Genesis Healthcare (GENN) 10-Q 3 Nov 14 2014 Q3 Quarterly report Financial data

Document_and_Entity_Informatio

Document and Entity Information Document	9 Months Ended
	Sep. 30, 2014	Oct. 31, 2014	Oct. 31, 2014
		Common Class A	Common Class B
Entity Listings [Line Items]	'	'	'
Entity Registrant Name	'Skilled Healthcare Group, Inc.	'	'
Entity Central Index Key	'0001351051	'	'
Current Fiscal Year End Date	'--12-31	'	'
Entity Filer Category	'Accelerated Filer	'	'
Document Type	'10-Q	'	'
Document Period End Date	30-Sep-14	'	'
Document Fiscal Year Focus	'2014	'	'
Document Fiscal Period Focus	'Q3	'	'
Amendment Flag	'false	'	'
Entity Common Stock, Shares Outstanding	'	24,616,068	15,511,603

Condensed_Consolidated_Balance

Condensed Consolidated Balance Sheets (USD $)	Sep. 30, 2014	Dec. 31, 2013
In Thousands, unless otherwise specified
Current assets:	'	'
Cash and cash equivalents	$10,536	$4,177
Accounts receivable, less allowance for doubtful accounts of $19,241 and $16,665 at September 30, 2014 and December 31, 2013, respectively	114,598	107,215
Deferred income taxes	14,627	9,876
Prepaid expenses	5,019	8,961
Other current assets	12,858	12,188
Total current assets	157,638	142,417
Property and equipment, less accumulated depreciation of $155,097 and $137,484 at September 30, 2014 and December 31, 2013, respectively	333,285	341,822
Leased facility assets, less accumulated depreciation of $4,791 and $4,432 at September 30, 2014 and December 31, 2013, respectively	9,057	9,416
Other assets:	'	'
Notes receivable	2,117	520
Deferred financing costs, net	8,043	9,189
Goodwill	68,833	69,065
Intangible assets, less accumulated amortization of $4,879 and $4,640 at September 30, 2014 and December 31, 2013, respectively	18,569	18,807
Deferred income taxes	5,146	9,472
Restricted Assets	31,462	26,965
Other assets	15,747	15,743
Total other assets	149,917	149,761
Total assets	649,897	643,416
Current liabilities:	'	'
Accounts payable and accrued liabilities	64,739	57,179
Employee compensation and benefits	42,201	32,979
Current portion of long-term debt	13,173	7,630
Total current liabilities	120,113	97,788
Long-term liabilities:	'	'
Insurance liability risks	28,075	29,534
Other long-term liabilities	12,641	12,367
Long-term debt, less current portion	394,644	411,495
Total liabilities	555,473	551,184
Stockholdersb equity:	'	'
Additional paid-in-capital	381,818	378,756
Accumulated deficit	-287,435	-286,592
Accumulated other comprehensive income	0	28
Total stockholdersb equity	94,424	92,232
Total liabilities and stockholdersb equity	649,897	643,416
Common Class A	'	'
Stockholdersb equity:	'	'
Common stock	25	24
Common Class B	'	'
Stockholdersb equity:	'	'
Common stock	$16	$16

Condensed_Consolidated_Balance1

Condensed Consolidated Balance Sheets (Parentheticals) (USD $)	Sep. 30, 2014	Dec. 31, 2013
In Thousands, except Share data, unless otherwise specified
Current Assets:	'	'
Allowance for doubtful accounts	$19,241	$16,665
Noncurrent Assets:	'	'
Accumulated depreciation on property and equipment	155,097	137,484
Accumulated depreciation for leased facility assets	4,791	4,432
Accumulated amortization on intangible assets	$4,879	$4,640
Common Class A	'	'
Stockholders' Equity:	'	'
Common Stock, Par or Stated Value Per Share (usd per share)	$0.00	$0.00
Common Stock, Shares Authorized	175,000,000	175,000,000
Common Stock, Shares, Issued	24,619,000	24,278,000
Common Stock, Shares, Outstanding	24,619,000	24,278,000
Common Class B	'	'
Stockholders' Equity:	'	'
Common Stock, Par or Stated Value Per Share (usd per share)	$0.00	$0.00
Common Stock, Shares Authorized	30,000,000	30,000,000
Common Stock, Shares, Issued	15,512,000	15,515,000
Common Stock, Shares, Outstanding	15,512,000	15,515,000

Condensed_Consolidated_Stateme

Condensed Consolidated Statements of Operations (USD $)	3 Months Ended		9 Months Ended
In Thousands, except Per Share data, unless otherwise specified	Sep. 30, 2014	Sep. 30, 2013	Sep. 30, 2014	Sep. 30, 2013
Revenue:	'	'	'	'
Net patient service revenue	$207,811	$207,957	$620,496	$631,660
Leased facility revenue	807	787	2,401	2,335
Total revenue	208,618	208,744	622,897	633,995
Expenses:	'	'	'	'
Cost of services (exclusive of rent cost of revenue and depreciation and amortization shown below)	176,689	181,078	535,527	550,164
Rent cost of revenue	5,146	4,806	14,842	14,160
General and administrative	12,780	6,490	26,151	19,782
Change in fair value of contingent consideration	7	79	-100	-2,082
Depreciation and amortization	6,120	5,900	18,240	17,700
Governmental investigation expense	0	0	6,000	0
Impairment of long-lived assets	0	19,000	82	19,000
Loss on disposal of asset	68	0	73	0
Expenses	200,810	217,353	600,815	618,724
Other (expenses) income:	'	'	'	'
Interest expense	-8,009	-8,744	-23,993	-26,153
Interest income	173	63	518	287
Other (expense) income, net	-26	-49	34	-111
Equity in earnings of joint venture	568	508	1,206	1,469
Debt modification/retirement costs	-21	-432	-843	-1,520
Total other (expenses) income, net	-7,315	-8,654	-23,078	-26,028
Income (loss) from continuing operations before benefit from income taxes	493	-17,263	-996	-10,757
Benefit from income taxes	-150	-5,324	-153	-3,940
Allocation of income (loss) from continuing operations	643	-11,939	-843	-6,817
Income (loss) from continuing operations	643	-11,939	-843	-6,817
Loss from discontinued operations, net of tax	0	-136	0	-665
Net (loss) income	$643	($12,075)	($843)	($7,482)
(Loss) earnings per common share from continuing operations (usd per share)	$0.02	($0.32)	($0.02)	($0.18)
Loss per share from discontinued operations (usd per share)	$0	$0	$0	($0.02)
(Loss) earnings per share (usd per share)	$0.02	($0.32)	($0.02)	($0.20)
(Loss) earnings per common share from continuing operations (usd per share)	$0.02	($0.32)	($0.02)	($0.18)
Loss per share from discontinued operations (usd per share)	$0	$0	$0	($0.02)
(Loss) earnings per share (usd per share)	$0.02	($0.32)	($0.02)	($0.20)
Weighted-average common shares outstanding, basic (in shares)	38,207	37,499	38,093	37,567
Weighted-average common shares outstanding, diluted (in shares)	38,463	37,499	38,093	37,567

Condensed_Consolidated_Stateme1

Condensed Consolidated Statements of Comprehensive Income (USD $)	3 Months Ended		9 Months Ended
In Thousands, unless otherwise specified	Sep. 30, 2014	Sep. 30, 2013	Sep. 30, 2014	Sep. 30, 2013
Statement of Comprehensive Income [Abstract]	'	'	'	'
Net income (loss)	$643	($12,075)	($843)	($7,482)
Other comprehensive income (loss):	'	'	'	'
Unrealized loss on investment available for sale - net of income tax (benefit) of ($2) for the three months ended September 30, 2013; net of income tax (benefit) of ($13) for the nine months ended September 30, 2013.	0	-3	0	-19
Reclassification adjustments:	'	'	'	'
Gain realized in net loss on investments available for sale - net of income tax expense of $17 for the nine months ended September 30, 2014.	0	0	-28	0
Interest expense on interest rate swap - net of income tax expense of $107 for the nine months ended September 30, 2013.	0	0	0	169
Other comprehensive income (loss), net of tax	0	-3	-28	150
Comprehensive income (loss)	$643	($12,078)	($871)	($7,332)

Condensed_Consolidated_Stateme2

Condensed Consolidated Statements of Comprehensive Income (Parenthetical) (USD $)	3 Months Ended		9 Months Ended
In Thousands, unless otherwise specified	Sep. 30, 2014	Sep. 30, 2013	Sep. 30, 2014	Sep. 30, 2013
Statement of Comprehensive Income [Abstract]	'	'	'	'
Unrealized gain (loss) on interest rate swap, tax	$0	$0	'	$0
Unrealized gain (loss) on Investment available for sale, tax	0	-2	0	-13
Other Comprehensive Income (Loss), Reclassification Adjustment from AOCI for Sale of Securities, Tax	0	0	17	0
Interest expense on interest rate swap, tax	$0	$0	$0	$107

Condensed_Consolidated_Stateme3

Condensed Consolidated Statements of Cash Flows (USD $)	9 Months Ended
In Thousands, unless otherwise specified	Sep. 30, 2014	Sep. 30, 2013
Cash Flows from Operating Activities	'	'
Net loss	($843)	($7,482)
Adjustments to reconcile net loss to net cash provided by operating activities:	'	'
Depreciation and amortization	18,240	18,396
Change in fair value of contingent consideration	100	2,082
Provision for doubtful accounts	10,362	8,758
Non-cash stock-based compensation	2,459	2,235
Loss on disposal of assets	73	379
Amortization of deferred financing costs	2,526	2,102
Debt modification/retirement costs	843	1,520
Deferred income taxes	-425	-2,284
Impairment of long lived assets	82	19,000
Amortization of discount on debt	416	710
Changes in operating assets and liabilities:	'	'
Accounts receivable	-20,535	-8,528
Payments on notes receivable	1,173	2,304
Other current and non-current assets	1,240	-3,036
Accounts payable and accrued liabilities	8,351	2,462
Employee compensation and benefits	6,275	-3,658
Insurance liability risks	949	6,949
Other long-term liabilities	373	-913
Net cash provided by operating activities	31,459	36,832
Cash Flows from Investing Activities	'	'
Additions to property and equipment	-9,243	-9,977
Proceeds from maturity of investments	1,060	0
Proceeds from the sale of home health agency	30	0
Proceeds from the sale of land	66	0
Net cash used in investing activities	-8,087	-9,977
Cash Flows from Financing Activities	'	'
Borrowings under line of credit	224,500	254,083
Repayments under line of credit	-233,392	-287,583
Repayments of long-term debt	-6,500	-67,055
Proceeds from exercise of stock options	948	0
Taxes paid related to net share settlement of equity awards	-346	-188
Proceeds from issuance of long-term debt	0	79,806
Payment of financing costs	-2,223	-5,326
Net cash used in financing activities	-17,013	-26,263
Increase in cash and cash equivalents	6,359	592
Cash and cash equivalents at beginning of period	4,177	2,003
Cash and cash equivalents at end of period	$10,536	$2,595

Condensed_Consolidated_Stateme4

Condensed Consolidated Statements of Cash Flows (Parentheticals) (USD $)	9 Months Ended
In Thousands, unless otherwise specified	Sep. 30, 2014	Sep. 30, 2013
Cash paid for:	'	'
Interest expense	$19,902	$23,743
Income taxes, net	-1,866	184
Non-cash activities:	'	'
Conversion of accounts receivable into notes receivable	2,782	0
Insurance premium financed	$3,668	$5,875

Description_of_Business

Description of Business	9 Months Ended
	Sep. 30, 2014
Organization, Consolidation and Presentation of Financial Statements [Abstract]	'
Description of Business	'
	Description of Business
	Skilled Healthcare Group, Inc. ("Skilled") is a holding company that owns subsidiary companies that operate long-term care facilities and provides a wide range of post-acute care services, with a strategic emphasis on sub-acute specialty medical care. Skilled and its consolidated wholly-owned companies are collectively referred to as the "Company." As of September 30, 2014, the Company operated facilities in California, Iowa, Kansas, Missouri, Nevada, Nebraska, New Mexico and Texas, including 73 skilled nursing facilities ("SNFs"), which offer sub-acute care, rehabilitative, specialty healthcare, and skilled nursing care, and 22 assisted living facilities ("ALFs"), which provide room and board and assistance with activities of daily living. The Company leases five skilled nursing facilities in California to an unaffiliated third party operator. In addition, through its Hallmark Rehabilitation subsidiary ("Hallmark"), the Company provides a variety of rehabilitative services such as physical, occupational and speech therapy in Company-operated facilities and unaffiliated facilities. Furthermore, as of September 30, 2014, the Company provided hospice care and home health services in Arizona, California, Idaho, Montana, Nevada and New Mexico. The Company also provides private duty care services in Montana and Nevada. The Company has an administrative services company that provides a full complement of administrative and consultative services that allows affiliated operators and third-party operators with whom the Company contracts to better focus on delivery of healthcare services. The Company currently has one such service agreement with an unrelated skilled nursing facility operator. The Company also owns a 50% interest in an institutional pharmacy in Texas, which currently serves eight of the Company's SNFs as well as other facilities unaffiliated with the Company.

Discontinued_Operations_Notes

Discontinued Operations (Notes)	9 Months Ended
	Sep. 30, 2014
Discontinued Operations and Disposal Groups [Abstract]	'
Discontinued Operations	'
	Discontinued Operations
	On December 1, 2013, the Company disposed of one owned SNF in Texas and one leased SNF in California. The results of operations of these facilities for all periods presented and the losses associated with the transaction have been classified as discontinued operations, net of tax, in the accompanying condensed consolidated statements of operations as the operations have been eliminated from the Company’s ongoing operations.
	Our selected historical consolidated statements of operations have been recast to reflect our disposal of two skilled nursing facilities on December 1, 2013, as discontinued operations for the quarters ended September 30, 2014 and September 30, 2013. Please refer to the information set forth below in conjunction with other sections of this report, including our consolidated historical financial statements and related notes included elsewhere in this report.
	A summary of the discontinued operations for the periods presented is as follows (in thousands):
		Three Months Ended September 30,					Nine Months Ended September 30,
		2014		2013			2014		2013
	Net operating revenues	$	—	$	3,701		$	—	$	11,018
	Operating expenses	—		3,923			—		12,103
	Loss from discontinued operations	—		(222		)	—		(1,085		)
	Income tax benefit	—		(86		)	—		(420		)
	Loss from discontinued operations	$	—	$	(136	)	$	—	$	(665	)

Summary_of_Significant_Account

Summary of Significant Accounting Policies	9 Months Ended
	Sep. 30, 2014
Accounting Policies [Abstract]	'
Summary of Significant Accounting Policies	'
	Summary of Significant Accounting Policies
	Basis of Presentation
	The accompanying condensed consolidated financial statements as of September 30, 2014 and for the three and nine months ended September 30, 2014 and 2013 (collectively, the "Interim Financial Statements"), are unaudited. Certain information and footnote disclosures normally included in the Company’s annual consolidated financial statements have been condensed or omitted, as permitted under applicable U.S. Securities and Exchange Commission rules and regulations. Readers of the Interim Financial Statements should refer to the Company's audited consolidated financial statements and notes thereto (as updated by Note 3, "Summary of Significant Accounting Policies," in this filing), for the year ended December 31, 2013, which are included in the Company's 2013 Annual Report on Form 10-K filed with the Securities and Exchange Commission ("SEC"). Management believes that the Interim Financial Statements reflect all adjustments that are of a normal and recurring nature necessary to fairly present the Company's financial information in all material respects as of the dates and for the periods presented. The results of operations presented in the Interim Financial Statements are not necessarily indicative of operations to be expected for the entire year or any other period.
	The accompanying Interim Financial Statements include the accounts of Skilled and its consolidated wholly-owned subsidiaries. All significant intercompany transactions have been eliminated in consolidation.
	Estimates and Assumptions
	The interim financial statements have been prepared in conformity with accounting principles generally accepted in the United States of America ("U.S. GAAP"), which require the Company to consolidate company financial information and make estimates and assumptions that affect the reported amounts of assets and liabilities, disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenue and expenses during the reporting period. The most significant estimates in the Company’s interim financial statements relate to revenue, allowance for doubtful accounts, self-insured liability risks, income taxes, governmental investigation, and valuation of contingent consideration.
	Revenue and Accounts Receivables
	Revenue and accounts receivable are recorded on an accrual basis as services are performed at their estimated net realizable value. The Company derives a majority of its revenue from funds under federal Medicare and state Medicaid assistance programs, the continuation of which are dependent upon governmental policies and are subject to audit risk and potential recoupment.
	The Company is participating in the recently established Upper Payment Limit (UPL) supplemental payment program in the state of Texas that provides supplemental Medicaid payments for skilled nursing facilities that are licensed to non-state government entities such as county hospital districts.  Company subsidiaries previously operating twenty Company-owned Texas skilled nursing facilities entered into transactions with such hospital districts providing for the transfer of the licenses for the twenty of the Company-owned Texas skilled nursing facilities to the hospital districts, and providing further for the Company’s operating subsidiaries to retain the management of those facilities on behalf of the hospital districts, which are all participating in the UPL program. Each affected Operating subsidiary therefore retains operations of its skilled nursing facility and each agreement between the hospital district and the Company subsidiary is terminable by either party to fully restore the prior license status. The Company may add an additional nursing center sometime during the remainder of 2014.
	Overall payments made by Medicare for hospice services are subject to an annual cap amount on a per hospice agency basis. Total Medicare payments received for services rendered during the applicable Medicare hospice cap year by each Medicare-certified agency during this period are compared to the cap amount for the relevant period. Payments in excess of the cap are subject to refund to and recoupment by Medicare. For the three months ended September 30, 2014 and 2013, the Company recorded hospice Medicare cap reserves of $1.2 million and $0.5 million, respectively, as adjustments to revenue. Of the $1.2 million recorded in the three months ended September 30, 2014, $1.4 million was related to the 2014 cap year and reversal of $0.2 million was related to the 2013 cap year. Of the $0.5 million recorded in the three months ended September 30, 2013, $0.2 million was related to the 2013 cap year and $0.3 million was related to the 2012 cap year. For the nine months ended September 30, 2014 and 2013, the Company recorded hospice Medicare cap reserves of $2.1 million and $3.4 million, respectively, as adjustments to revenue. Of the $2.1 million recorded in the nine months ended September 30, 2014, $2.0 million was related to the 2014 cap year and $0.1 million was related to the 2013 cap year. Of the $3.4 million recorded in the nine months ended September 30, 2013, $0.9 million was related to the 2013 cap year, $2.3 million was related to the 2012 cap year, and $0.2 million was related to the 2011 cap year.
	Notes Receivable
	As of September 30, 2014 and December 31, 2013, net notes receivable were approximately $3.6 million and $2.0 million, respectively, of which $1.5 million was reflected as current assets as of September 30, 2014 and December 31, 2013, respectively, with the remaining balances reflected as long-term assets. Interest rates on these notes approximated market rates as of the date the notes were originated.
	As of September 30, 2014, two customers of the Company's rehabilitation therapy services business were responsible for 100% of the net notes receivable balance. The notes receivable, as well as the receivables from these customers, are secured by the assets of the customers as well as personal guaranties by the principal owners of the customers. Additionally, the customers represented $6.4 million, or 35.9% of the net accounts receivable for the Company's rehabilitation therapy services business and approximately $28.5 million, or 41.8%, of the external revenue of the rehabilitation therapy services business for the nine months ended September 30, 2014.
	At September 30, 2014, there was no note receivable reserve balance.
	Recent Accounting Pronouncement
	In April 2014, the FASB issued ASU No. 2014-08, Reporting Discontinued Operations and Disclosures of Disposals of Components of an Entity, ("ASU 2014-08").  This ASU requires an entity to report disposed components or components held-for-sale in discontinued operations if such components represent a strategic shift that has or will have a significant effect on operations and financial results. Additionally, expanded disclosure about discontinued operations and disposals of significant components that do not qualify for discontinued operations presentation will be required. The adoption of ASU 2014-08 is effective prospectively for disposals that occur within annual periods beginning on or after December 15, 2014, with early adoption permitted. The Company is currently evaluating the impact of the ASU on its consolidated financial statements.
	In May 2014, the FASB issued ASU No. 2014-09, Revenue from Contracts with Customers, ("ASU 2014-08").  This ASU requires an entity to recognize revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration to which the entity expects to be entitled in exchange for those goods or services. To achieve this core principle, the guidance provides that an entity should apply the following steps: (1) identify the contract(s) with a customer; (2) identify the performance obligations in the contract; (3) determine the transaction price; (4) allocate the transaction price to the performance obligations in the contract; and (5) recognize revenue when, or as, the entity satisfies a performance obligation. The ASU is effective beginning in the first quarter of our fiscal year 2017. Early adoption is not permitted. The Company is currently evaluating the impact to the consolidated financial statements.

