, Options, Expected to Vest, Number	1,998		1,998
Restricted Stock Awards
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Share-based compensation expense	$ 588	652	$ 1,140	1,200
Employee Service Share-based Compensation, Nonvested Awards, Total Compensation Cost Not yet Recognized [Abstract]
Employee Service Share-based Compensation, Nonvested Awards, Total Compensation Cost Not yet Recognized	7,814		$ 7,814
Employee Service Share-based Compensation, Nonvested Awards, Total Compensation Cost Not yet Recognized, Period for Recognition			3 years 4 months 10 days
Stock awards
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Share-based compensation expense	$ 132	$ 166	$ 264	$ 319

Options and Awards Intrinsic Va

Options and Awards Intrinsic Values (Details) - Stock Options - USD ($) $ in Thousands	6 Months Ended	12 Months Ended
	Jun. 30, 2017	Dec. 31, 2016
Outstanding	$ 48,939	$ 55,610
Vested	37,505	38,101
Expected to Vest	10,493	15,983
Exercised	$ 3,739	$ 9,199

Options and Awards Subsidiary E

Options and Awards Subsidiary Equity Plan (Details) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2017	Jun. 30, 2016	Jun. 30, 2017	Jun. 30, 2016
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Award Vesting Period			5 years
Employee stock award compensation	$ 2,039	$ 2,137	$ 3,930	$ 4,022
Subsidiaries [Member] | Subsidiaries Stock awards [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Award Vesting Period			5 years
Employee stock award compensation	$ 337	$ 643	$ 670	$ 643
Common Stock Required to Settle Subsidiary Shares	269	226	269	226

Leases (Details)

Leases (Details) $ in Thousands	Jun. 01, 2014facilities	Jun. 30, 2017USD ($)facilities	Jun. 30, 2016USD ($)	Jun. 30, 2017USD ($)facilitiesRenewals	Jun. 30, 2016USD ($)
Operating Leased Assets [Line Items]
Master Lease agreements		6		6
Operating Leases, Rent Expense | $		$ 32,851	$ 30,916	$ 64,843	$ 58,051
Average operating lease minimum term				5 years
Average operating lease maximum term				20 years
Average non-cancellable equipment leases minimum term				3 years
Average non-cancellable equipment lease maximum term				5 years
Facilities under master lease arrangement		25		25
Various Landlords[Member] [Member]
Operating Leased Assets [Line Items]
Lessee Leasing Arrangements, Operating Leases, Term of Contract				15 years
Lessee Leasing Arrangements, Operating Leases, Number of Renewal Terms, Minimum | Renewals				2
Lessee Leasing Arrangements, Operating Leases, Renewal Term				5 years
CareTrust REIT [Member]
Operating Leased Assets [Line Items]
Payments for Rent | $		$ 14,217	$ 14,039	$ 28,333	$ 28,039
Average operating lease minimum term	12 years
Average operating lease maximum term	19 years
Operating Leases of Lessee, Contingent Rentals, Description of Variable Rate Basis	0.025
Real Estate Investment Trust Spin-Off Transaction [Member] | CareTrust REIT [Member]
Operating Leased Assets [Line Items]
Skilled Nursing, Assisted Living and Independent Living Facilities	93
Master Lease agreements	8