Income_Per_Share

Income Per Share	9 Months Ended
	Sep. 30, 2014
Earnings Per Share [Abstract]	'
Income Per Share	'
	Income (loss) Per Share
	The Company computes income (loss) per share of Class A common stock and Class B common stock using the two-class method. The Company's Class A common stock and Class B common stock are identical in all respects, except with respect to voting rights and that each share of Class B common stock is convertible into one share of Class A common stock under certain circumstances. Income (loss) is allocated on a proportionate basis to each class of common stock in the determination of income (loss) per share.
	Basic net income (loss) per share was computed by dividing net income (loss) by the weighted-average number of outstanding shares for the period. Diluted earnings per share is computed by dividing income (loss) plus the effect of assumed conversions (if applicable) by the weighted-average number of outstanding shares after giving effect to all potential dilutive common stock, including options, warrants, common stock subject to repurchase and convertible preferred stock, if any. The following table sets forth the computation of basic and diluted net (loss) income per share of Class A common stock and Class B common stock for the three and nine months ended September 30, 2014 and September 30, 2013 (amounts in thousands, except per share data):
		Three months ended September 30, 2014								Three months ended September 30, 2013									Nine months ended September 30, 2014									Nine months ended September 30, 2013
		Class A			Class B			Total		Class A			Class B			Total			Class A			Class B			Total			Class A			Class B			Total
	Net income (loss) per share, basic
	Numerator:
	Allocation of income (loss) from continuing operations	$	382		$	261		$	643	$	(6,991	)	$	(4,948	)	$	(11,939	)	$	(500	)	$	(343	)	$	(843	)	$	(3,993	)	$	(2,824	)	$	(6,817	)
	Allocation of loss from discontinued operations	—			—			—		(80		)	(56		)	(136		)	—			—			—			(389		)	(276		)	(665		)
	Allocation of net income (loss)	$	382		$	261		$	643	$	(7,071	)	$	(5,004	)	$	(12,075	)	$	(500	)	$	(343	)	$	(843	)	$	(4,382	)	$	(3,100	)	$	(7,482	)
	Net income (loss) per share, diluted
	Numerator:
	Allocation of income (loss) from continuing operations	$	384		$	259		$	643	$	(6,991	)	$	(4,948	)	$	(11,939	)	$	(500	)	$	(343	)	$	(843	)	$	(3,993	)	$	(2,824	)	$	(6,817	)
	Allocation of loss from discontinued operations	—			—			—		(80		)	(56		)	(136		)	—			—			—			(389		)	(276		)	$	(665	)
	Allocation of net income (loss)	$	384		$	259		$	643	$	(7,071	)	$	(5,004	)	$	(12,075	)	$	(500	)	$	(343	)	$	(843	)	$	(4,382	)	$	(3,100	)	$	(7,482	)
	Denominator for basic and diluted income (loss) per share:
	Weighted average common shares outstanding, basic	22,695			15,512			38,207		21,959			15,540			37,499			22,580			15,513			38,093			22,003			15,564			37,567
	Plus: incremental shares related to dilutive effect of stock options and restricted stock, if applicable	256			—			256		—			—			—			—			—			—			—			—			—
	Adjusted weighted-average common shares outstanding, diluted	22,951			15,512			38,463		21,959			15,540			37,499			22,580			15,513			38,093			22,003			15,564			37,567
	Earnings (loss) per share, basic:
	Earnings (loss) per common share from continuing operations	$	0.02		$	0.02		$	0.02	$	(0.32	)	$	(0.32	)	$	(0.32	)	$	(0.02	)	$	(0.02	)	$	(0.02	)	$	(0.18	)	$	(0.18	)	$	(0.18	)
	Loss per share from discontinued operations	—			—			—		—			—			—			—			—			—			$	(0.02	)	$	(0.02	)	$	(0.02	)
	Earnings (loss) per share	$	0.02		$	0.02		$	0.02	$	(0.32	)	$	(0.32	)	$	(0.32	)	$	(0.02	)	$	(0.02	)	$	(0.02	)	$	(0.20	)	$	(0.20	)	$	(0.20	)
	Earnings (loss) per share, diluted:
	Earnings (loss) per common share from continuing operations	$	0.02		$	0.02		$	0.02	$	(0.32	)	$	(0.32	)	$	(0.32	)	$	(0.02	)	$	(0.02	)	$	(0.02	)	$	(0.18	)	$	(0.18	)	$	(0.18	)
	Loss per share from discontinued operations	—			—			—		—			—			—			—			—			—			$	(0.02	)	$	(0.02	)	$	(0.02	)
	Earnings (loss) per share	$	0.02		$	0.02		$	0.02	$	(0.32	)	$	(0.32	)	$	(0.32	)	$	(0.02	)	$	(0.02	)	$	(0.02	)	$	(0.20	)	$	(0.20	)	$	(0.20	)
	The following were excluded from the weighted-average diluted shares computation for the three and nine months ended September 30, 2014 and 2013, as their inclusion would have been anti-dilutive (shares in thousands):
		Three Months Ended September 30,					Nine Months Ended September 30,
		2014		2013			2014		2013
	Options to purchase common shares	205		807			363		807
	Non-vested common shares	123		528			175		536
	Total excluded	328		1,335			538		1,343

Business_Segments

Business Segments	9 Months Ended
	Sep. 30, 2014
Segment Reporting [Abstract]	'
Business Segments	'
	Business Segments
	The Company has three reportable operating segments: (i) long-term care services ("LTC"), which includes the operation of SNFs and ALFs (which is the most significant portion of the Company's business), the Company's administrative services provided to an unrelated SNF operator, and the facility lease revenue from a third-party operator; (ii) the Company's rehabilitation therapy services business; and (iii) the Company's hospice and home health businesses. The "other" column in the table below includes general and administrative items, as well as joint venture equity earnings. The Company's reporting segments are business units that offer different services, and that are managed differently due to the nature of the services provided.
	At September 30, 2014, LTC services included 73 wholly-owned SNF operating companies that offer post-acute, rehabilitative custodial and specialty skilled nursing care, as well as 22 wholly-owned ALF operating companies that provide room and board and social services. Therapy services included rehabilitative services such as physical, occupational and speech therapy provided in the Company's facilities and in unaffiliated facilities. Hospice and home health services were provided by the Company's wholly-owned subsidiaries to patients.
	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. Accordingly, earnings from operations before net interest, tax, depreciation and amortization, non-core expenses ("Adjusted EBITDA") and rent cost of revenue ("Adjusted EBITDAR") is used as the primary measure of each segment’s operating results because it does not include such costs as interest expense, income taxes, depreciation, amortization and rent cost of revenue which may vary from segment to segment depending upon various factors, including the method used to finance the original purchase of assets within a segment or the tax law of the states in which a segment operates. By excluding these items, the Company is better able to evaluate operating performance of the segment by focusing on more controllable measures. Adjusted EBITDA and Adjusted EBITDAR are non‑GAAP financial measures. For a full discussion of the definitions of these terms and the reasons why the Company utilizes such measures, see Item 2, Management's Discussion and Analysis of Financial Condition and Results of Operations, of this filing. General and administrative expenses are not allocated to any segment for purposes of determining segment profit or loss, and are included in the "other" category in the selected segment financial data that follows. Intersegment sales and transfers are recorded at cost plus standard mark-up; intersegment transactions have been eliminated in consolidation.
	The following table sets forth selected interim financial data consolidated by business segment (dollars in thousands):
		Long-Term			Therapy Services			Hospice & Home Health Services			Other			Elimination			Total
		Care Services
	Three months ended September 30, 2014
	Net patient service revenue from external customers	$	165,555		$	22,093		$	20,163		$	—		$	—		$	207,811
	Leased facility revenue	807			—			—			—			—			807
	Intersegment revenue	595			14,135			—			—			(14,730		)	—
	Total revenue	$	166,957		$	36,228		$	20,163		$	—		$	(14,730	)	$	208,618
	Operating income (loss)	$	15,936		$	3,617		$	1,190		$	(12,935	)	$	—		$	7,808
	Interest expense, net of interest income																(7,836		)
	Other income																(26		)
	Equity in earnings of joint venture																568
	Debt modification/retirement costs																(21		)
	Income from continuing operations before benefit from income taxes																$	493
	Depreciation and amortization	$	5,579		$	164		$	222		$	155		$	—		$	6,120
	Segment capital expenditures	$	2,386		$	26		$	15		$	556		$	—		$	2,983
	Adjusted EBITDA	$	22,307		$	3,851		$	1,752		$	(6,122	)	$	—		$	21,788
	Adjusted EBITDAR	$	26,996		$	3,851		$	2,209		$	(6,122	)	$	—		$	26,934
	Three months ended September 30, 2013
	Net patient service revenue from external customers	$	157,506		$	25,313		$	25,138		$	—		$	—		$	207,957
	Leased facility revenue	787			—			—			—			—			787
	Intersegment revenue	598			13,888			—			—			(14,486		)	—
	Total revenue	$	158,891		$	39,201		$	25,138		$	—		$	(14,486	)	$	208,744
	Operating (loss) income	$	11,820		$	2,740		$	(16,524	)	$	(6,645	)	$	—		$	(8,609	)
	Interest expense, net of interest income																(8,681		)
	Other expense																(49		)
	Equity in earnings of joint venture																508
	Debt modification/retirement costs																(432		)
	Loss from continuing operations before benefit from income taxes																$	(17,263	)
	Depreciation and amortization	$	5,439		$	170		$	136		$	155		$	—		$	5,900
	Segment capital expenditures	$	3,323		$	18		$	579		$	76		$	—		$	3,996
	Adjusted EBITDA	$	17,352		$	3,335		$	3,007		$	(5,267	)	$	—		$	18,427
	Adjusted EBITDAR	$	21,700		$	3,335		$	3,465		$	(5,267	)	$	—		$	23,233
	Nine months ended September 30, 2014
	Net patient service revenue from external customers	$	488,405		$	68,236		$	63,856		$	—		$	—		$	620,496
	Leased facility revenue	2,401			—			—			—			—			2,401
	Intersegment revenue	1,549			42,037			—			—			(43,586		)	—
	Total revenue	$	492,355		$	110,273		$	63,856		$	—		$	(43,586	)	$	622,897
	Operating income (loss)	$	39,857		$	10,814		$	(2,019	)	$	(26,570	)	$	—		$	22,082
	Interest expense, net of interest income																(23,475		)
		Long-Term			Therapy Services			Hospice & Home Health Services			Other			Elimination			Total
		Care Services
	Other income																34
	Equity in earnings of joint venture																1,206
	Debt modification/retirement costs																(843		)
	Loss from continuing operations before benefit from income taxes																$	(996	)
	Depreciation and amortization	$	16,640		$	498		$	683		$	419		$	—		$	18,240
	Segment capital expenditures	$	7,692		$	80		$	122		$	1,349		$	—		$	9,243
	Adjusted EBITDA	$	58,271		$	11,381		$	5,616		$	(17,350	)	$	—		$	57,918
	Adjusted EBITDAR	$	71,732		$	11,381		$	6,997		$	(17,350	)	$	—		$	72,760
	Nine months ended September 30, 2013
	Net patient service revenue from external customers	$	476,115		$	79,057		76,488			$	—		$	—		$	631,660
	Leased facility revenue	2,335			—			—			—			—			2,335
	Intersegment revenue	1,791			43,079			—			—			(44,870		)	—
	Total revenue	$	480,241		$	122,136		76,488			$	—		$	(44,870	)	$	633,995
	Operating income (loss)	$	37,110		$	8,399		(9,943		)	$	(20,295	)	$	—		$	15,271
	Interest expense, net of interest income																(25,866		)
	Other expense																(111		)
	Equity in earnings of joint venture																1,469
Debt modification/retirement costs																(1,520		)
Loss from continuing operations before benefit from income taxes																$	(10,757	)
Depreciation and amortization	$	16,241		$	520		$	426		$	513		$	—		$	17,700
Segment capital expenditures	$	8,885		$	111		$	792		$	189		$	—		$	9,977
Adjusted EBITDA	$	54,339		$	9,345		$	8,226		$	(16,123	)	$	—		$	55,787
Adjusted EBITDAR	$	67,123		$	9,345		$	9,602		$	(16,123	)	$	—		$	69,947
A reconciliation of Adjusted EBITDA and Adjusted EBITDAR to net (loss) income is as follows (in thousands):
	Three Months Ended September 30,						Nine Months Ended September 30,
	2014			2013			2014			2013
Adjusted EBITDAR	$	26,934		$	23,233		$	72,760		$	69,947
Rent cost of revenue	(5,146		)	(4,806		)	(14,842		)	(14,160		)
Adjusted EBITDA	21,788			18,427			57,918			55,787
Depreciation and amortization	(6,120		)	(5,900		)	(18,240		)	(17,700		)
Interest expense	(8,009		)	(8,744		)	(23,993		)	(26,153		)
Interest income	173			63			518			287
Change in fair value of contingent consideration	(7		)	(79		)	100			2,082
Organization restructure costs	(359		)	(457		)	(1,430		)	(2,006		)
Exit costs related to divested facilities	(57		)	—			(397		)	—
Losses at skilled nursing facility not at full operation	(450		)	—			(583		)	—
Governmental investigation expense	—			—			(6,000		)	—
Legal expense for non-routine matters	(616		)	(416		)	(1,590		)	(1,809		)
Merger related expense	(5,761		)	(306		)	(6,306		)	(306		)
Debt modification/retirement costs	(21		)	(432		)	(843		)	(1,520		)
Impairment of long-lived assets	—			(19,000		)	(82		)	(19,000		)
Closure of California home health agency	—			(419		)	—			(419		)
Loss on disposal of asset	(68		)	—			(68		)	—
Discontinued operations, net of taxes	—			(136		)	—			(665		)
Benefit from income taxes	150			5,324			153			3,940
Net income (loss)	$	643		$	(12,075	)	$	(843	)	$	(7,482	)
The following table presents the segment assets as of September 30, 2014 compared to December 31, 2013 (in thousands):
	Long-Term			Therapy Services			Hospice & Home Health Services			Other			Total
	Care  Services
September 30, 2014:
Segment total assets	$	457,225		$	47,173		$	77,414		$	68,085		$	649,897
Goodwill and intangibles included in total assets	$	1,102		$	23,693		$	62,607		$	—		$	87,402
December 31, 2013:
Segment total assets	$	445,987		$	48,251		$	80,290		$	68,888		$	643,416
Goodwill and intangibles included in total assets	$	1,300		$	23,693		$	62,879		$	—		$	87,872

Property_and_Equipment

Property and Equipment	9 Months Ended
	Sep. 30, 2014
Property, Plant and Equipment [Abstract]	'
Property and Equipment	'
	Property and Equipment
	Property and equipment consisted of the following as of September 30, 2014 and December 31, 2013 (in thousands):
		September 30, 2014			December 31, 2013
	Land and land improvements	$	62,236		$	62,370
	Buildings and leasehold improvements	325,095			320,923
	Furniture and equipment	94,185			87,392
	Construction in progress	6,866			8,621
		488,382			479,306
	Less accumulated depreciation	(155,097		)	(137,484		)
		$	333,285		$	341,822
	Leased facility assets consisted of the following as of September 30, 2014 and December 31, 2013 (in thousands):
		September 30, 2014			December 31, 2013
	Leased facility assets	$	13,848		$	13,848
	Less accumulated depreciation	(4,791		)	(4,432		)
		$	9,057		$	9,416
	The Company began leasing five skilled nursing facilities in California to an unaffiliated third party operator in April 2011 and at that time signed a 10-year lease with two 10-year extension options exercisable by the lessee.

Income_Taxes

Income Taxes	9 Months Ended
	Sep. 30, 2014
Income Tax Disclosure [Abstract]	'
Income Taxes	'
	Income Taxes
	For the three months ended September 30, 2014, the Company recorded an income tax benefit of $0.2 million representing an effective tax rate of 30.4% compared to an income tax benefit of $5.3 million from continuing operations, representing an effective tax rate of 30.8% for the same period in 2013. The decrease in tax benefit for the three months ended September 30, 2014 was due to a $17.8 million increase in pretax income, from a $17.3 million loss for the three months ended September 30, 2013 to income from continuing operations of $0.5 million for the three months ended September 30, 2014, partially offset by an increase in the state valuation allowance as a result of 2013 legislation in California which limited the Company's ability to utilize unused enterprise zone tax credits.
	For the nine months ended September 30, 2014, the Company recorded an income tax benefit of $0.2 million representing an effective tax rate of 15.4% compared to an income tax benefit of $3.9 million from continuing operations, representing an effective tax rate of 36.6% for the same period in 2013. The decrease in tax benefit was primarily due to a $9.8 million increase in pretax income, from a $10.8 million loss for the nine months ended September 30, 2013 to a loss from continuing operations of $1.0 million for the nine months ended September 30, 2014.

Commitments_and_Contingencies

Commitments and Contingencies	9 Months Ended
	Sep. 30, 2014
Commitments and Contingencies Disclosure [Abstract]	'
Commitments and Contingencies	'
	Commitments and Contingencies
	Legal Matters
	General
	Skilled and its subsidiaries are party to various legal actions and administrative proceedings and are subject to various claims arising in the ordinary course of business, including without limitation claims that their services have resulted in injury or death to patients who receive care from the Company's businesses and claims related to employment, staffing requirements and commercial and other matters. Although Skilled and its subsidiaries intend to vigorously defend themselves in these matters, there can be no assurance that the outcomes of these matters will not have a material adverse effect on the Company's results of operations and financial condition. The Company makes provisions for liabilities when it is both probable that a liability has been incurred and the amount of the loss can be reasonably estimated. Such provisions are reviewed at least quarterly and adjusted to reflect the impact of settlement negotiations, judicial and administrative rulings, advice of legal counsel and other information and events pertaining to a particular case.
	Skilled and its subsidiaries operate in a highly regulated industry. They are subject to ongoing regulatory oversight by state and federal regulatory authorities. Actual or alleged failure to comply with legal and regulatory requirements could subject Skilled and its subsidiaries to civil, administrative or criminal fines, penalties or restitutionary relief, and authorities could seek the suspension or exclusion of the offending provider or individual from participation in government healthcare programs and could lead to recoupment claims on prior payments by government healthcare programs. Adverse determinations in legal and regulatory investigations, actions and proceedings, whether currently asserted or arising in the future, could have a material adverse effect on the Company's financial position, results of operations and cash flows.
	See also Part II, Item 1A -- Risk Factors, included elsewhere in this report, including without limitation the sections therein entitled "Significant legal actions, which are commonplace in our professions, could subject us to increased operating costs and substantial uninsured liabilities, which would materially and adversely affect our results of operations, liquidity and financial condition," "Revenue we receive from Medicare and Medicaid is subject to potential retroactive reduction or repayment," "We are subject to extensive and complex laws and government regulations. If we are not operating in compliance with these laws and regulations or if these laws and regulations change, we could be required to make significant expenditures or change our operations in order to bring our facilities and operations into compliance" and "We face reviews, audits and investigations under federal and state government programs and contracts. These audits could have adverse findings that may negatively affect our business."
	Creekside Hospice Investigation
	On August 2, 2013, the United States Attorney for the District of Nevada and the Civil Division of the U.S. Department of Justice (collectively, the “DOJ”) informed the Company that its Civil Division was investigating the Company, as well as its subsidiary, Creekside Hospice II, LLC, for possible violations of federal and state healthcare fraud and abuse laws and regulations. Those laws could have included the federal False Claims Act ("FCA") and the Nevada False Claims Act ("NFCA"). The FCA provides for civil and administrative fines and penalties, plus treble damages. The NFCA provides for similar fines and penalties, including treble damages. Violations of those federal or state laws could also subject the Company and/or its subsidiaries to exclusion from participation in the Medicare and Medicaid programs.
	On or about August 6, 2014, in relation to the investigation the DOJ filed a notice of intervention in two pending qui tam proceedings filed by private party relators under the FCA and the NFCA and advised that it intends to take over the actions and file an amended complaint within 90 days, asserting that certain claims for hospice services provided by Creekside in the time period 2010 to 2013 did not meet Medicare requirements for reimbursement and are in violation of the civil False Claims Act. The Company expects the DOJ to file its amended complaint in November 2014. The private party relators may attempt to continue to pursue any claims that the DOJ does not elect to pursue. The Company believes that False Claims Act remedies will be pursued for an unspecified amount, with a request to treble provable damages and impose penalties per proved false claim in the amount ranging from $5,500 to $11,500 per claim. Additionally, alternative remedies such as overpayment, mistake or unjust enrichment may be sought.
	While the Company denies the allegations and will defend this action, including any portion of the action that the private party relators may continue to pursue, the Company has accrued $6.0 million as a contingent liability in connection with the matter. However, it could ultimately cost more than that amount to settle or otherwise resolve the matter(s), including to satisfy any judgment that might be rendered against the Company or Creekside if the litigation defense were ultimately unsuccessful.
	Humboldt County Litigation
	In connection with the September 2010 settlement of class action litigation against Skilled and certain of its subsidiaries related to, among other matters, alleged understaffing at certain California skilled nursing facilities operated by Skilled's subsidiaries (the "Humboldt County Action"), Skilled and its defendant subsidiaries (collectively, the "Defendants”) entered into settlement agreements with the plaintiffs and intervenor and agreed to an injunction. The settlement was approved by the Superior Court of California, Humboldt County on November 30, 2010. Under the terms of the settlement agreements, the defendant entities deposited a total of $50.0 million into escrow accounts to cover settlement payments to class members, notice and claims administration costs, reasonable attorneys' fees and costs and certain other payments, including $5.0 million to settle certain government agency claims and potential government claims that may arise. Of the $5.0 million provided for such government claims, $1.0 million was initially released by the court to the Humboldt County Treasurer-Tax Collector on behalf of the People of the State of California for their release of the Defendants. The remaining $4.0 million was available for the settlement and releases by the California Attorney General and certain other District Attorneys. However, in the event that any of these government authorities were to instead file certain actions against the Defendants by February 2013, the entire $4.0 million would have reverted to the Defendants upon their request to the Settlement Administrator. No such actions were filed, however, resulting in an additional $1.0 million distribution to the Humboldt County District Attorney's Office and the remaining $3.0 million was distributed to the class settlement fund, as required by the settlement agreement.
	In addition to the payments to the Humboldt County Treasurer-Tax Collector on behalf of the People of the State of California, the court also approved payments from the escrow of up to approximately $24.8 million for plaintiff attorneys' fees and costs and $10,000 to each of the three named plaintiffs.  Pursuant to the injunction, the twenty-two Defendants that operated California nursing facilities were required to provide specified nurse staffing levels, comply with specified state and federal regulations governing staffing levels and posting requirements, and provide reports and information to a court-appointed auditor. The injunction was to remain in effect for a period of twenty-four months unless extended for additional three-month periods as to any Defendants who violated the injunction. Defendants demonstrating compliance for an eighteen-month period that ended September 30, 2012 were permitted to petition for early termination of the injunction. The Defendants were required to demonstrate over the term of the injunction that the costs of the injunction met a minimum threshold level pursuant to the settlement agreement, which level, initially $9.6 million, was reduced by the portion attributable to any Defendant in the case that no longer operated a skilled nursing facility during the injunction period.
	In April 2011, five of the subsidiary Defendants transferred their operations to an unaffiliated third party skilled nursing facility operator (the “Former Humboldt County Facilities”). On November 14, 2012, the Defendants filed a motion to terminate the injunction and vacate the final judgment in the Humboldt County Action. Based upon compliance with the injunction through the requisite eighteen-month period, on December 21, 2012, the Superior Court of California, Humboldt County granted the Defendants' motion for early termination of the injunction, and the injunction has now ended with respect to the 17 California nursing facilities that the subsidiary Defendants still operate. In its order, the court determined that the injunction termination did not apply to the Former Humboldt County Facilities. However, the 2010 court-approved stipulation and order establishing the injunction provides that the injunction applies to the named defendants and any successor licensees of the applicable nursing facilities, but only if those successor licensees are affiliates of the named defendants. As noted above, the Former Humboldt County Facilities have been operated by an unaffiliated third party since April 2011. Therefore, under the terms of the injunction it does not apply to the Former Humboldt County Facilities unless an affiliate of the Defendants operates them. Pursuant to the BMFEA matter discussed below the California theories in this context were released in February 2013.
	In the course of ongoing communications with the California Attorney General's Bureau of Medi-Cal Fraud & Elder Abuse ("BMFEA") related to the BMFEA matter discussed below, representatives of the California Attorney General and the U.S. Department of Justice ("DOJ") indicated an interest in pursuing an action under the False Claims Act ("FCA"). The DOJ expressed that it believes the company has FCA and other legal liabilities based upon the jury findings in the Humboldt County Action and otherwise related to staffing and perhaps other considerations related thereto. While the Company continues to cooperate with the government's evaluation of the matter, the Company views the government's apparent legal theories, including the False Claims Act theories, as lacking support in the established case law. The Company intends to vigorously defend any such action if brought whether under the aforementioned legal theories or otherwise.
	BMFEA Matter
	On April 15, 2009, two of Skilled's wholly-owned companies, Eureka Healthcare and Rehabilitation Center, LLC (“EHRC”), which at the time operated Eureka Healthcare and Rehabilitation Center (the "Facility"), and Skilled Healthcare, LLC (“SHC”), the administrative services provider for the Facility, were served with a search warrant that related to an investigation of the Facility by the BMFEA. The search warrant related to, among other things, records, property and information regarding certain enumerated patients of the Facility and covered the period from January 1, 2007 through the date of the search. On October 31, 2012, the BMFEA filed a criminal complaint (the “BMFEA Action”) in California Superior Court, Humboldt County against EHRC, SHC and Skilled alleging elder endangerment in nine misdemeanor counts under Penal Code Section 368(c) and two felony counts under Penal Code Section 368(b)(1) related to the care of certain patients at the Facility in 2008. No individuals were named as defendants in the complaint. The Company disputed the BMFEA's theories of alleged criminal liability and vigorously defended the action. The charges filed by the BMFEA, if proven, would have carried fines of up to $6,000 for each of the two felony counts and $2,000 for each of the nine misdemeanor counts. Convictions could also lead to exclusion from participation in federal healthcare programs under federal laws such as the Federal False Claims Act and the Civil Monetary Penalty Law, which could be materially adverse to Skilled's business. EHRC transferred its operations in April 2011 to an unaffiliated third party skilled nursing facility operator, and has not had any ongoing operations since that time.
	On February 15, 2013, the parties reached a mutually satisfactory settlement of the BMFEA Action. Pursuant to the settlement: (i) Skilled and SHC were dismissed from the case with prejudice; (ii) EHRC pled no contest to a single misdemeanor count of elder endangerment under Penal Code Section 368(c) and agreed to pay a statutory fine of $680, pay $145,000 to the California Attorney General for its costs of investigation, and to serve two (2) years of summary probation; and (iii) the California Attorney General granted Skilled, SHC, and twenty-five (25) of their affiliates who currently or formerly operated skilled nursing facilities in California, a release of any potential liability to the California Attorney General under certain civil statutes based upon conduct occurring through the effective date of the settlement (including the FCA theories discussed under Humboldt County Litigation above). The court accepted EHRC's misdemeanor plea and the other relevant terms of the settlement on February 15, 2013. Notwithstanding EHRC's no contest plea to the single misdemeanor charge, the Company, SHC and EHRC continue to deny any liability for the allegations in the BMFEA Action. The release granted by the California Attorney General may not apply to the DOJ should it choose to pursue action against us.
	Pursuant to the settlement, Skilled, SHC and their twenty (20) affiliated current California skilled nursing facility operators also agreed to a 2-year staffing agreement (the “2013 Staffing Agreement”) with the California Attorney General that essentially continues the requirements of the staffing-related injunction that was in effect until December 2012 as a result of the September 2010 settlement of the Humboldt County Action. Similar to the former staffing-related injunction, the 2013 Staffing Agreement requires the applicable nursing facility operators to provide a minimum of 3.2 nursing hours per patient day as required by applicable California regulation and to adhere to related regulatory requirements, as well as to submit to periodic compliance audits of the same. Unlike the former staffing-related injunction, however, the 2013 Staffing Agreement does not provide for early termination based on demonstrated compliance and does not contain a minimum spend requirement. To date the 2013 Staffing Agreement has not, and the Company does not believe it will, require the Company or its affected affiliates to incur any material staffing or other costs beyond what they would otherwise incur in the ordinary course of business.
	Stockholder Litigation Regarding Pending Genesis HealthCare Combination
	As discussed more fully in Note 13, on August 18 2014, Skilled entered into the Purchase Agreement with FC-GEN Operations Investment, LLC ("Genesis") pursuant to which the businesses and operations of Skilled and Genesis will be combined (the "Combination"). Skilled, the Skilled board of directors, Onex Corporation ("Onex"), Genesis and Genesis HealthCare LLC ("Genesis HealthCare") are named as defendants in two purported class action lawsuits files in the Court of Chancery of the State of Delaware on September 5, 2014 and September 15, 2014, respectively, brought by individuals who claim to be stockholders of Skilled. The stockholder actions allege, among other things, that the board of directors and Onex breached fiduciary duties purportedly owed to Skilled's stockholders and that the remaining defendants aided and abetted in that breach. The complaint sees to enjoin the defendants from completing the Combination on the agreed-upon terms or, in the event that the Combination is consummated, to recover damages resulting from defendants' alleged wrongful conduct.
	Skilled, the Skilled board of directors and Genesis believe that the claims in these actions are without merit and intend to defend against them vigorously.
	Insurance
	The Company maintains various insurance and self insurance for property and casualty including workers' compensation and general and professional liability. The Company believes that its insurance programs are adequate and appropriate, and where there has not been a direct transfer of risk to the insurance carrier, the Company recognizes a liability in the consolidated financial statements.
	Workers' Compensation. The Company has maintained workers' compensation insurance where statutorily required. The commercial workers' compensation insurance purchased is loss sensitive in nature. As a result, the Company is responsible for adverse loss development. The Company self-insures the first unaggregated $1.0 million per workers' compensation claim for all operations. The Company has elected not to carry workers' compensation insurance in Texas as a qualified non-subscriber and may be liable for negligence claims that are asserted against it by its Texas-based employees. The Company recognizes a liability in its financial statements for its estimated self-insured workers' compensation risks. Historically, estimated liabilities have been sufficient to cover actual claims. Effective January 1, 2014 the Company self-insures its workers compensation for all its business operations, other than those based in Texas, through its wholly-owned insurance company based on actuarially determined estimates.
	General and Professional Liability. The Company's services subject it to certain liability risks. Malpractice and similar claims may be asserted against the Company if its services are alleged to have resulted in patient injury or other harm. The Company is subject to malpractice and similar claims and other litigation in the ordinary course of business.
	The Company purchases excess liability policies for claims in excess of its unaggregated self insured retention for all businesses. The Company also self-insures professional liability claims through its wholly-owned insurance company.
	The Company's Hospice and home health businesses are insured under a separate general and professional liability insurance policy. The excess liability coverage referenced above is also applicable to this policy.
	Employee Medical Insurance. Medical preferred provider option programs are offered as a component of the Company's employee benefits. The Company retains a self-insured amount up to a contractual stop loss amount of $0.25 million deductible for its preferred provider organization plan. All other employee medical plans are guaranteed cost plans.
	Actuarial Analysis. Changes in actuarial estimates are reviewed on a quarterly basis for both general and professional liability and Employee Medical Insurance claims and semi-annually for workers compensation claims. Variances in expected ultimate liabilities are recognized accordingly.
	A summary of the liabilities related to insurance risks are as follows (dollars in thousands):
		As of September 30, 2014:											As of December 31, 2013
		General and			Employee			Workers’			Total		General and			Employee			Workers’			Total
		Professional			Medical			Compensation					Professional			Medical			Compensation
	Current	$	7,436	(1)	$	1,859	(2)	$	6,713	(2)	$	16,008	$	8,228	(1)	$	2,446	(2)	$	3,178	(2)	$	13,852
	Non-current	13,657			—			14,418			28,075		12,762			—			16,772			29,534
		$	21,093		$	1,859		$	21,131		$	44,083	$	20,990		$	2,446		$	19,950		$	43,386
	-1	Included in accounts payable and accrued liabilities.
	-2	Included in employee compensation and benefits.
	Hallmark Indemnification
	Hallmark, the Company's rehabilitation services subsidiary, provides physical, occupational and speech therapy services to various unaffiliated skilled nursing facilities. These unaffiliated skilled nursing facilities are reimbursed for these services from the Medicare Program and other third-party payors. Hallmark has indemnified these unaffiliated skilled nursing facilities from a portion of certain disallowances of these services. Additionally, to the extent a Recovery Auditor ("RA") or other regulatory authority or contractor is successful in making a claim for recoupment of revenue from any of these skilled nursing facilities, Hallmark will typically be required to indemnify them against their charges associated with this loss. No material indemnification payments were required to be made in the three and nine months ended September 30, 2014 or 2013.
	Financial Guarantees
	Substantially of all Skilled's wholly-owned subsidiaries guarantee the Company's first lien senior secured credit facility, excluding the subsidiaries that are pledged as collateral for the ten mortgage loans insured by the U.S. Department of Housing and Urban Development Program ("HUD") and the ten facilities pledged to MidCap Financial as collateral for the MidCap Financial credit facility. These loans are discussed in Note 11, "Debt", below. The aforementioned guarantees are full and unconditional and joint and several. Other subsidiaries of Skilled that are not guarantors are considered minor.

Stockholders_Equity

Stockholders' Equity	9 Months Ended
	Sep. 30, 2014
Equity [Abstract]	'
Shareholders' Equity	'
	Stockholders' Equity
	Accumulated Other Comprehensive Income
	Accumulated other comprehensive income refers to gains and losses that are recorded as an element of stockholders' equity but are excluded from net income (loss). The Company's other comprehensive (loss) income consists of net deferred gains and losses on certain derivative instruments accounted for as cash flow hedges and gains and losses from investments available for sale. Details of other comprehensive income (loss) are included in the accompanying condensed consolidated Statements of Comprehensive Income (Loss).
	2007 Incentive Award Plan
	During the nine months ended September 30, 2014, the Company granted performance stock awards covering 512,475 shares of common stock. Each of the stock awards is subject to market-based vesting criteria. In order for the shares to vest, the Company must attain various average stock prices, each over a thirty-day period. There were no such market-based awards issued in the nine months ended September 30, 2013.
	During the nine months ended September 30, 2014, the following occurred with respect to restricted stock awards, restricted stock units, and performance stock awards under the Company’s existing plans (number of shares in thousands):
		Number of		Weighted-
		Shares		Average
				Grant Date
				Fair Value
	Non-vested balance at January 1, 2014	2,256		$	6.42
	Granted	946		4.86
	Vested	(326	)	4.55
	Forfeited	(603	)	5.43
	Non-vested balance at September 30, 2014	2,273		$	6.3
	As of September 30, 2014, there was approximately $4.8 million of total unrecognized compensation costs related to restricted stock awards, restricted stock units and performance stock awards. These costs have a weighted-average remaining recognition period of 1.6 years as of September 30, 2014. The total fair value of shares vested during the period ended September 30, 2014 was $1.2 million.
	The following table summarizes stock option activity during the nine months ended September 30, 2014 under the Skilled Healthcare Group, Inc. Amended and Restated 2007 Incentive Award Plan:
		Number of		Weighted-		Weighted-	Aggregate
		Shares		Average		Average	Intrinsic
				Exercise		Remaining	Value
				Price		Contractual	(in thousands)
						Term
						(in years)
	Outstanding at January 1, 2014	794,645		$	8.54
	Granted	—		$	—
	Exercised	(160,548	)	$	5.91
	Forfeited or cancelled	(200,429	)	$	9.76
	Outstanding at September 30, 2014	433,668		$	8.95	4.77	$	—
	Fully vested and expected to vest at September 30, 2014	432,862		$	8.95	4.77	$	—
	Exercisable at September 30, 2014	413,145		$	9	4.65	$	—
	As of September 30, 2014, there was $0.1 million of unrecognized compensation cost related to outstanding stock options, net of estimated forfeitures. This amount is expected to be recognized over a weighted-average period of 1.2 years. To the extent the forfeiture rate is different than the Company has anticipated, stock-based compensation related to these awards will be different from the Company's expectations.
	Aggregate intrinsic value represents the value of Skilled's closing stock price on the New York Stock Exchange on the last trading day of the fiscal period in excess of the exercise price, multiplied by the number of options outstanding or exercisable.
	Compensation related to stock option grants and stock awards included in general and administrative expenses was $0.6 million and $0.3 million for the three months ended September 30, 2014 and 2013, respectively. The amount of compensation included in general and administrative expense was $1.8 million and $1.1 million for the nine months ended September 30, 2014 and 2013, respectively. The amount of compensation included in cost of services was $0.4 million and $0.3 million for the three months ended September 30, 2014 and 2013, respectively. The amount of compensation included in cost of services was $0.6 million and $1.1 million for the nine months ended September 30, 2014 and 2013.