Leases Additional Disclosures (

Leases Additional Disclosures (Details) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2017USD ($)	Jun. 30, 2016USD ($)	Jun. 30, 2017USD ($)facilities	Jun. 30, 2016USD ($)facilities
Operating Leased Assets [Line Items]
Gain (Loss) on Contract Termination			$ 2,715	$ 6,512
(Gain)/losses related to operational closures (Note 7 and 17)	$ (1,286)	$ 0	$ 2,731	$ 7,935
Skilled Nursing, Assisted Living and Independent Living Facilities [Member]
Operating Leased Assets [Line Items]
Number of Businesses with Lease Terminations | facilities			4
8051 Services, Skilled Nursing Care Facilities [Member]
Operating Leased Assets [Line Items]
Number of Businesses with Lease Terminations | facilities			1
Disposal Group, Disposed of by Means Other than Sale, Not Discontinued Operations [Member] | 8051 Services, Skilled Nursing Care Facilities [Member]
Operating Leased Assets [Line Items]
Number of Businesses Closed | facilities			1	1
Facility Closing [Member]
Operating Leased Assets [Line Items]
(Gain)/losses related to operational closures (Note 7 and 17)	$ (1,286)		$ 2,830
Contract Termination [Member]
Operating Leased Assets [Line Items]
(Gain)/losses related to operational closures (Note 7 and 17)			$ 1,187

Leases Sale Leaseback Transacti

Leases Sale Leaseback Transactions (Details) - USD ($) $ in Thousands	Jun. 01, 2017	Jun. 30, 2017
Sale Leaseback Transaction [Line Items]
Sale Leaseback Transaction, Lease Terms	20
Sale Leaseback Transaction, Gross Proceeds, Investing Activities	$ 38,000
Sale Leaseback Transaction, Historical Cost		$ 24,847
Sale Leaseback Transaction, Current Period Gain Recognized		$ 13,153
Number of Optional Lease Extension [Member] [Member]
Sale Leaseback Transaction [Line Items]
Sale Leaseback Transaction, Lease Terms	3
Optional Lease Extension [Member]
Sale Leaseback Transaction [Line Items]
Sale Leaseback Transaction, Lease Terms	5
8051 Services, Skilled Nursing Care Facilities [Member]
Sale Leaseback Transaction [Line Items]
Sale Leaseback Transaction, Description of Asset(s)	2
Assisted Living Facility [Member]
Sale Leaseback Transaction [Line Items]
Sale Leaseback Transaction, Description of Asset(s)	1

Leases Future minimum lease pay

Leases Future minimum lease payments (Details) $ in Thousands	Jun. 30, 2017USD ($)
Leases [Abstract]
2017 (remainder)	$ 82,757
2,018	132,331
2,019	131,633
2,020	131,149
2,021	130,408
2,022	128,449
Thereafter	994,990
Operating Leases, Future Minimum Payments Due	$ 1,731,717

Commitments and Contingencies L

Commitments and Contingencies Litigation (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2017	Jun. 30, 2016
Litigation [Line Items]
Litigation Settlement, Amount	$ 11,000	$ 0

Commitments and Contingencies M

Commitments and Contingencies Medicare Revenue Recoupments (Details)	6 Months Ended
	Jun. 30, 2017facilities
Medicare Probe Reviews [Abstract]
Facilities under Medicare Probe Reviews	5

Commitments and Contingencies O

Commitments and Contingencies Other Matters (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2013USD ($)
Other Commitments [Line Items]
Litigation Settlement Paid to U.S. Government	$ 48,000

Commitments and Contingencies C

Commitments and Contingencies Concentrations (Details)	3 Months Ended		6 Months Ended
	Jun. 30, 2017Rate	Jun. 30, 2016Rate	Jun. 30, 2017Rate	Jun. 30, 2016Rate	Dec. 31, 2016Rate
Concentration Risk [Line Items]
% of Revenue	100.00%	100.00%	100.00%	100.00%
Total Medicaid and Medicare
Concentration Risk [Line Items]
Accounts receivable by payor as a percent of total accounts receivable	56.40%		56.40%		58.60%
% of Revenue	68.20%	68.00%	68.20%	67.30%

Commitments and Contingencies89

Commitments and Contingencies Cash in Excess of FDIC Limits (Details) - USD ($) $ in Thousands	Aug. 01, 2017	Jun. 30, 2017
Cash in Excess of FDIC limits [Line Items]
Cash, FDIC Insured Amount		$ 250
Subsequent Event [Member]
Cash in Excess of FDIC limits [Line Items]
Cash, Uninsured Amount	$ 136