Fair_Value_Measurements

Fair Value Measurements	9 Months Ended
	Sep. 30, 2014
Fair Value Disclosures [Abstract]	'
Fair Value Measurements	'
	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 prices in active markets; Level 2, defined as inputs other than quoted prices in active markets that are either directly or indirectly observable; 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 valuation of the Company’s marketable securities and contingent consideration as of September 30, 2014 (dollars in thousands) and December 31, 2013:
		September 30, 2014							December 31, 2013
		Level 1			Level 2		Level 3		Level 1		Level 2		Level 3
	Available for sale securities	$	—		$	—	$	—	$	—	$	1,046	$	—
	Trading securities	$	—		$	9,060	$	—	$	—	$	—	$	—
	Contingent consideration – acquisitions	$	—		$	—	$	836	$	—	$	—	$	1,736
	The Company's wholly-owned offshore captive insurance company is required by regulatory agencies to set aside assets to comply with the laws of the jurisdiction in which it operates. These assets consist of restricted cash and trading securities, which are included in restricted assets in the Company's consolidated September 30, 2014 condensed balance sheet. The unrealized holding gain included in (loss) income on the Company's trading securities was negligible for the three and nine months ended September 30, 2014 and 2013.
	On October 24, 2011, a wholly-owned subsidiary of the Company acquired substantially all of the assets of Cornerstone Hospice, Inc. ("Cornerstone"). The acquisition included contingent earn-out consideration which can be earned based on the acquired business's achievement of an EBITDA threshold. The contingent consideration is up to $1.5 million over a period of 5 years following the closing. The fair value of the contingent consideration was estimated using a probability-weighted discounted cash flow model. This fair value measurement is based on significant inputs not observable in the market and thus represents a Level 3 measurement. The fair value of the earn-out at December 31, 2013 was $1.1 million and at September 30, 2014 was $0.8 million which reflects payments of $0.3 million to the seller and a fair value adjustment of less than $0.1 million.
	As discussed above, EBITDA is the basis for calculating the contingent consideration. The unobservable inputs to the determination of the fair value of the contingent consideration include assumptions as to the ability of the acquired businesses to meet their EBITDA targets and discount rates used in the calculation. Should the actual EBITDA generated by the acquired businesses increase or decrease as compared to our assumptions, the fair value of the contingent consideration obligations would increase or decrease, up to the contracted limit, as applicable. As the timing of contingent payments go further into the future, discount rate assumptions increase due to the increased uncertainty of the EBITDA that may be generated in those periods.
	The Company's assumptions range from the acquired businesses achieving none, a portion, or all of the consideration, and discount rates range from 2%- 5%.
	Below is a table listing the Level 3 rollforward as of September 30, 2014 (in thousands):
	Level 3 Rollforward
	Value at January 1, 2014	$	1,736
	Change in fair value	(100		)
	Payout	(800		)
	Value at September 30, 2014	$	836
	Long Term Debt
	At September 30, 2014 and December 31, 2013, the aggregate fair value of the Company's term loan due 2016, the revolving credit facility due 2015, the HUD insured loans due in 2043 and 2048, the mortgage term loan due 2016, and the asset based revolving credit facility due 2016, using Level 2 inputs, approximated the carrying value. The carrying value of the debt was approximately $407.8 million and $419.1 million at September 30, 2014 and December 31, 2013 respectively. Fair value was estimated based on current yield rates plus the Company's estimated credit spread available for loan products with similar terms and maturities.

Debt

Debt	9 Months Ended
	Sep. 30, 2014
Debt Disclosure [Abstract]	'
Debt	'
	Debt
	The Company’s long-term debt is summarized as follows (dollars in thousands):
		As of September 30, 2014			As of December 31, 2013
	Term Loan, due April 2016, interest rate based on LIBOR (subject to a 1.50% floor) plus 5.50%, or 7.00%, at September 30, 2014 and LIBOR (subject to a 1.50% floor) plus 5.25%, or 6.75%, at December 31, 2013; collateralized by substantially all assets of the Company excluding the skilled nursing facilities that collateralize the HUD insured mortgage loans and the skilled nursing facilities that collateralize the MidCap Financial credit facility	$	243,953		$	243,953
	Term Loan original issue discount	(838		)	(1,254		)
	Revolving Credit Facility due April 2015, interest rate comprised of the Prime rate of 3.25% plus 3.50%, or 6.75%, at December 31, 2013	—			11,000
	Revolving Credit Facility due April 2016, interest rate comprised of LIBOR plus 5.50%, or 5.74%, at September 30, 2014	6,090			—
	Revolving Credit Facility due April 2015, interest rate comprised of LIBOR plus 4.50%, or 4.74%, at September 30, 2014 and December 31, 2013	3,910			7,057
	HUD insured loans due in 2043 and 2048, with a weighted average interest rate of 4.28% and 4.24% at September 30, 2014 and December 31, 2013, respectively	86,339			87,314
	Term Loan, due December 2016, interest rate based on LIBOR rate (subject to a floor of 0.75%) plus 5.95%, or 6.70%, at September 30, 2014 and December 31, 2013; collateralized by 10 skilled nursing facilities	60,761			62,000
	Revolving Credit Facility due December 2016, interest rate comprised of LIBOR (subject to a floor of 0.75%) plus 5.95%, or 6.70%, at September 30, 2014 and December 31, 2013; collateralized by the accounts receivable of 10 skilled nursing facilities	4,165			5,000
	Note payable due December 2018, interest rate fixed at 6.50%, payable in monthly installments, collateralized by a first priority deed of trust	833			959
	Insurance premiums financed	2,604			2,990
	Other	—			106
	Total long-term debt	407,817			419,125
	Less amounts due within one year	(13,173		)	(7,630		)
	Long-term debt, less current portion	$	394,644		$	411,495
	Term Loan and Revolving Credit Facility
	On April 9, 2010, the Company entered into an up to $360.0 million senior secured term loan and a $100.0 million revolving credit facility (the "Prior Credit Agreement") that amended and restated the senior secured term loan and revolving credit facility that were set to mature in June 2012. On April 12, 2012, the Company entered into an Amendment and Restatement and Additional Term Loan Assumption Agreement (“Restated Credit Agreement”) that amended and restated the Prior Credit Agreement and pursuant to which, among other things, the size of the Company's existing senior secured term loan was increased by $100.0 million (hereinafter referred to as the incremental senior secured term loan).
	On June 6, 2013, the Company entered into an amendment to the Restated Credit Agreement that increased the maximum leverage ratio by 0.50 throughout the life of the Restated Credit Agreement. The amendment additionally permits the Company to make future offers to the lenders under the revolving credit facility to extend the maturity date of all or a portion of the revolving credit facility. The credit arrangements provided under the Restated Credit Agreement are collectively referred to herein as the Company's senior secured credit facility.
	In connection with the June 2013 modification, the Company paid fees totaling $2.5 million, of which $1.1 million was recorded as debt modification costs in the consolidated statement of operations, and $1.4 million was recorded as other assets in the consolidated balance sheet. Substantially all of the Company's assets, except those skilled nursing facilities securing the HUD and MidCap mortgage loans, are pledged as collateral under the senior secured credit facility. Amounts borrowed under the senior secured term loan may be prepaid at any time without penalty, except for LIBOR breakage costs. The senior secured term loan matures on April 9, 2016.
	On June 23, 2014, the Company entered into an Amendment No. 2 and Loan Modification Agreement ("Amendment No. 2") to our Fourth Amended and Restated Credit Agreement dated April 12, 2012, as previously amended on June 6, 2013. Amendment No. 2 increased the maximum leverage ratio to 5.25 and decreased the fixed charge coverage ratio to 1.85, both up to but not including June 30, 2015. Amendment No. 2 increased the interest rate by 0.25% to the London Interbank Offered Rate ("LIBOR") (subject to a floor of 1.50%) plus a margin of 5.50 or the prime rate (subject to a floor of 2.50%) plus a margin of 4.50%. Amendment No. 2 extended the maturity date of the revolving credit facility to April 9, 2016 and reduced the commitments of any extending revolving lenders by 25%. After giving effect to Amendment No. 2, the extended revolving credit facility commitments are $50.6 million and the non-extended revolving credit facility commitments are $32.5 million, for a total capacity of $83.1 million. The capacity of the revolving credit facility will decrease to $50.6 million on April 9, 2015 until its maturity. Lenders that take an assignment of non-extended commitments may subsequently agree to extend those commitments in accordance with Amendment No. 2. Amendment No. 2 also modified the interest rate for the extended revolving credit commitments to be, at the Company’s option, LIBOR plus a margin between 5.25% and 5.50% (based upon consolidated leverage) or the prime rate plus a margin between 4.25% and 4.50% (based upon consolidated leverage). The interest rates on the non-extended revolving credit facility commitments remain, at the Company’s option, at LIBOR plus a margin of between 4.25% and 4.50% (based upon consolidated leverage) or the prime rate plus a margin between 3.25% and 3.50% (based upon consolidated leverage). In connection with the June 2014 modification, the Company paid fees totaling $2.0 million of which $0.8 million were recorded as debt modification costs in the condensed consolidated statements of operations, and $1.2 million was recorded as other assets in the condensed consolidated balance sheet.
	Pursuant to the Restated Credit Agreement, the quarterly term loan amortization payments increased to $2.6 million beginning June 30, 2012 compared to $0.9 million under the Prior Credit Agreement. Due to the principal reductions made in 2013 made in association with the HUD insured financings, no amortization payments are due until December 2014, at which time the quarterly principal payments due will be $1.6 million. Additionally, the maximum portion of the annual Consolidated Excess Cash Flow (as defined in the Restated Credit Agreement) to be applied to term debt reductions increased to 75% from 50%, subject to step-downs to 50% and 25% based on consolidated leverage. The Company has also increased its ability to refinance a portion of its credit facility with U.S. Department of Housing and Urban Development ("HUD") insured debt up to $250 million, subject to certain credit facility covenants. Any HUD insured borrowings beyond $250 million would necessitate either refinancing the senior secured credit facility in full or otherwise seeking a waiver or amendment from the senior secured lenders.
	Under the senior secured credit facility, the Company must maintain compliance with specified financial covenants measured on a quarterly basis. The senior secured credit facility also includes certain additional affirmative and negative covenants, including limitations on the incurrence of additional indebtedness, liens, investments in other businesses and capital expenditures. Also under the senior secured credit facility, subject to certain exceptions and minimum thresholds, the Company is required to apply all of the proceeds from any issuance of debt, as much as half of the proceeds from any issuance of equity, as much as 75% of the Company's annual Consolidated Excess Cash Flow (as defined in the Restated Credit Agreement), and amounts received in connection with any sale of the Company's assets to repay the outstanding amounts under the Restated Credit Agreement. The Company believes that it is in compliance with its debt covenants as of September 30, 2014. As of September 30, 2014, the fixed charge coverage ratio was 2.38, which compares to a minimum requirement of 1.85 and the leverage ratio was 4.42, as compared to an allowed maximum of 5.25.
	HUD Insured Loans and Other Mortgage Loans
	In 2013, the Company received funding of 10 loans insured by HUD. The loans have a combined aggregate original principal balance of $87.6 million and are secured by 10 of the Company's skilled nursing facilities. The HUD insured loans have an average all in interest rate of approximately 5.3% and an amortization term of 30 to 35 years. As of September 30, 2014 the HUD insured loans have a combined aggregate principal balance of $86.3 million.
	Accordingly, as of September 30, 2014, the Company has 10 mortgages insured by HUD, which are each secured by a skilled nursing facility. These mortgages have an average remaining term of 33 years with fixed interest rates ranging from 3.4% to 4.6% and a weighted average interest rate of 4.2%. Depending on the mortgage agreement, prepayments are generally allowed only after 12 months from the inception of the mortgage. Prepayments are subject to a penalty of 10% of the remaining principal balances in the first year and the prepayment penalty decreases each subsequent year by 1% until no penalty is required. As all $87.6 million of the HUD insured mortgage loans were originated in 2013, none of the loans could be prepaid at September 30, 2014. Any further HUD insured mortgages will require additional HUD approval.
	All HUD-insured mortgages are non-recourse loans to the Company. All mortgages are subject to HUD regulatory agreements that require escrow reserve funds to be deposited with the loan servicer for mortgage insurance premiums, property taxes, insurance and for capital replacement expenditures. As of September 30, 2014, the Company has escrow reserve funds of $1.8 million with the loan servicer that are reported within other current assets, and replacement reserve funds of $3.3 million in other assets. The net proceeds of the HUD insured loans were required to be used to pay down term debt under the Restated Credit Agreement. In 2013, $87.6 million of HUD insured loan proceeds were used to pay down term debt.
	As of September 30, 2014 the Company has 10 additional skilled nursing facilities securing a $60.8 million mortgage loan and a $4.2 million asset based revolving credit facility with MidCap Financial. Both loans have an interest rate of LIBOR plus a margin of 5.95% with a LIBOR floor of 0.75%. The mortgage loan amortizes over 25 years with the remaining principal due December 1, 2016. There are additional quarterly principal payments of $0.3 million beginning after six months, $0.4 million in year two and $0.5 million in year three. The mortgage loan has a debt service coverage ratio and a minimum debt coverage ratio, both of which were met at September 30, 2014. The asset based revolving credit facility is secured by the accounts receivable of the 10 skilled nursing facilities. In 2013, $65.0 million of mortgage loan and asset based revolving credit facility proceeds were used to pay down term debt.

Investment_in_Joint_Venture

Investment in Joint Venture	9 Months Ended
	Sep. 30, 2014
Equity Method Investments and Joint Ventures [Abstract]	'
Investment in Joint Venture	'
	Investment in Joint Venture
	Since 1996, the Company has held a 50% equity interest in APS - Summit Care Pharmacy, LLC, or APS - Summit Care, which is a company that serves the pharmaceutical needs of a limited number of the Company's affiliated Texas operations, as well as a number of other unaffiliated customers. The remaining 50% equity interest in APS - Summit Care is owned by an unaffiliated third party. APS - Summit Care operates a pharmacy in Austin, Texas, through which the Company's affiliated operations pay market value for prescription drugs and receives a 50% share of the net income related to the joint venture. The Company’s investment balance at September 30, 2014 and December 31, 2013 of $4.4 million and $5.6 million, respectively, is included in other assets in the accompanying condensed consolidated balance sheets. The following tables provide summarized information from the balance sheet and statement of earnings for APS - Summit Care as of September 30, 2014:
	Statement of Earnings
	(In thousands)
		Three Months Ended September 30,				Nine Months Ended September 30,
		2014		2013		2014		2013
	Sales, Net	$	5,045	$	4,209	$	11,127	$	11,150
	Gross Profit	809		1,243		2,248		3,377
	Net Income	$	1,068	$	933	$	1,870	$	2,496
	Balance Sheet
	(In thousands)
		30-Sep-14		December 31, 2013
	Current Assets	$	3,262	$	3,518
	Non-Current Assets	1,188		1,078
	Current Liabilities	125		96
	Non-Current Liabilities	$	—	$	—

Proposed_Combination_with_Gene

Proposed Combination with Genesis (Notes)	9 Months Ended
	Sep. 30, 2014
Business Combinations [Abstract]	'
Proposed Combination with Genesis	'
	On August 18, 2014, Skilled entered into the Purchase Agreement with Genesis pursuant to which the businesses and operations of Skilled and Genesis will be combined. Immediately following the consummation of the transactions contemplated by the Purchase Agreement, the common stock, par value $0.001 per share (the "Company Common Stock"), and options to purchase shares of Company Common Stock, which will remain outstanding, will represent 25.75% of the equity of the combined entity and the holders of equity interests of Genesis, Healthcare REIT, Inc., a Delaware corporation, and the participants under the management incentive compensation plan of Genesis will hold 74.25% of the equity of the combined entity, calculated on a fully diluted, as-exchanged and as-converted basis. The Skilled board of directors has unanimously approved the Purchase Agreement and the consummation of the transactions and agreements contemplated thereby. Following the execution and delivery of the Purchase Agreement, the Onex Group (as defined in the Purchase Agreement) executed and delivered a written consent (the “Written Consent”) on August 18, 2014, adopting and approving in all respects the Purchase Agreement and the transactions and agreements contemplated thereby.
	The consummation of the transactions contemplated by the Purchase Agreement is subject to the satisfaction or waiver of certain closing conditions, including, without limitation, (i) the approval and adoption by Skilled’s stockholders of the Purchase Agreement and the transactions contemplated thereby, which approval was obtained following the execution and delivery of the Purchase Agreement by the Written Consent from the Onex Group, (ii) expiration or termination of the waiting period under the Hard-Scott-Rodino Antitrust Improvements Act of 1976, as amended, which occurred on September 16, 2014, and any other competition, merger control, antitrust or similar law, (iii) delivery of an information statement to Skilled’s stockholders with respect to the Purchase Agreement and the transactions contemplated thereby, (iv) absence of a Company Material Adverse Effect or a Genesis Material Adverse Effect (each, as defined in the Purchase Agreement), (v) absence of certain orders or regulations prohibiting the consummation of the transactions contemplated by the Purchase Agreement, and (vi) the approval or consent of certain governmental authorities with respect to the transactions contemplated by the Purchase Agreement.
	Skilled currently anticipates that the Combination will be completed in the first quarter of 2015. However, there can be no assurance that the Combination will be completed at all or, if completed, that it will be completed in the first quarter of 2015.

Summary_of_Significant_Account1

Summary of Significant Accounting Policies (Policies)	9 Months Ended
	Sep. 30, 2014
Accounting Policies [Abstract]	'
Basis of Presentation	'
	Basis of Presentation
	The accompanying condensed consolidated financial statements as of September 30, 2014 and for the three and nine months ended September 30, 2014 and 2013 (collectively, the "Interim Financial Statements"), are unaudited. Certain information and footnote disclosures normally included in the Company’s annual consolidated financial statements have been condensed or omitted, as permitted under applicable U.S. Securities and Exchange Commission rules and regulations. Readers of the Interim Financial Statements should refer to the Company's audited consolidated financial statements and notes thereto (as updated by Note 3, "Summary of Significant Accounting Policies," in this filing), for the year ended December 31, 2013, which are included in the Company's 2013 Annual Report on Form 10-K filed with the Securities and Exchange Commission ("SEC"). Management believes that the Interim Financial Statements reflect all adjustments that are of a normal and recurring nature necessary to fairly present the Company's financial information in all material respects as of the dates and for the periods presented. The results of operations presented in the Interim Financial Statements are not necessarily indicative of operations to be expected for the entire year or any other period.
	The accompanying Interim Financial Statements include the accounts of Skilled and its consolidated wholly-owned subsidiaries. All significant intercompany transactions have been eliminated in consolidation.
Estimates and Assumptions	'
	Estimates and Assumptions
	The interim financial statements have been prepared in conformity with accounting principles generally accepted in the United States of America ("U.S. GAAP"), which require the Company to consolidate company financial information and make estimates and assumptions that affect the reported amounts of assets and liabilities, disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenue and expenses during the reporting period. The most significant estimates in the Company’s interim financial statements relate to revenue, allowance for doubtful accounts, self-insured liability risks, income taxes, governmental investigation, and valuation of contingent consideration.
Revenue and Accounts Receivable	'
	Revenue and Accounts Receivables
	Revenue and accounts receivable are recorded on an accrual basis as services are performed at their estimated net realizable value. The Company derives a majority of its revenue from funds under federal Medicare and state Medicaid assistance programs, the continuation of which are dependent upon governmental policies and are subject to audit risk and potential recoupment.
	The Company is participating in the recently established Upper Payment Limit (UPL) supplemental payment program in the state of Texas that provides supplemental Medicaid payments for skilled nursing facilities that are licensed to non-state government entities such as county hospital districts.  Company subsidiaries previously operating twenty Company-owned Texas skilled nursing facilities entered into transactions with such hospital districts providing for the transfer of the licenses for the twenty of the Company-owned Texas skilled nursing facilities to the hospital districts, and providing further for the Company’s operating subsidiaries to retain the management of those facilities on behalf of the hospital districts, which are all participating in the UPL program. Each affected Operating subsidiary therefore retains operations of its skilled nursing facility and each agreement between the hospital district and the Company subsidiary is terminable by either party to fully restore the prior license status. The Company may add an additional nursing center sometime during the remainder of 2014.
	Overall payments made by Medicare for hospice services are subject to an annual cap amount on a per hospice agency basis. Total Medicare payments received for services rendered during the applicable Medicare hospice cap year by each Medicare-certified agency during this period are compared to the cap amount for the relevant period. Payments in excess of the cap are subject to refund to and recoupment by Medicare. For the three months ended September 30, 2014 and 2013, the Company recorded hospice Medicare cap reserves of $1.2 million and $0.5 million, respectively, as adjustments to revenue. Of the $1.2 million recorded in the three months ended September 30, 2014, $1.4 million was related to the 2014 cap year and reversal of $0.2 million was related to the 2013 cap year. Of the $0.5 million recorded in the three months ended September 30, 2013, $0.2 million was related to the 2013 cap year and $0.3 million was related to the 2012 cap year. For the nine months ended September 30, 2014 and 2013, the Company recorded hospice Medicare cap reserves of $2.1 million and $3.4 million, respectively, as adjustments to revenue. Of the $2.1 million recorded in the nine months ended September 30, 2014, $2.0 million was related to the 2014 cap year and $0.1 million was related to the 2013 cap year. Of the $3.4 million recorded in the nine months ended September 30, 2013, $0.9 million was related to the 2013 cap year, $2.3 million was related to the 2012 cap year, and $0.2 million was related to the 2011 cap year.
Notes Receivable	'
	Notes Receivable
	As of September 30, 2014 and December 31, 2013, net notes receivable were approximately $3.6 million and $2.0 million, respectively, of which $1.5 million was reflected as current assets as of September 30, 2014 and December 31, 2013, respectively, with the remaining balances reflected as long-term assets. Interest rates on these notes approximated market rates as of the date the notes were originated.
	As of September 30, 2014, two customers of the Company's rehabilitation therapy services business were responsible for 100% of the net notes receivable balance. The notes receivable, as well as the receivables from these customers, are secured by the assets of the customers as well as personal guaranties by the principal owners of the customers. Additionally, the customers represented $6.4 million, or 35.9% of the net accounts receivable for the Company's rehabilitation therapy services business and approximately $28.5 million, or 41.8%, of the external revenue of the rehabilitation therapy services business for the nine months ended September 30, 2014.
	At September 30, 2014, there was no note receivable reserve balance.
Recent Accounting Pronouncements	'
	Recent Accounting Pronouncement
	In April 2014, the FASB issued ASU No. 2014-08, Reporting Discontinued Operations and Disclosures of Disposals of Components of an Entity, ("ASU 2014-08").  This ASU requires an entity to report disposed components or components held-for-sale in discontinued operations if such components represent a strategic shift that has or will have a significant effect on operations and financial results. Additionally, expanded disclosure about discontinued operations and disposals of significant components that do not qualify for discontinued operations presentation will be required. The adoption of ASU 2014-08 is effective prospectively for disposals that occur within annual periods beginning on or after December 15, 2014, with early adoption permitted. The Company is currently evaluating the impact of the ASU on its consolidated financial statements.
	In May 2014, the FASB issued ASU No. 2014-09, Revenue from Contracts with Customers, ("ASU 2014-08").  This ASU requires an entity to recognize revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration to which the entity expects to be entitled in exchange for those goods or services. To achieve this core principle, the guidance provides that an entity should apply the following steps: (1) identify the contract(s) with a customer; (2) identify the performance obligations in the contract; (3) determine the transaction price; (4) allocate the transaction price to the performance obligations in the contract; and (5) recognize revenue when, or as, the entity satisfies a performance obligation. The ASU is effective beginning in the first quarter of our fiscal year 2017. Early adoption is not permitted. The Company is currently evaluating the impact to the consolidated financial statements.

Discontinued_Operations_Tables

Discontinued Operations (Tables)	9 Months Ended
	Sep. 30, 2014
Discontinued Operations and Disposal Groups [Abstract]	'
Summary of Discontinued Operations	'
	A summary of the discontinued operations for the periods presented is as follows (in thousands):
		Three Months Ended September 30,					Nine Months Ended September 30,
		2014		2013			2014		2013
	Net operating revenues	$	—	$	3,701		$	—	$	11,018
	Operating expenses	—		3,923			—		12,103
	Loss from discontinued operations	—		(222		)	—		(1,085		)
	Income tax benefit	—		(86		)	—		(420		)
	Loss from discontinued operations	$	—	$	(136	)	$	—	$	(665	)

Income_Per_Share_Tables

Income Per Share (Tables)	9 Months Ended
	Sep. 30, 2014
Earnings Per Share [Abstract]	'
Schedule of Earnings Per Share, Basic and Diluted	'
	The following table sets forth the computation of basic and diluted net (loss) income per share of Class A common stock and Class B common stock for the three and nine months ended September 30, 2014 and September 30, 2013 (amounts in thousands, except per share data):
		Three months ended September 30, 2014								Three months ended September 30, 2013									Nine months ended September 30, 2014									Nine months ended September 30, 2013
		Class A			Class B			Total		Class A			Class B			Total			Class A			Class B			Total			Class A			Class B			Total
	Net income (loss) per share, basic
	Numerator:
	Allocation of income (loss) from continuing operations	$	382		$	261		$	643	$	(6,991	)	$	(4,948	)	$	(11,939	)	$	(500	)	$	(343	)	$	(843	)	$	(3,993	)	$	(2,824	)	$	(6,817	)
	Allocation of loss from discontinued operations	—			—			—		(80		)	(56		)	(136		)	—			—			—			(389		)	(276		)	(665		)
	Allocation of net income (loss)	$	382		$	261		$	643	$	(7,071	)	$	(5,004	)	$	(12,075	)	$	(500	)	$	(343	)	$	(843	)	$	(4,382	)	$	(3,100	)	$	(7,482	)
	Net income (loss) per share, diluted
	Numerator:
	Allocation of income (loss) from continuing operations	$	384		$	259		$	643	$	(6,991	)	$	(4,948	)	$	(11,939	)	$	(500	)	$	(343	)	$	(843	)	$	(3,993	)	$	(2,824	)	$	(6,817	)
	Allocation of loss from discontinued operations	—			—			—		(80		)	(56		)	(136		)	—			—			—			(389		)	(276		)	$	(665	)
	Allocation of net income (loss)	$	384		$	259		$	643	$	(7,071	)	$	(5,004	)	$	(12,075	)	$	(500	)	$	(343	)	$	(843	)	$	(4,382	)	$	(3,100	)	$	(7,482	)
	Denominator for basic and diluted income (loss) per share:
	Weighted average common shares outstanding, basic	22,695			15,512			38,207		21,959			15,540			37,499			22,580			15,513			38,093			22,003			15,564			37,567
	Plus: incremental shares related to dilutive effect of stock options and restricted stock, if applicable	256			—			256		—			—			—			—			—			—			—			—			—
	Adjusted weighted-average common shares outstanding, diluted	22,951			15,512			38,463		21,959			15,540			37,499			22,580			15,513			38,093			22,003			15,564			37,567
	Earnings (loss) per share, basic:
	Earnings (loss) per common share from continuing operations	$	0.02		$	0.02		$	0.02	$	(0.32	)	$	(0.32	)	$	(0.32	)	$	(0.02	)	$	(0.02	)	$	(0.02	)	$	(0.18	)	$	(0.18	)	$	(0.18	)
	Loss per share from discontinued operations	—			—			—		—			—			—			—			—			—			$	(0.02	)	$	(0.02	)	$	(0.02	)
	Earnings (loss) per share	$	0.02		$	0.02		$	0.02	$	(0.32	)	$	(0.32	)	$	(0.32	)	$	(0.02	)	$	(0.02	)	$	(0.02	)	$	(0.20	)	$	(0.20	)	$	(0.20	)
	Earnings (loss) per share, diluted:
	Earnings (loss) per common share from continuing operations	$	0.02		$	0.02		$	0.02	$	(0.32	)	$	(0.32	)	$	(0.32	)	$	(0.02	)	$	(0.02	)	$	(0.02	)	$	(0.18	)	$	(0.18	)	$	(0.18	)
	Loss per share from discontinued operations	—			—			—		—			—			—			—			—			—			$	(0.02	)	$	(0.02	)	$	(0.02	)
	Earnings (loss) per share	$	0.02		$	0.02		$	0.02	$	(0.32	)	$	(0.32	)	$	(0.32	)	$	(0.02	)	$	(0.02	)	$	(0.02	)	$	(0.20	)	$	(0.20	)	$	(0.20	)
Schedule of Antidilutive Securities Excluded from Computation of Earnings Per Share	'
	The following were excluded from the weighted-average diluted shares computation for the three and nine months ended September 30, 2014 and 2013, as their inclusion would have been anti-dilutive (shares in thousands):
		Three Months Ended September 30,					Nine Months Ended September 30,
		2014		2013			2014		2013
	Options to purchase common shares	205		807			363		807
	Non-vested common shares	123		528			175		536
	Total excluded	328		1,335			538		1,343

Business_Segments_Tables

Business Segments (Tables)	9 Months Ended
	Sep. 30, 2014
Segment Reporting [Abstract]	'
Schedule of Segment Reporting Information, by Segment	'
		Long-Term			Therapy Services			Hospice & Home Health Services			Other			Elimination			Total
		Care Services
	Three months ended September 30, 2014
	Net patient service revenue from external customers	$	165,555		$	22,093		$	20,163		$	—		$	—		$	207,811
	Leased facility revenue	807			—			—			—			—			807
	Intersegment revenue	595			14,135			—			—			(14,730		)	—
	Total revenue	$	166,957		$	36,228		$	20,163		$	—		$	(14,730	)	$	208,618
	Operating income (loss)	$	15,936		$	3,617		$	1,190		$	(12,935	)	$	—		$	7,808
	Interest expense, net of interest income																(7,836		)
	Other income																(26		)
	Equity in earnings of joint venture																568
	Debt modification/retirement costs																(21		)
	Income from continuing operations before benefit from income taxes																$	493
	Depreciation and amortization	$	5,579		$	164		$	222		$	155		$	—		$	6,120
	Segment capital expenditures	$	2,386		$	26		$	15		$	556		$	—		$	2,983
	Adjusted EBITDA	$	22,307		$	3,851		$	1,752		$	(6,122	)	$	—		$	21,788
	Adjusted EBITDAR	$	26,996		$	3,851		$	2,209		$	(6,122	)	$	—		$	26,934
	Three months ended September 30, 2013
	Net patient service revenue from external customers	$	157,506		$	25,313		$	25,138		$	—		$	—		$	207,957
	Leased facility revenue	787			—			—			—			—			787
	Intersegment revenue	598			13,888			—			—			(14,486		)	—
	Total revenue	$	158,891		$	39,201		$	25,138		$	—		$	(14,486	)	$	208,744
	Operating (loss) income	$	11,820		$	2,740		$	(16,524	)	$	(6,645	)	$	—		$	(8,609	)
	Interest expense, net of interest income																(8,681		)
	Other expense																(49		)
	Equity in earnings of joint venture																508
	Debt modification/retirement costs																(432		)
	Loss from continuing operations before benefit from income taxes																$	(17,263	)
	Depreciation and amortization	$	5,439		$	170		$	136		$	155		$	—		$	5,900
	Segment capital expenditures	$	3,323		$	18		$	579		$	76		$	—		$	3,996
	Adjusted EBITDA	$	17,352		$	3,335		$	3,007		$	(5,267	)	$	—		$	18,427
	Adjusted EBITDAR	$	21,700		$	3,335		$	3,465		$	(5,267	)	$	—		$	23,233
	Nine months ended September 30, 2014
	Net patient service revenue from external customers	$	488,405		$	68,236		$	63,856		$	—		$	—		$	620,496
	Leased facility revenue	2,401			—			—			—			—			2,401
	Intersegment revenue	1,549			42,037			—			—			(43,586		)	—
	Total revenue	$	492,355		$	110,273		$	63,856		$	—		$	(43,586	)	$	622,897
	Operating income (loss)	$	39,857		$	10,814		$	(2,019	)	$	(26,570	)	$	—		$	22,082
	Interest expense, net of interest income																(23,475		)
		Long-Term			Therapy Services			Hospice & Home Health Services			Other			Elimination			Total
		Care Services
	Other income																34
	Equity in earnings of joint venture																1,206
	Debt modification/retirement costs																(843		)
	Loss from continuing operations before benefit from income taxes																$	(996	)
	Depreciation and amortization	$	16,640		$	498		$	683		$	419		$	—		$	18,240
	Segment capital expenditures	$	7,692		$	80		$	122		$	1,349		$	—		$	9,243
	Adjusted EBITDA	$	58,271		$	11,381		$	5,616		$	(17,350	)	$	—		$	57,918
	Adjusted EBITDAR	$	71,732		$	11,381		$	6,997		$	(17,350	)	$	—		$	72,760
	Nine months ended September 30, 2013
	Net patient service revenue from external customers	$	476,115		$	79,057		76,488			$	—		$	—		$	631,660
	Leased facility revenue	2,335			—			—			—			—			2,335
	Intersegment revenue	1,791			43,079			—			—			(44,870		)	—
	Total revenue	$	480,241		$	122,136		76,488			$	—		$	(44,870	)	$	633,995
	Operating income (loss)	$	37,110		$	8,399		(9,943		)	$	(20,295	)	$	—		$	15,271
	Interest expense, net of interest income																(25,866		)
	Other expense																(111		)
	Equity in earnings of joint venture																1,469
	Debt modification/retirement costs																(1,520		)
	Loss from continuing operations before benefit from income taxes																$	(10,757	)
	Depreciation and amortization	$	16,241		$	520		$	426		$	513		$	—		$	17,700
	Segment capital expenditures	$	8,885		$	111		$	792		$	189		$	—		$	9,977
	Adjusted EBITDA	$	54,339		$	9,345		$	8,226		$	(16,123	)	$	—		$	55,787
Adjusted EBITDAR	$	67,123		$	9,345		$	9,602		$	(16,123	)	$	—		$	69,947
Reconciliation of Adjusted EBITDA and Adjusted EBITDAR to Net Income	'
	A reconciliation of Adjusted EBITDA and Adjusted EBITDAR to net (loss) income is as follows (in thousands):
		Three Months Ended September 30,						Nine Months Ended September 30,
		2014			2013			2014			2013
	Adjusted EBITDAR	$	26,934		$	23,233		$	72,760		$	69,947
	Rent cost of revenue	(5,146		)	(4,806		)	(14,842		)	(14,160		)
	Adjusted EBITDA	21,788			18,427			57,918			55,787
	Depreciation and amortization	(6,120		)	(5,900		)	(18,240		)	(17,700		)
	Interest expense	(8,009		)	(8,744		)	(23,993		)	(26,153		)
	Interest income	173			63			518			287
	Change in fair value of contingent consideration	(7		)	(79		)	100			2,082
	Organization restructure costs	(359		)	(457		)	(1,430		)	(2,006		)
	Exit costs related to divested facilities	(57		)	—			(397		)	—
	Losses at skilled nursing facility not at full operation	(450		)	—			(583		)	—
	Governmental investigation expense	—			—			(6,000		)	—
	Legal expense for non-routine matters	(616		)	(416		)	(1,590		)	(1,809		)
	Merger related expense	(5,761		)	(306		)	(6,306		)	(306		)
	Debt modification/retirement costs	(21		)	(432		)	(843		)	(1,520		)
	Impairment of long-lived assets	—			(19,000		)	(82		)	(19,000		)
	Closure of California home health agency	—			(419		)	—			(419		)
	Loss on disposal of asset	(68		)	—			(68		)	—
	Discontinued operations, net of taxes	—			(136		)	—			(665		)
	Benefit from income taxes	150			5,324			153			3,940
	Net income (loss)	$	643		$	(12,075	)	$	(843	)	$	(7,482	)
Schedule of Total Assets, Goodwill, and Intangibles, by Segment	'
	The following table presents the segment assets as of September 30, 2014 compared to December 31, 2013 (in thousands):
		Long-Term			Therapy Services			Hospice & Home Health Services			Other			Total
		Care  Services
	September 30, 2014:
	Segment total assets	$	457,225		$	47,173		$	77,414		$	68,085		$	649,897
	Goodwill and intangibles included in total assets	$	1,102		$	23,693		$	62,607		$	—		$	87,402
	December 31, 2013:
	Segment total assets	$	445,987		$	48,251		$	80,290		$	68,888		$	643,416
	Goodwill and intangibles included in total assets	$	1,300		$	23,693		$	62,879		$	—		$	87,872

Property_and_Equipment_Tables

Property and Equipment (Tables)	9 Months Ended
	Sep. 30, 2014
Property, Plant and Equipment [Abstract]	'
Property, Plant and Equipment	'
	Property and equipment consisted of the following as of September 30, 2014 and December 31, 2013 (in thousands):
		September 30, 2014			December 31, 2013
	Land and land improvements	$	62,236		$	62,370
	Buildings and leasehold improvements	325,095			320,923
	Furniture and equipment	94,185			87,392
	Construction in progress	6,866			8,621
		488,382			479,306
	Less accumulated depreciation	(155,097		)	(137,484		)
		$	333,285		$	341,822
Leased Facility Assets	'
	Leased facility assets consisted of the following as of September 30, 2014 and December 31, 2013 (in thousands):
		September 30, 2014			December 31, 2013
	Leased facility assets	$	13,848		$	13,848
	Less accumulated depreciation	(4,791		)	(4,432		)
		$	9,057		$	9,416

Commitments_and_Contingencies_

Commitments and Contingencies Commitments and Contingencies (Tables)	9 Months Ended
	Sep. 30, 2014
Commitments and Contingencies Disclosure [Abstract]	'
Liabilities Related to Insurance Risks	'
	A summary of the liabilities related to insurance risks are as follows (dollars in thousands):
		As of September 30, 2014:											As of December 31, 2013
		General and			Employee			Workers’			Total		General and			Employee			Workers’			Total
		Professional			Medical			Compensation					Professional			Medical			Compensation
	Current	$	7,436	(1)	$	1,859	(2)	$	6,713	(2)	$	16,008	$	8,228	(1)	$	2,446	(2)	$	3,178	(2)	$	13,852
	Non-current	13,657			—			14,418			28,075		12,762			—			16,772			29,534
		$	21,093		$	1,859		$	21,131		$	44,083	$	20,990		$	2,446		$	19,950		$	43,386

Stockholders_Equity_Tables

Stockholders' Equity (Tables)	9 Months Ended
	Sep. 30, 2014
Equity [Abstract]	'
Schedule of Share-based Compensation, Restricted Stock Activity	'
	During the nine months ended September 30, 2014, the following occurred with respect to restricted stock awards, restricted stock units, and performance stock awards under the Company’s existing plans (number of shares in thousands):
		Number of		Weighted-
		Shares		Average
				Grant Date
				Fair Value
	Non-vested balance at January 1, 2014	2,256		$	6.42
	Granted	946		4.86
	Vested	(326	)	4.55
	Forfeited	(603	)	5.43
	Non-vested balance at September 30, 2014	2,273		$	6.3
Schedule of Share-based Compensation, Stock Options, Activity	'
	The following table summarizes stock option activity during the nine months ended September 30, 2014 under the Skilled Healthcare Group, Inc. Amended and Restated 2007 Incentive Award Plan:
		Number of		Weighted-		Weighted-	Aggregate
		Shares		Average		Average	Intrinsic
				Exercise		Remaining	Value
				Price		Contractual	(in thousands)
						Term
						(in years)
	Outstanding at January 1, 2014	794,645		$	8.54
	Granted	—		$	—
	Exercised	(160,548	)	$	5.91
	Forfeited or cancelled	(200,429	)	$	9.76
	Outstanding at September 30, 2014	433,668		$	8.95	4.77	$	—
	Fully vested and expected to vest at September 30, 2014	432,862		$	8.95	4.77	$	—
	Exercisable at September 30, 2014	413,145		$	9	4.65	$	—

Fair_Value_Measurements_Tables

Fair Value Measurements (Tables)	9 Months Ended
	Sep. 30, 2014
Fair Value Disclosures [Abstract]	'
Fair Value Measurements, Recurring and Nonrecurring	'
	The following table summarizes the valuation of the Company’s marketable securities and contingent consideration as of September 30, 2014 (dollars in thousands) and December 31, 2013:
		September 30, 2014							December 31, 2013
		Level 1			Level 2		Level 3		Level 1		Level 2		Level 3
	Available for sale securities	$	—		$	—	$	—	$	—	$	1,046	$	—
	Trading securities	$	—		$	9,060	$	—	$	—	$	—	$	—
	Contingent consideration – acquisitions	$	—		$	—	$	836	$	—	$	—	$	1,736
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation	'
	Below is a table listing the Level 3 rollforward as of September 30, 2014 (in thousands):
	Level 3 Rollforward
	Value at January 1, 2014	$	1,736
	Change in fair value	(100		)
	Payout	(800		)
	Value at September 30, 2014	$	836

Debt_Tables

Debt (Tables)	9 Months Ended
	Sep. 30, 2014
Debt Disclosure [Abstract]	'
Schedule of Debt	'
	The Company’s long-term debt is summarized as follows (dollars in thousands):
		As of September 30, 2014			As of December 31, 2013
	Term Loan, due April 2016, interest rate based on LIBOR (subject to a 1.50% floor) plus 5.50%, or 7.00%, at September 30, 2014 and LIBOR (subject to a 1.50% floor) plus 5.25%, or 6.75%, at December 31, 2013; collateralized by substantially all assets of the Company excluding the skilled nursing facilities that collateralize the HUD insured mortgage loans and the skilled nursing facilities that collateralize the MidCap Financial credit facility	$	243,953		$	243,953
	Term Loan original issue discount	(838		)	(1,254		)
	Revolving Credit Facility due April 2015, interest rate comprised of the Prime rate of 3.25% plus 3.50%, or 6.75%, at December 31, 2013	—			11,000
	Revolving Credit Facility due April 2016, interest rate comprised of LIBOR plus 5.50%, or 5.74%, at September 30, 2014	6,090			—
	Revolving Credit Facility due April 2015, interest rate comprised of LIBOR plus 4.50%, or 4.74%, at September 30, 2014 and December 31, 2013	3,910			7,057
	HUD insured loans due in 2043 and 2048, with a weighted average interest rate of 4.28% and 4.24% at September 30, 2014 and December 31, 2013, respectively	86,339			87,314
	Term Loan, due December 2016, interest rate based on LIBOR rate (subject to a floor of 0.75%) plus 5.95%, or 6.70%, at September 30, 2014 and December 31, 2013; collateralized by 10 skilled nursing facilities	60,761			62,000
	Revolving Credit Facility due December 2016, interest rate comprised of LIBOR (subject to a floor of 0.75%) plus 5.95%, or 6.70%, at September 30, 2014 and December 31, 2013; collateralized by the accounts receivable of 10 skilled nursing facilities	4,165			5,000
	Note payable due December 2018, interest rate fixed at 6.50%, payable in monthly installments, collateralized by a first priority deed of trust	833			959
	Insurance premiums financed	2,604			2,990
	Other	—			106
	Total long-term debt	407,817			419,125
	Less amounts due within one year	(13,173		)	(7,630		)
	Long-term debt, less current portion	$	394,644		$	411,495

Investment_in_Joint_Venture_Ta

Investment in Joint Venture (Tables)	9 Months Ended
	Sep. 30, 2014
Equity Method Investments and Joint Ventures [Abstract]	'
Schedule of summarized financial information for equity method investment	'
	The following tables provide summarized information from the balance sheet and statement of earnings for APS - Summit Care as of September 30, 2014:
	Statement of Earnings
	(In thousands)
		Three Months Ended September 30,				Nine Months Ended September 30,
		2014		2013		2014		2013
	Sales, Net	$	5,045	$	4,209	$	11,127	$	11,150
	Gross Profit	809		1,243		2,248		3,377
	Net Income	$	1,068	$	933	$	1,870	$	2,496
	Balance Sheet
	(In thousands)
		30-Sep-14		December 31, 2013
	Current Assets	$	3,262	$	3,518
	Non-Current Assets	1,188		1,078
	Current Liabilities	125		96
	Non-Current Liabilities	$	—	$	—

Description_of_Business_Detail

Description of Business (Details)	Sep. 30, 2014
	facility
Facility Count [Line Items]	'
Number of skilled nursing facilities	10
Number of leased facility asset	5
Long-Term Care Services	'
Facility Count [Line Items]	'
Number of skilled nursing facilities	73
Number of assisted living facility	22

Discontinued_Operations_Detail

Discontinued Operations (Details) (USD $)	3 Months Ended		9 Months Ended
In Thousands, unless otherwise specified	Sep. 30, 2014	Sep. 30, 2013	Sep. 30, 2014	Sep. 30, 2013
Discontinued Operations and Disposal Groups [Abstract]	'	'	'	'
Net operating revenues	$0	$3,701	$0	$11,018
Operating expenses	0	3,923	0	12,103
Loss from discontinued operations	0	-222	0	-1,085
Income tax benefit	0	-86	0	-420
Loss from discontinued operations	$0	($136)	$0	($665)

Summary_of_Significant_Account2

Summary of Significant Accounting Policies - Notes Receivable (Details) (USD $)	Sep. 30, 2014	Dec. 31, 2013	Sep. 30, 2014	Sep. 30, 2014	Sep. 30, 2014
			Therapy Services	Therapy Services	Therapy Services
			Notes Receivable	Accounts Receivable	Sales Revenue, Services, Net
Accounting Policies [Abstract]	'	'	'	'	'
Financing receivable, net	$3,600,000	$2,000,000	'	'	'
Financing receivable, net, current	1,500,000	1,500,000	'	'	'
Accounts, Notes, Loans and Financing Receivable [Line Items]	'	'	'	'	'
Concentration risk, percentage	'	'	100.00%	35.90%	41.80%
Accounts receivable, net	'	'	'	6,400,000	28,500,000
Financing receivable, allowance for credit losses	$0	'	'	'	'

Summary_of_Significant_Account3

Summary of Significant Accounting Policies - Revenue and Accounts Receivable (Details) (USD $)	3 Months Ended			6 Months Ended		9 Months Ended
In Millions, unless otherwise specified	Sep. 30, 2014	Sep. 30, 2013	Jun. 30, 2012	Jun. 30, 2012	Jun. 30, 2011	Sep. 30, 2014	Sep. 30, 2013
Accounting Policies [Abstract]	'	'	'	'	'	'	'
Revenue cap adjustment	$1.20	$0.50	'	'	'	$2.10	$3.40
Revenue cap adjustment related to 2014 cap year	1.4	'	'	'	'	2	'
Revenue cap adjustment related to 2013 cap year	-0.2	0.2	'	'	'	0.1	0.9
Revenue cap adjustment related to 2012 cap year	'	'	0.3	2.3	'	'	'
Revenue cap adjustment related to 2011 cap year	'	'	'	'	$0.20	'	'

Income_Per_Share_Details

Income Per Share (Details) (USD $)	3 Months Ended		9 Months Ended
In Thousands, except Per Share data, unless otherwise specified	Sep. 30, 2014	Sep. 30, 2013	Sep. 30, 2014	Sep. 30, 2013
Net income (loss) per share, basic	'	'	'	'
Allocation of income (loss) from continuing operations	$643	($11,939)	($843)	($6,817)
Allocation of loss from discontinued operations	0	-136	0	-665
Allocation of net income (loss)	643	-12,075	-843	-7,482
Net income (loss) per share, diluted	'	'	'	'
Allocation of income (loss) from continuing operations	643	-11,939	-843	-6,817
Allocation of loss from discontinued operations	0	-136	0	-665
Allocation of net income (loss)	643	-12,075	-843	-7,482
Denominator for basic and diluted income (loss) per share:	'	'	'	'
Weighted-average common shares outstanding, basic (in shares)	38,207	37,499	38,093	37,567
Plus: incremental shares related to dilutive effect of stock options and restricted stock, if applicable (in shares)	256	0	0	0
Adjusted weighted-average common shares outstanding, diluted (in shares)	38,463	37,499	38,093	37,567
Earnings per common share from continuing operations (usd per share)	$0.02	($0.32)	($0.02)	($0.18)
Loss per share from discontinued operations (usd per share)	$0	$0	$0	($0.02)
Income (loss) per share, basic (usd per share)	$0.02	($0.32)	($0.02)	($0.20)
Earnings per common share from continuing operations (usd per share)	$0.02	($0.32)	($0.02)	($0.18)
Loss per share from discontinued operations (usd per share)	$0	$0	$0	($0.02)
Income (loss) per share, diluted (usd per share)	$0.02	($0.32)	($0.02)	($0.20)
Common Class A	'	'	'	'
Net income (loss) per share, basic	'	'	'	'
Allocation of income (loss) from continuing operations	382	-6,991	-500	-3,993
Allocation of loss from discontinued operations	0	-80	0	-389
Allocation of net income (loss)	382	-7,071	-500	-4,382
Net income (loss) per share, diluted	'	'	'	'
Allocation of income (loss) from continuing operations	384	-6,991	-500	-3,993
Allocation of loss from discontinued operations	0	-80	0	-389
Allocation of net income (loss)	384	-7,071	-500	-4,382
Denominator for basic and diluted income (loss) per share:	'	'	'	'
Weighted-average common shares outstanding, basic (in shares)	22,695	21,959	22,580	22,003
Plus: incremental shares related to dilutive effect of stock options and restricted stock, if applicable (in shares)	256	0	0	0
Adjusted weighted-average common shares outstanding, diluted (in shares)	22,951	21,959	22,580	22,003
Earnings per common share from continuing operations (usd per share)	$0.02	($0.32)	($0.02)	($0.18)
Loss per share from discontinued operations (usd per share)	$0	$0	$0	($0.02)
Income (loss) per share, basic (usd per share)	$0.02	($0.32)	($0.02)	($0.20)
Earnings per common share from continuing operations (usd per share)	$0.02	($0.32)	($0.02)	($0.18)
Loss per share from discontinued operations (usd per share)	$0	$0	$0	($0.02)
Income (loss) per share, diluted (usd per share)	$0.02	($0.32)	($0.02)	($0.20)
Common Class B	'	'	'	'
Net income (loss) per share, basic	'	'	'	'
Allocation of income (loss) from continuing operations	261	-4,948	-343	-2,824
Allocation of loss from discontinued operations	0	-56	0	-276
Allocation of net income (loss)	261	-5,004	-343	-3,100
Net income (loss) per share, diluted	'	'	'	'
Allocation of income (loss) from continuing operations	259	-4,948	-343	-2,824
Allocation of loss from discontinued operations	0	-56	0	-276
Allocation of net income (loss)	$259	($5,004)	($343)	($3,100)
Denominator for basic and diluted income (loss) per share:	'	'	'	'
Weighted-average common shares outstanding, basic (in shares)	15,512	15,540	15,513	15,564
Plus: incremental shares related to dilutive effect of stock options and restricted stock, if applicable (in shares)	0	0	0	0
Adjusted weighted-average common shares outstanding, diluted (in shares)	15,512	15,540	15,513	15,564
Earnings per common share from continuing operations (usd per share)	$0.02	($0.32)	($0.02)	($0.18)
Loss per share from discontinued operations (usd per share)	$0	$0	$0	($0.02)
Income (loss) per share, basic (usd per share)	$0.02	($0.32)	($0.02)	($0.20)
Earnings per common share from continuing operations (usd per share)	$0.02	($0.32)	($0.02)	($0.18)
Loss per share from discontinued operations (usd per share)	$0	$0	$0	($0.02)
Income (loss) per share, diluted (usd per share)	$0.02	($0.32)	($0.02)	($0.20)

Schedule_of_Antidilutive_Secur

Schedule of Antidilutive Securities Excluded from Computation of Earnings Per Share (Details)	3 Months Ended		9 Months Ended
In Thousands, unless otherwise specified	Sep. 30, 2014	Sep. 30, 2013	Sep. 30, 2014	Sep. 30, 2013
Earnings Per Share [Abstract]	'	'	'	'
Options to purchase common shares	205	807	363	807
Non-vested common shares	123	528	175	536
Total excluded	328	1,335	538	1,343

Business_Segments_Segment_Info

Business Segments Segment Information (Details)	3 Months Ended
	Sep. 30, 2014
	segment
	facility
Facility Count [Line Items]	'
Number of reportable segments	3
Number of skilled nursing facilities	10
Long-Term Care Services	'
Facility Count [Line Items]	'
Number of skilled nursing facilities	73
Number of assisted living facility	22

Business_Segments_Segment_Repo

Business Segments Segment Reporting (Details) (USD $)	3 Months Ended		9 Months Ended
In Thousands, unless otherwise specified	Sep. 30, 2014	Sep. 30, 2013	Sep. 30, 2014	Sep. 30, 2013
Segment Reporting Information [Line Items]	'	'	'	'
Net patient service revenue from external customers	$207,811	$207,957	$620,496	$631,660
Intersegment revenue	208,618	208,744	622,897	633,995
Operating income (loss)	'	'	22,082	15,271
Interest expense, net of interest income	-7,836	-8,681	-23,475	-25,866
Other expense (income)	-26	-49	34	-111
Equity in earnings of joint venture	568	508	1,206	1,469
Debt modification/retirement costs	-21	'	-843	'
Debt modification/retirement costs	'	-432	'	-1,520
Loss from continuing operations before benefit from income taxes	493	-17,263	-996	-10,757
Depreciation and amortization	6,120	5,900	18,240	17,700
Segment capital expenditures	2,983	3,996	9,243	9,977
Adjusted EBITDA	21,788	18,427	57,918	55,787
Adjusted EBITDAR	26,934	23,233	72,760	69,947
Long-Term Care Services	'	'	'	'
Segment Reporting Information [Line Items]	'	'	'	'
Operating income (loss)	'	'	39,857	37,110
Depreciation and amortization	5,579	5,439	16,640	16,241
Segment capital expenditures	2,386	3,323	7,692	8,885
Adjusted EBITDA	22,307	17,352	58,271	54,339
Adjusted EBITDAR	26,996	21,700	71,732	67,123
Therapy Services	'	'	'	'
Segment Reporting Information [Line Items]	'	'	'	'
Operating income (loss)	'	'	10,814	8,399
Depreciation and amortization	164	170	498	520
Segment capital expenditures	26	18	80	111
Adjusted EBITDA	3,851	3,335	11,381	9,345
Adjusted EBITDAR	3,851	3,335	11,381	9,345
Hospice and Home Health Services	'	'	'	'
Segment Reporting Information [Line Items]	'	'	'	'
Operating income (loss)	'	'	-2,019	-9,943
Depreciation and amortization	222	136	683	426
Segment capital expenditures	15	579	122	792
Adjusted EBITDA	1,752	3,007	5,616	8,226
Adjusted EBITDAR	2,209	3,465	6,997	9,602
Other	'	'	'	'
Segment Reporting Information [Line Items]	'	'	'	'
Operating income (loss)	'	'	-26,570	-20,295
Depreciation and amortization	155	155	419	513
Segment capital expenditures	556	76	1,349	189
Adjusted EBITDA	-6,122	-5,267	-17,350	-16,123
Adjusted EBITDAR	-6,122	-5,267	-17,350	-16,123
Elimination	'	'	'	'
Segment Reporting Information [Line Items]	'	'	'	'
Operating income (loss)	'	'	0	0
Depreciation and amortization	0	0	0	0
Segment capital expenditures	0	0	0	0
Adjusted EBITDA	0	0	0	0
Adjusted EBITDAR	0	0	0	0
Operating Segments	'	'	'	'
Segment Reporting Information [Line Items]	'	'	'	'
Net patient service revenue from external customers	207,811	207,957	620,496	631,660
Leased facility revenue	807	787	2,401	2,335
Intersegment revenue	208,618	208,744	622,897	633,995
Operating income (loss)	7,808	-8,609	'	'
Operating Segments | Long-Term Care Services	'	'	'	'
Segment Reporting Information [Line Items]	'	'	'	'
Net patient service revenue from external customers	165,555	157,506	488,405	476,115
Leased facility revenue	807	787	2,401	2,335
Intersegment revenue	166,957	158,891	492,355	480,241
Operating income (loss)	15,936	11,820	'	'
Operating Segments | Therapy Services	'	'	'	'
Segment Reporting Information [Line Items]	'	'	'	'
Net patient service revenue from external customers	22,093	25,313	68,236	79,057
Leased facility revenue	0	0	0	0
Intersegment revenue	36,228	39,201	110,273	122,136
Operating income (loss)	3,617	2,740	'	'
Operating Segments | Hospice and Home Health Services	'	'	'	'
Segment Reporting Information [Line Items]	'	'	'	'
Net patient service revenue from external customers	20,163	25,138	63,856	76,488
Leased facility revenue	0	0	0	0
Intersegment revenue	20,163	25,138	63,856	76,488
Operating income (loss)	1,190	-16,524	'	'
Operating Segments | Other	'	'	'	'
Segment Reporting Information [Line Items]	'	'	'	'
Net patient service revenue from external customers	0	0	0	0
Leased facility revenue	0	0	0	0
Intersegment revenue	0	0	0	0
Operating income (loss)	-12,935	-6,645	'	'
Operating Segments | Elimination	'	'	'	'
Segment Reporting Information [Line Items]	'	'	'	'
Net patient service revenue from external customers	0	0	0	0
Leased facility revenue	0	0	0	0
Intersegment revenue	-14,730	-14,486	-43,586	-44,870
Operating income (loss)	0	0	'	'
Segment Reconciling Items	'	'	'	'
Segment Reporting Information [Line Items]	'	'	'	'
Intersegment revenue	0	0	0	0
Segment Reconciling Items | Long-Term Care Services	'	'	'	'
Segment Reporting Information [Line Items]	'	'	'	'
Intersegment revenue	595	598	1,549	1,791
Segment Reconciling Items | Therapy Services	'	'	'	'
Segment Reporting Information [Line Items]	'	'	'	'
Intersegment revenue	14,135	13,888	42,037	43,079
Segment Reconciling Items | Hospice and Home Health Services	'	'	'	'
Segment Reporting Information [Line Items]	'	'	'	'
Intersegment revenue	0	0	0	0
Segment Reconciling Items | Other	'	'	'	'
Segment Reporting Information [Line Items]	'	'	'	'
Intersegment revenue	0	0	0	0
Segment Reconciling Items | Elimination	'	'	'	'
Segment Reporting Information [Line Items]	'	'	'	'
Intersegment revenue	($14,730)	($14,486)	($43,586)	($44,870)

Business_Segments_Reconciliati

Business Segments Reconciliation of Adjusted EBITDA and Adjusted EBITDAR to Net Income (Details) (USD $)	3 Months Ended		9 Months Ended
In Thousands, unless otherwise specified	Sep. 30, 2014	Sep. 30, 2013	Sep. 30, 2014	Sep. 30, 2013
Segment Reporting [Abstract]	'	'	'	'
Adjusted EBITDAR	$26,934	$23,233	$72,760	$69,947
Rent cost of revenue	-5,146	-4,806	-14,842	-14,160
Adjusted EBITDA	21,788	18,427	57,918	55,787
Depreciation and amortization	-6,120	-5,900	-18,240	-17,700
Interest expense	-8,009	-8,744	-23,993	-26,153
Interest income	-173	-63	-518	-287
Change in fair value of contingent consideration	-7	-79	100	2,082
Organization restructure costs	-359	-457	-1,430	-2,006
Exit costs related to divested facilities	-57	0	-397	0
Losses at skilled nursing facility not at full operation	-450	0	-583	0
Governmental investigation expense	0	0	-6,000	0
Legal Fees	-616	-416	-1,590	-1,809
Merger related expense	-5,761	-306	-6,306	-306
Debt modification/retirement costs	-21	-432	-843	-1,520
Impairment of long-lived assets	0	-19,000	-82	-19,000
Disposal Group, Not Discontinued Operation, Gain (Loss) on Disposal	0	-419	0	-419
Loss on disposal of asset	-68	0	-68	0
Loss from discontinued operations, net of tax	0	-136	0	-665
Benefit from income taxes	150	5,324	153	3,940
Net (loss) income	$643	($12,075)	($843)	($7,482)

Business_Segments_Reconciliati1

Business Segments Reconciliation of Assets by Segment (Details) (USD $)	Sep. 30, 2014	Dec. 31, 2013
In Thousands, unless otherwise specified
Segment Reporting, Asset Reconciling Item [Line Items]	'	'
Segment total assets	$649,897	$643,416
Goodwill and intangibles included in total assets	87,402	87,872
Long-Term Care Services	'	'
Segment Reporting, Asset Reconciling Item [Line Items]	'	'
Segment total assets	457,225	445,987
Goodwill and intangibles included in total assets	1,102	1,300
Therapy Services	'	'
Segment Reporting, Asset Reconciling Item [Line Items]	'	'
Segment total assets	47,173	48,251
Goodwill and intangibles included in total assets	23,693	23,693
Hospice and Home Health Services	'	'
Segment Reporting, Asset Reconciling Item [Line Items]	'	'
Segment total assets	77,414	80,290
Goodwill and intangibles included in total assets	62,607	62,879
Other	'	'
Segment Reporting, Asset Reconciling Item [Line Items]	'	'
Segment total assets	68,085	68,888
Goodwill and intangibles included in total assets	$0	$0

Property_and_Equipment_Schedul

Property and Equipment Schedule of Property and Equipment (Details) (USD $)	Sep. 30, 2014	Dec. 31, 2013
In Thousands, unless otherwise specified
Property, Plant and Equipment [Abstract]	'	'
Land and land improvements	$62,236	$62,370
Buildings and leasehold improvements	325,095	320,923
Furniture and equipment	94,185	87,392
Construction in progress	6,866	8,621
Property, plant and equipment, gross	488,382	479,306
Less accumulated depreciation	-155,097	-137,484
Property, plant and equipment, net	$333,285	$341,822

Property_and_Equipment_Leased_

Property and Equipment Leased Facility Assets Schedule (Details) (USD $)	1 Months Ended	9 Months Ended
In Thousands, unless otherwise specified	Apr. 30, 2011	Sep. 30, 2014	Dec. 31, 2013
		option
		facility
Property, Plant and Equipment [Abstract]	'	'	'
Leased facility assets	'	$13,848	$13,848
Less accumulated depreciation	'	-4,791	-4,432
Leased facility assets, net	'	$9,057	$9,416
Number of leased facility asset	'	5	'
Lease period	'10 years	'	'
Number of lease extension options	'	2	'
Lease extension, lease period	'	'10 years	'

Income_Taxes_Details

Income Taxes (Details) (USD $)	3 Months Ended		9 Months Ended
	Sep. 30, 2014	Sep. 30, 2013	Sep. 30, 2014	Sep. 30, 2013
Income Tax Disclosure [Abstract]	'	'	'	'
Benefit from income taxes	($150,000)	($5,324,000)	($153,000)	($3,940,000)
Effective income tax rate	-30.40%	30.80%	15.40%	36.60%
Change from net Income to net loss	17,800,000	'	9,800,000	'
(Loss) income from continuing operations before (benefit) provision for income taxes	$493,000	($17,263,000)	($996,000)	($10,757,000)

Commitments_and_Contingencies_1

Commitments and Contingencies Commitments and Contingencies (Details) (USD $)

3 Months Ended

9 Months Ended

12 Months Ended

0 Months Ended

1 Months Ended

9 Months Ended

0 Months Ended

0 Months Ended

Sep. 30, 2014

Sep. 30, 2013

Sep. 30, 2014

Sep. 30, 2013

Dec. 31, 2013

Dec. 31, 2013

Nov. 30, 2010

Apr. 30, 2011

Sep. 30, 2014

Nov. 30, 2010

Nov. 30, 2010

Nov. 30, 2010

Nov. 30, 2010

Feb. 15, 2013

Apr. 15, 2009

Sep. 30, 2014

Feb. 15, 2013

Sep. 30, 2014

Aug. 02, 2013

facility

facility

Workers' Compensation Liability [Member]

Employee Medical Liability [Member]

Humboldt County Action [Member]

Humboldt County Action [Member]

Humboldt County Action [Member]

Humboldt County Action [Member]

Humboldt County Action [Member]

Humboldt County Action [Member]

State of California and Other Districts [Member]

BMFEA Matter [Member]

BMFEA Matter [Member]

BMFEA Matter [Member]

BMFEA Matter [Member]

Creekside Hospice Investigation [Member]

Creekside Hospice Investigation [Member]

Texas [Member]

defendent

defendent

Governmental Claims [Member]

Professional Fees [Member]

Plaintiffs [Member]

Governmental Claims [Member]

subsidiary

Affiliated Entity [Member]

Affiliated Entity [Member]

Fountain View Reinsurance, Ltd. [Member]

count

H

facility

Loss Contingencies [Line Items]

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

Loss Contingency, Range of Possible Loss, Minimum

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

$5,500

Loss Contingency, Range of Possible Loss, Maximum

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

11,500

Loss Contingency, Estimate of Possible Loss

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

6,000,000

'

Litigation settlement amount

'

'

'

'

'

'

50,000,000

'

'

5,000,000

'

'

4,000,000

'

'

'

'

'

'

Legal settlement payments approved from court

'

'

'

'

'

'

3,000,000

'

'

1,000,000

'

10,000

'

'

'

'

'

'

'

Professional fees

5,761,000

306,000

6,306,000

306,000

'

'

'

'

'

'

24,800,000

'

'

'

'

'

'

'

'

Loss contingency, number of defendants

'

'

'

'

'

'

'

5

22

'

'

'

'

'

'

'

'

'

'

Injunction Costs

'

'

'

'

'

'

9,600,000

'

'

'

'

'

'

'

'

'

'

'

'

Number of subsidiaries under investigation

'

'

'

'

'

'

'

'

'

'

'

'

'

'

2

'

'

'

'

Loss contingency, fine

'

'

'

'

'

'

'

'

'

'

'

'

'

'

6,000

'

'

'

'

Number of felony counts

'

'

'

'

'

'

'

'

'

'

'

'

'

'

2

'

'

'

'

Loss contingency, fine per misdemeanor count

'

'

'

'

'

'

'

'

'

'

'

'

'

'

2,000

'

'

'

'

Number of misdemeanor counts

'

'

'

'

'

'

'

'

'

'

'

'

'

'

9

'

'

'

'

Statutory fine

'

'

'

'

'

'

'

'

'

'

'

'

'

680

'

'

'

'

'

Investigation costs of plaintiff paid by defendant

'

'

'

'

'

'

'

'

'

'

'

'

'

145,000

'

'

'

'

'

Period of summary probation

'

'

'

'

'

'

'

'

'

'

'

'

'

'2 years

'

'

'

'

'

Number of skilled nursing facilities

10

'

10

'

'

'

'

'

'

'

'

'

'

'

'

'

20

'

'

Number of nursing hours per patient day

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

3.2

'

'

'

Self-insured per loss limit

'

'

'

'

1,000,000

'

'

'

'

'

'

'

'

'

'

'

'

'

'

Self-Insured stop loss limit

'

'

'

'

'

250,000

'

'

'

'

'

'

'

'

'

'

'

'

'

Required indemnification payments made

$0

$0

$0

$0

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

Commitments_and_Contingencies_2

Commitments and Contingencies Schedule of Liabilities Related to Insurance Risks (Details) (USD $)	Sep. 30, 2014		Dec. 31, 2013
In Thousands, unless otherwise specified
Liabilities Related to Insurance Risks [Line Items]	'		'
Self Insurance Reserve, Current	$16,008		$13,852
Insurance liability risks	28,075		29,534
Self Insurance Reserve	44,083		43,386
General and Professional Liability [Member]	'		'
Liabilities Related to Insurance Risks [Line Items]	'		'
Self Insurance Reserve, Current	7,436	[1]	8,228	[1]
Insurance liability risks	13,657		12,762
Self Insurance Reserve	21,093		20,990
Employee Medical Liability [Member]	'		'
Liabilities Related to Insurance Risks [Line Items]	'		'
Self Insurance Reserve, Current	1,859	[2]	2,446	[2]
Insurance liability risks	0		0
Self Insurance Reserve	1,859		2,446
Workers' Compensation Liability [Member]	'		'
Liabilities Related to Insurance Risks [Line Items]	'		'
Self Insurance Reserve, Current	6,713	[2]	3,178	[2]
Insurance liability risks	14,418		16,772
Self Insurance Reserve	$21,131		$19,950
[1]	Included in accounts payable and accrued liabilities.
[2]	Included in employee compensation and benefits.

Stockholders_Equity_Restricted

Stockholders' Equity Restricted Stock Activity (Details) (2007 Incentive Award plan, USD $)	9 Months Ended
	Sep. 30, 2014	Sep. 30, 2013
Performance Stock Awards	'	'
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Number of Shares [Roll Forward]	'	'
Granted (shares)	512,475	0
Restricted Stock Awards	'	'
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Number of Shares [Roll Forward]	'	'
Non-vested balance at January 1, 2014 (shares)	2,256,000	'
Granted (shares)	946,000	'
Vested (shares)	-326,000	'
Forfeited (shares)	-603,000	'
Non-vested balance at September 30, 2014 (shares)	2,273,000	'
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Weighted Average Grant Date Fair Value [Abstract]	'	'
Non-vested balance at January 1, 2014 (dollars per share)	6.42	'
Granted (dollars per share)	4.86	'
Vested (dollars per share)	4.55	'
Forfeited (dollars per share)	5.43	'
Non-vested balance at September 30, 2014 (dollars per share)	6.3	'

Stockholders_Equity_Stock_Opti

Stockholders' Equity Stock Options (Details) (2007 Incentive Award plan, USD $)	3 Months Ended
In Millions, unless otherwise specified	Sep. 30, 2014
Stock Options	'
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]	'
Unrecognized compensation	$0.10
Remaining award vesting period	'1 year 2 months 12 days
Restricted Stock Awards	'
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]	'
Unrecognized compensation	4.8
Remaining award vesting period	'1 year 7 months 24 days
Fair value of shares vested in period	$1.20

Stockholders_Equity_Stock_Opti1

Stockholders' Equity Stock Option Activity (Details) (2007 Incentive Award plan, Stock Options, USD $)	3 Months Ended
In Thousands, except Share data, unless otherwise specified	Sep. 30, 2014	Dec. 31, 2013
2007 Incentive Award plan | Stock Options	'	'
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding [Roll Forward]	'	'
Outstanding at January 1, 2014 (in shares)	'	794,645
Granted (in shares)	0	'
Exercised (in shares)	-160,548	'
Forfeited or cancelled (in shares)	-200,429	'
Outstanding at September 30, 2014 (in shares)	433,668	794,645
Fully vested and expected to vest at September 30, 2014 (in shares)	432,862	'
Exercisable at September 30, 2014 (in shares)	413,145	'
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding, Weighted Average Exercise Price [Roll Forward]	'	'
Outstanding at January 1, 2014, Weighted-Average Exercise Price (usd per share)	'	$8.54
Granted, Weighted-Average Exercise Price (usd per share)	$0	'
Exercised, Weighted-Average Exercise Price (usd per share)	$5.91	'
Forfeited or cancelled, Weighted-Average Exercise Price (usd per share)	$9.76	'
Outstanding a September 30, 2014, Weighted-Average Exercise Price (usd per share)	$8.95	$8.54
Fully vested and expected to vest at September 30, 2014, Weighted-Average Exercise Price (usd per share)	$8.95	'
Exercisable at September 30, 2014, Weighted-Average Exercise Price (usd per share)	$9	'
Weighted average remaining contractual term in years for outstanding options	'4 years 9 months 7 days	'
Weighted average remaining contractual term in years for vested	'4 years 9 months 7 days	'
Weighted average remaining contractual term in years for excersiable options	'4 years 7 months 24 days	'
Outstanding at September 30, 2013, Aggregate Intrinsic Value	$0	'
Fully vested and expected to vest at September 30, 2014, Aggregate Intrinsic Value	0	'
Exercisable at September 30, 2014, Aggregate Intrinsic Value	$0	'

Stockholders_Equity_Stock_Comp

Stockholders' Equity Stock Compensation Expense for Awards and Options (Details) (USD $)	3 Months Ended		9 Months Ended
In Millions, unless otherwise specified	Sep. 30, 2014	Sep. 30, 2013	Sep. 30, 2014	Sep. 30, 2013
General and Administrative Expense	'	'	'	'
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]	'	'	'	'
Allocated share-based compensation expense	$0.60	$0.30	$1.80	$1.10
Cost of Sales	'	'	'	'
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]	'	'	'	'
Allocated share-based compensation expense	$0.40	$0.20	$0.60	$1.10

Fair_Value_Measurements_Fair_V

Fair Value Measurements - Fair Value, Hierarchy (Details) (Fair Value, Measurements, Recurring, USD $)	Sep. 30, 2014	Dec. 31, 2013
In Thousands, unless otherwise specified
Level 1	'	'
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]	'	'
Contingent Consideration - Acquisitions	$0	$0
Level 1 | Available-for-sale Securities	'	'
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]	'	'
Available-for-sale Securities	0	0
Level 1 | Trading Liabilities [Member]	'	'
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]	'	'
Trading Securities	0	0
Level 2	'	'
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]	'	'
Contingent Consideration - Acquisitions	0	0
Level 2 | Available-for-sale Securities	'	'
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]	'	'
Available-for-sale Securities	0	1,046
Level 2 | Trading Liabilities [Member]	'	'
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]	'	'
Trading Securities	9,060	0
Level 3	'	'
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]	'	'
Contingent Consideration - Acquisitions	836	1,736
Level 3 | Available-for-sale Securities	'	'
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]	'	'
Available-for-sale Securities	0	0
Level 3 | Trading Liabilities [Member]	'	'
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]	'	'
Trading Securities	$0	$0

Fair_Value_Measurements_Narrat

Fair Value Measurements - Narrative (Details) (USD $)

3 Months Ended

9 Months Ended

9 Months Ended

0 Months Ended

9 Months Ended

Sep. 30, 2014

Sep. 30, 2013

Sep. 30, 2014

Sep. 30, 2013

Dec. 31, 2013

Sep. 30, 2014

Sep. 30, 2014

Oct. 24, 2011

Sep. 30, 2014

Dec. 31, 2013

Oct. 24, 2011

Sep. 30, 2014

Dec. 31, 2013

Fair Value, Measurements, Recurring

Fair Value, Measurements, Recurring

Fair Value, Measurements, Recurring

Fair Value, Measurements, Recurring

Fair Value, Measurements, Recurring

Fair Value, Measurements, Recurring

Fair Value, Measurements, Recurring

Fair Value, Measurements, Recurring

Level 3

Level 3

Cornerstone Acquisition

Cornerstone Acquisition

Cornerstone Acquisition

Cornerstone Acquisition

Cornerstone Acquisition

A Better Care Home Health

Minimum

Maximum

Level 3

Level 3

Level 3

Level 3

Level 3

Level 3

Cash

Payment to Seller

Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]

'

'

'

'

'

'

'

'

'

'

'

'

'

Business Acquisition, Contingent Consideration, Potential Cash Payment

'

'

'

'

'

'

'

'

'

'

$1,500,000

'

'

Contingent consideration period

'

'

'

'

'

'

'

'5 years

'

'

'

'

'

Fair value of contingent consideration

'

'

'

'

'

'

'

'

800,000

1,100,000

'

'

500,000

Payments to seller

'

'

-100,000

-2,082,000

'

'

'

'

'

'

'

300,000

'

Change in fair value of contingent consideration

7,000

79,000

-100,000

-2,082,000

'

'

'

'

'

'

'

100,000

'

Business acquisition, effective date of acquisition

'

'

'

'

'

'

'

24-Oct-11

'

'

'

'

'

Discount rate

'

'

'

'

'

200.00%

500.00%

'

'

'

'

'

'

Long-term debt, carrying value

$407,817,000

'

$407,817,000

'

$419,125,000

'

'

'

'

'

'

'

'

Fair_Value_Measurements_Level_

Fair Value Measurements - Level 3 Rollforward (Details) (USD $)	9 Months Ended
In Thousands, unless otherwise specified	Sep. 30, 2014	Sep. 30, 2013
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]	'	'
Value at January 1, 2014	$1,736	'
Change in fair value	-100	-2,082
Payout	-800	'
Value at September 30, 2014	$836	'

Debt_Schedule_of_Long_Term_Deb

Debt - Schedule of Long Term Debt Instruments (Details) (USD $)	Sep. 30, 2014	Dec. 31, 2013
In Thousands, unless otherwise specified
Debt Instrument [Line Items]	'	'
Term Loan original issue discount	($838)	($1,254)
Insurance premiums financed	2,604	2,990
Other	0	106
Total long-term debt	407,817	419,125
Less amounts due within one year	-13,173	-7,630
Long-term debt, less current portion	394,644	411,495
HUD insured loans due in 2043 and 2048, with a weighted average interest rate of 4.28% and 4.24% at September 30, 2014 and December 31, 2013, respectively	'	'
Debt Instrument [Line Items]	'	'
Total long-term debt	'	87,600
Senior Secured Term Loan Amended [Member] | Term Loan, due April 2016, interest rate based on LIBOR (subject to a 1.50% floor) plus 5.50%, or 7.00%, at September 30, 2014 and LIBOR (subject to a 1.50% floor) plus 5.25%, or 6.75%, at December 31, 2013; collateralized by substantially all assets of the Company excluding the skilled nursing facilities that collateralize the HUD insured mortgage loans and the skilled nursing facilities that collateralize the MidCap Financial credit facility	'	'
Debt Instrument [Line Items]	'	'
Secured debt	243,953	243,953
Senior Secured Term Loan Amended [Member] | Term Loan, due December 2016, interest rate based on LIBOR rate (subject to a floor of 0.75%) plus 5.95%, or 6.70%, at September 30, 2014 and December 31, 2013; collateralized by 10 skilled nursing facilities	'	'
Debt Instrument [Line Items]	'	'
Secured debt	60,761	62,000
Revolving Credit Facility Amended [Member] | Revolving Credit Facility due April 2015, interest rate comprised of the Prime rate of 3.25% plus 3.50%, or 6.75%, at December 31, 2013	'	'
Debt Instrument [Line Items]	'	'
Revolving Credit Facility Outstanding, Prime Rate	0	11,000
Revolving Credit Facility Amended [Member] | Revolving Credit Facility due 2016, interest rate comprised of LIBOR plus 5.50% or 5.74% [Member] [Domain]	'	'
Debt Instrument [Line Items]	'	'
Revolving Credit Facility Outstanding, Libor Rate	6,090	0
Revolving Credit Facility Amended [Member] | Revolving Credit Facility due April 2016, interest rate comprised of LIBOR plus 5.50%, or 5.74%, at September 30, 2014	'	'
Debt Instrument [Line Items]	'	'
Revolving Credit Facility Outstanding, Libor Rate	3,910	7,057
Revolving Credit Facility Amended [Member] | Revolving Credit Facility due December 2016, interest rate comprised of LIBOR (subject to a floor of 0.75%) plus 5.95%, or 6.70%, at September 30, 2014 and December 31, 2013; collateralized by the accounts receivable of 10 skilled nursing facilities	'	'
Debt Instrument [Line Items]	'	'
Revolving Credit Facility Outstanding, Libor Rate	4,165	5,000
Notes Payable to Banks [Member] | HUD insured loans due in 2043 and 2048, with a weighted average interest rate of 4.28% and 4.24% at September 30, 2014 and December 31, 2013, respectively	'	'
Debt Instrument [Line Items]	'	'
Total long-term debt	86,339	87,314
Mortgages [Member] | HUD insured loans due in 2043 and 2048, with a weighted average interest rate of 4.28% and 4.24% at September 30, 2014 and December 31, 2013, respectively	'	'
Debt Instrument [Line Items]	'	'
Total long-term debt	87,600	'
Mortgages [Member] | Note payable due December 2018, interest rate fixed at 6.50%, payable in monthly installments, collateralized by a first priority deed of trust	'	'
Debt Instrument [Line Items]	'	'
Notes payable	$833	$959

Debt_Schedule_of_Debt_Parenthe

Debt - Schedule of Debt Parenthetical (Details)	Sep. 30, 2014	Dec. 31, 2013
Debt Instrument [Line Items]	'	'
Debt instrument, interest rate percentage	'	5.30%
Senior Secured Term Loan Amended [Member] | Term Loan, due April 2016, interest rate based on LIBOR (subject to a 1.50% floor) plus 5.50%, or 7.00%, at September 30, 2014 and LIBOR (subject to a 1.50% floor) plus 5.25%, or 6.75%, at December 31, 2013; collateralized by substantially all assets of the Company excluding the skilled nursing facilities that collateralize the HUD insured mortgage loans and the skilled nursing facilities that collateralize the MidCap Financial credit facility	'	'
Debt Instrument [Line Items]	'	'
LIBOR Floor	1.50%	1.50%
Libor rate margin	5.50%	5.25%
Prime Rate Margin 2	7.00%	6.75%
Senior Secured Term Loan Amended [Member] | Term Loan, due December 2016, interest rate based on LIBOR rate (subject to a floor of 0.75%) plus 5.95%, or 6.70%, at September 30, 2014 and December 31, 2013; collateralized by 10 skilled nursing facilities	'	'
Debt Instrument [Line Items]	'	'
Prime Rate Margin 2	6.70%	6.70%
Prime rate	0.75%	0.75%
Prime rate margin	5.95%	5.95%
Revolving Credit Facility Amended [Member] | Revolving Credit Facility due April 2015, interest rate comprised of the Prime rate of 3.25% plus 3.50%, or 6.75%, at December 31, 2013	'	'
Debt Instrument [Line Items]	'	'
Prime Rate Margin 2	6.75%	6.75%
Prime rate	3.25%	3.25%
Prime rate margin	3.50%	3.50%
Revolving Credit Facility Amended [Member] | Revolving Credit Facility due 2016, interest rate comprised of LIBOR plus 5.50% or 5.74% [Member] [Domain]	'	'
Debt Instrument [Line Items]	'	'
Prime rate margin	5.74%	'
Revolving Credit Facility Amended [Member] | Revolving Credit Facility due April 2016, interest rate comprised of LIBOR plus 5.50%, or 5.74%, at September 30, 2014	'	'
Debt Instrument [Line Items]	'	'
Prime rate	4.50%	4.50%
Prime rate margin	4.74%	4.74%
Revolving Credit Facility Amended [Member] | Revolving Credit Facility due December 2016, interest rate comprised of LIBOR (subject to a floor of 0.75%) plus 5.95%, or 6.70%, at September 30, 2014 and December 31, 2013; collateralized by the accounts receivable of 10 skilled nursing facilities	'	'
Debt Instrument [Line Items]	'	'
LIBOR Floor	0.75%	'
Libor rate margin	5.95%	'
Prime Rate Margin 2	6.70%	6.70%
Prime rate	0.75%	0.75%
Prime rate margin	5.95%	5.95%
Revolving Credit Facility due 2016, interest rate comprised of LIBOR plus 5.50% or 5.74% [Member] [Domain] | Revolving Credit Facility Amended [Member]	'	'
Debt Instrument [Line Items]	'	'
Prime rate margin	5.50%	'
Notes Payable to Banks [Member] | HUD insured loans due in 2043 and 2048, with a weighted average interest rate of 4.28% and 4.24% at September 30, 2014 and December 31, 2013, respectively	'	'
Debt Instrument [Line Items]	'	'
Weighted average interest rate	4.28%	4.24%
Mortgages [Member] | HUD insured loans due in 2043 and 2048, with a weighted average interest rate of 4.28% and 4.24% at September 30, 2014 and December 31, 2013, respectively	'	'
Debt Instrument [Line Items]	'	'
Weighted average interest rate	4.20%	'
Mortgages [Member] | Note payable due December 2018, interest rate fixed at 6.50%, payable in monthly installments, collateralized by a first priority deed of trust	'	'
Debt Instrument [Line Items]	'	'
Debt instrument, interest rate percentage	6.50%	6.50%

Debt_Long_Term_Debt_Terms_and_

Debt - Long Term Debt Terms and Details (Details) (USD $)

9 Months Ended

9 Months Ended

12 Months Ended

0 Months Ended

9 Months Ended

12 Months Ended

12 Months Ended

3 Months Ended

9 Months Ended

3 Months Ended

9 Months Ended

0 Months Ended

9 Months Ended

9 Months Ended

0 Months Ended

Sep. 30, 2014

Sep. 30, 2013

Dec. 31, 2013

Sep. 30, 2014

Sep. 30, 2014

Sep. 30, 2014

Dec. 31, 2013

Dec. 31, 2013

Jun. 23, 2014

Jun. 23, 2014

Mar. 31, 2014

Dec. 31, 2013

Sep. 30, 2014

Dec. 31, 2013

Sep. 30, 2014

Dec. 31, 2013

Sep. 30, 2014

Sep. 30, 2014

Sep. 30, 2014

Sep. 30, 2014

Dec. 31, 2013

Dec. 31, 2013

Sep. 30, 2014

Dec. 31, 2013

Mar. 31, 2014

Apr. 09, 2010

Sep. 30, 2014

Apr. 09, 2010

Jun. 23, 2014

Mar. 31, 2014

Sep. 30, 2014

Jun. 06, 2013

Apr. 12, 2012

Jun. 23, 2014

Sep. 30, 2014

Jun. 23, 2014

Sep. 30, 2014

Jun. 23, 2014

Jun. 23, 2014

Jun. 23, 2014

Jun. 23, 2014

Jun. 23, 2014

Jun. 23, 2014

Jun. 23, 2014

facility

Repayment Period One [Member]

Repayment Period Two [Member]

Repayment Period Three [Member]

Minimum

Maximum

Senior Secured Credit Facility Amended June 2014 [Member]

Senior Secured Credit Facility Amended June 2014 [Member]

HUD insured loans due in 2043 and 2048, with a weighted average interest rate of 4.28% and 4.24% at September 30, 2014 and December 31, 2013, respectively

HUD insured loans due in 2043 and 2048, with a weighted average interest rate of 4.28% and 4.24% at September 30, 2014 and December 31, 2013, respectively

HUD insured loans due in 2043 and 2048, with a weighted average interest rate of 4.28% and 4.24% at September 30, 2014 and December 31, 2013, respectively

HUD insured loans due in 2043 and 2048, with a weighted average interest rate of 4.28% and 4.24% at September 30, 2014 and December 31, 2013, respectively

HUD insured loans due in 2043 and 2048, with a weighted average interest rate of 4.28% and 4.24% at September 30, 2014 and December 31, 2013, respectively

HUD insured loans due in 2043 and 2048, with a weighted average interest rate of 4.28% and 4.24% at September 30, 2014 and December 31, 2013, respectively

HUD insured loans due in 2043 and 2048, with a weighted average interest rate of 4.28% and 4.24% at September 30, 2014 and December 31, 2013, respectively

HUD insured loans due in 2043 and 2048, with a weighted average interest rate of 4.28% and 4.24% at September 30, 2014 and December 31, 2013, respectively

HUD insured loans due in 2043 and 2048, with a weighted average interest rate of 4.28% and 4.24% at September 30, 2014 and December 31, 2013, respectively

Term Loan, due December 2016, interest rate based on LIBOR rate (subject to a floor of 0.75%) plus 5.95%, or 6.70%, at September 30, 2014 and December 31, 2013; collateralized by 10 skilled nursing facilities

Term Loan, due December 2016, interest rate based on LIBOR rate (subject to a floor of 0.75%) plus 5.95%, or 6.70%, at September 30, 2014 and December 31, 2013; collateralized by 10 skilled nursing facilities

Revolving Credit Facility due December 2016, interest rate comprised of LIBOR (subject to a floor of 0.75%) plus 5.95%, or 6.70%, at September 30, 2014 and December 31, 2013; collateralized by the accounts receivable of 10 skilled nursing facilities

Revolving Credit Facility due December 2016, interest rate comprised of LIBOR (subject to a floor of 0.75%) plus 5.95%, or 6.70%, at September 30, 2014 and December 31, 2013; collateralized by the accounts receivable of 10 skilled nursing facilities

Revolving Credit Facility due December 2016, interest rate comprised of LIBOR (subject to a floor of 0.75%) plus 5.95%, or 6.70%, at September 30, 2014 and December 31, 2013; collateralized by the accounts receivable of 10 skilled nursing facilities

Senior Secured Term Loan [Member]

Senior Secured Term Loan [Member]

Senior Secured Term Loan [Member]

Revolving Credit Facility [Member]

Revolving Credit Facility [Member]

Senior Secured Term Loan Amended [Member]

Senior Secured Term Loan Amended [Member]

Senior Secured Term Loan Amended [Member]

Senior Secured Term Loan Amended [Member]

Senior Secured Term Loan Amended [Member]

Senior Secured Term Loan Amended [Member]

Senior Secured Term Loan Amended [Member]

Senior Secured Term Loan Amended [Member]

Extended Revolving Credit Facility [Member]

Extended Revolving Credit Facility [Member]

Extended Revolving Credit Facility [Member]

Extended Revolving Credit Facility [Member]

Non-extended Revolving Credit Facility [Member]

Non-extended Revolving Credit Facility [Member]

Non-extended Revolving Credit Facility [Member]

mortgage

Other Current Assets [Member]

Notes Payable to Banks [Member]

Notes Payable to Banks [Member]

Mortgages [Member]

Mortgages [Member]

Mortgages [Member]

Mortgages [Member]

Mortgages [Member]

Senior Secured Term Loan Amended [Member]

Senior Secured Term Loan Amended [Member]

Mortgages [Member]

Revolving Credit Facility Amended [Member]

Revolving Credit Facility Amended [Member]

Prior Credit Agreement [Member]

Prior Credit Agreement [Member]

Senior Secured Term Loan Amended [Member]

Prior Credit Agreement [Member]

Senior Secured Credit Facility Amended June 2014 [Member]

Restated Credit Agreement [Member]

Restated Credit Agreement [Member]

Restated Credit Agreement [Member]

Restated Credit Agreement [Member]

Senior Secured Credit Facility Amended June 2014 [Member]

Senior Secured Credit Facility Amended June 2014 [Member]

Senior Secured Credit Facility Amended June 2014 [Member]

Senior Secured Credit Facility Amended June 2014 [Member]

Senior Secured Credit Facility Amended June 2014 [Member]

Senior Secured Credit Facility Amended June 2014 [Member]

Senior Secured Credit Facility Amended June 2014 [Member]

Senior Secured Credit Facility Amended June 2014 [Member]

Senior Secured Credit Facility Amended June 2014 [Member]

Senior Secured Credit Facility Amended June 2014 [Member]

Senior Secured Credit Facility Amended June 2014 [Member]

Other Current Assets [Member]

Minimum

Maximum

Secured Debt [Member]

Secured Debt [Member]

Secured Debt [Member]

Secured Debt [Member]

Secured Debt [Member]

Secured Debt [Member]

Secured Debt [Member]

Secured Debt [Member]

Secured Debt [Member]

Secured Debt [Member]

Secured Debt [Member]

Secured Debt [Member]

Secured Debt [Member]

Secured Debt [Member]

Secured Debt [Member]

Secured Debt [Member]

Secured Debt [Member]

Secured Debt [Member]

Secured Debt [Member]

Secured Debt [Member]

Repayment Period One [Member]

Minimum

Maximum

Minimum

Maximum

Debt Instrument [Line Items]

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

Debt instrument, face amount

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

$360,000,000

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

Line of credit facility, maximum borrowing capacity

'

'

'

'

'

'

'

'

'

'

250,000,000

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

100,000,000

83,100,000

'

'

'

'

'

'

'

'

'

50,600,000

'

'

32,500,000

'

'

Addition of debt issuance on senior secured term loan

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

100,000,000

'

'

'

'

'

'

'

'

'

'

'

Leverage ratio, maximum allowable

5.25

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

0.5

'

'

'

5.25

'

'

'

'

'

'

'

'

Debt modifcation fees

2,500,000

'

'

'

'

'

'

'

2,000,000

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

Debt modification costs

1,100,000

'

'

'

'

'

'

'

800,000

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

Debt modification fees, capitalized

1,400,000

'

'

'

'

'

'

'

'

1,200,000

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

Fixed charge coverage ratio, minimum requirement

1.85

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

1.85

'

'

'

'

'

'

'

'

Interest rate increase

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

0.25%

'

'

'

'

'

'

'

'

'

'

LIBOR Floor

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

0.75%

'

'

'

'

'

'

'

'

'

'

'

'

1.50%

'

'

'

'

'

'

'

'

Libor rate margin

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

5.95%

'

'

'

'

'

'

'

'

'

'

'

'

550.00%

'

'

'

5.25%

5.50%

'

4.25%

4.50%

Prime rate

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

0.75%

0.75%

'

0.75%

0.75%

'

'

'

'

'

'

'

'

'

'

'

2.50%

'

'

'

'

'

'

'

'

Prime rate margin

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

5.95%

5.95%

'

5.95%

5.95%

'

'

'

'

'

'

'

'

'

'

'

4.50%

'

'

'

4.25%

4.50%

'

3.25%

3.50%

Commitments decrease (Percentage)

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

25.00%

'

'

'

'

'

'

Line of credit facility, maximum borrowing capacity future limit

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

50,600,000

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

Periodic payment

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

900,000

'

'

'

'

'

'

'

2,600,000

'

1,600,000

'

'

'

'

'

'

'

Consolidated excess cash flow percentage

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

50.00%

'

'

'

'

75.00%

75.00%

'

'

'

'

'

'

'

'

'

'

'

'

'

Stepdown percentage

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

25.00%

'

'

'

'

50.00%

'

'

'

'

'

'

'

'

'

'

'

'

'

'

Refinance portion of credit facility

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

250,000,000

'

'

'

'

'

'

'

'

'

'

'

'

'

'

Fixed charge coverage ratio

2.38

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

Leverage ratio

4.42

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

Number of mortgages insured by HUD

10

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

Debt

407,817,000

'

419,125,000

'

'

'

'

'

'

'

'

87,600,000

86,339,000

87,314,000

87,600,000

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

Debt instrument, interest rate percentage

'

'

5.30%

'

'

'

'

'

'

'

'

'

'

'

'

'

'

3.40%

4.60%

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

Debt Term

'25 years

'

'

'

'

'

'30 years

'35 years

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

Average Debt Term

'33 years

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

Weighted average interest rate

'

'

'

'

'

'

'

'

'

'

'

'

4.28%

4.24%

4.20%

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

Debt prepayment penalty

'

'

'

'

'

'

'

'

'

'

'

'

'

'

10.00%

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

Escrow deposit

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

1,800,000

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

Replacement reserve escrow

'

'

'

'

'

'

'

'

'

'

'

'

'

'

3,300,000

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

Proceeds from issuance of long-term debt

0

79,806,000

'

'

'

'

'

'

'

'

'

'

'

'

'

87,600,000

'

'

'

'

'

65,000,000

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

Secured debt

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

60,761,000

62,000,000

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

Revolving Credit Facility Outstanding, Libor Rate

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

4,165,000

5,000,000

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

Additional quarterly payments due

'

'

'

$300,000

$400,000

$500,000

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

Number of skilled nursing facilities

10

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

'

Investment_in_Joint_Venture_Na

Investment in Joint Venture - Narrative (Details) (APS - Summit Care [Member], USD $)	9 Months Ended
In Millions, unless otherwise specified	Sep. 30, 2014	Jun. 30, 2013
APS - Summit Care [Member]	'	'
Schedule of Equity Method Investments [Line Items]	'	'
Equity method investment, ownership percentage	50.00%	'
Equity method investment, percentage owned by another company	50.00%	'
Equity method investment, percentage of net income received	50.00%	'
Equity investment in joint ventures	$4.40	$5.60

Investment_in_Joint_Venture_Su

Investment in Joint Venture Summarized Financial Information (Details) (APS - Summit Care [Member], USD $)	3 Months Ended		9 Months Ended
In Thousands, unless otherwise specified	Sep. 30, 2014	Sep. 30, 2013	Sep. 30, 2014	Sep. 30, 2013	Dec. 31, 2013
APS - Summit Care [Member]	'	'	'	'	'
Statement of Earnings [Abstract]	'	'	'	'	'
Sales, Net	$5,045	$4,209	$11,127	$11,150	'
Gross Profit	809	1,243	2,248	3,377	'
Net Income	1,068	933	1,870	2,496	'
Balance Sheet [Abstract]	'	'	'	'	'
Current Assets	3,262	'	3,262	'	3,518
Non-Current Assets	1,188	'	1,188	'	1,078
Current Liabilities	125	'	125	'	96
Non-Current Liabilities	$0	'	$0	'	$0

Proposed_Combination_with_Gene1

Proposed Combination with Genesis (Details) (Genesis [Member], USD $)	Aug. 18, 2014
Genesis [Member]	'
Business Acquisition [Line Items]	'
Common Stock, Par or Stated Value Per Share (usd per share)	$0.00
Outstanding options to purchase equity (percent)	25.75%
Voting interests acquired (percent)	74.25%