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BUSINESS SEGMENTS
 3 Months Ended
Mar. 31, 2025
Segment Reporting [Abstract]  
BUSINESS SEGMENTS BUSINESS SEGMENTS
The Company has two reportable segments: (1) skilled services, which includes the operation of skilled nursing facilities and rehabilitation therapy services and (2) Standard Bearer, which is comprised of selected real estate properties owned by Standard Bearer and leased to skilled nursing and senior living operators.

As of March 31, 2025, the skilled services segment includes 297 skilled nursing and 31 campus operations that provide both skilled nursing and rehabilitative care services and senior living services. The Company's Standard Bearer segment consists of 135 owned real estate properties.

The Company also reports an “All Other” category that includes results from its senior living operations, which includes 12 stand-alone senior living operations and the senior living operations at 31 campus operations that provide both skilled nursing and rehabilitative care services and senior living services. In addition, the "All Other" category includes mobile diagnostics, medical transportation, other real estate, other ancillary operations and the Service Center. Services included in the “All Other” category are insignificant individually, and therefore do not constitute a reportable segment.

The Company’s reportable segments are significant operating segments that offer differentiated services. The segment structure reflects the Company's current operational and financial management and provides the best structure to maximize the quality of care and investment strategy provided, while maintaining financial discipline.

Segment income (loss) is defined as income or loss before provision for income taxes, excluding gain or loss from sale of real estate, real estate insurance recoveries and impairment of long-lived assets. The Company's chief operating decision maker or CODM, who is the Chief Executive Officer, reviews segment income or loss for each operating segment to evaluate performance and allocate capital resources. The CODM uses segment income or loss to analyze actual results as part of operational planning and to decide whether to reinvest profits into the segments or into other parts of the Company, such as through acquisitions, to pay dividends or to recommend a stock repurchase program. The Company's CODM does not review assets by segment in his resource allocation and therefore assets by segment are not disclosed below.

Intercompany revenue is eliminated in consolidation, along with corresponding intercompany expenses. Included in segment income for Standard Bearer is expense for intercompany services provided by the Service Center as described in Note 6, Standard Bearer, as it is part of the CODM financial information.
The following tables set forth financial information for the segments:

 Three Months Ended March 31, 2025
 Skilled ServicesStandard BearerTotal
Service revenue(1)
$1,123,554 $— $1,123,554 
Rental revenue— 28,401 28,401 
Segment revenue$1,123,554 $28,401 $1,151,955 
Reconciliation of revenue:
All other revenue(2)
52,426 
Elimination of intercompany revenue(3)
(31,340)
TOTAL CONSOLIDATED REVENUE
$1,173,041 
Less:
Other segment items(4)
966,410 2,606 
Depreciation and amortization13,213 8,476 
Interest expense(5)
— 8,736 
Segment income
$143,931 $8,583 $152,514 
Reconciliation of profit or loss:
All other not included in segment income
(45,934)
INCOME BEFORE PROVISION FOR INCOME TAXES$106,580 
(1) Skilled services service revenue does not include intercompany service revenue generated by ancillary operations provided to the Company's independent subsidiaries and management service revenue generated by the Service Center with Standard Bearer. Intercompany service revenue is eliminated in "Elimination of intercompany revenue".
(2) All other revenue includes $49,427 of service revenue and $2,999 of rental revenue for the three months ended March 31, 2025, both of which include intercompany revenue that is eliminated in "Elimination of intercompany revenue".
(3) Elimination of intercompany revenue includes the elimination of intercompany rental revenue of $25,399 and intercompany service revenue of $5,941 for the three months ended March 31, 2025.
(4) Other segment items includes cost of services and rent expense for the skilled services segment and cost of services, rent expense and general and administrative expenses for the Standard Bearer segment. Additionally, there are intercompany expenses of $31,340 during the three months ended March 31, 2025, which are eliminated in consolidation.
(5) Included in interest expense in Standard Bearer is interest from intercompany debt arrangements between Standard Bearer and The Ensign Group, Inc. of $7,040 during the three months ended March 31, 2025, which is eliminated in consolidation.
 Three Months Ended March 31, 2024
 Skilled ServicesStandard BearerTotal
Service revenue(1)
$969,602 $— $969,602 
Rental revenue— 22,201 22,201 
Segment revenue$969,602 $22,201 $991,803 
Reconciliation of revenue:
All other revenue(2)
42,572 
Elimination of intercompany revenue(3)
(24,203)
TOTAL CONSOLIDATED REVENUE
$1,010,172 
Less:
Other segment items(4)
832,257 2,137 
Depreciation and amortization10,536 6,829 
Interest expense(5)
— 5,977 
Segment income
$126,809 $7,258 $134,067 
Reconciliation of profit or loss:
All other not included in segment income
(44,469)
INCOME BEFORE PROVISION FOR INCOME TAXES$89,598 
(1) Skilled services service revenue does not include intercompany service revenue generated by ancillary operations provided to the Company's independent subsidiaries and management service revenue generated by the Service Center with Standard Bearer. Intercompany service revenue is eliminated in "Elimination of intercompany revenue".
(2) All Other revenue includes $39,626 of service revenue and $2,946 of rental revenue for the three months ended March 31, 2024, both of which include intercompany revenue that is eliminated in "Elimination of intercompany revenue".
(3) Elimination of intercompany revenue includes the elimination intercompany rental revenue of $19,460 and intercompany service revenue of $4,743 for the three months ended March 31, 2024.
(4) Other segment items includes cost of services and rent expense for the skilled services segment and cost of services, rent expense and general and administrative expenses for the Standard Bearer segment. Additionally, there are intercompany expenses of $24,203 during the three months ended March 31, 2024, which is eliminated in consolidation.
(5) Included in interest expense in Standard Bearer is interest from intercompany debt arrangements between Standard Bearer and The Ensign Group, Inc. of $4,285 during the three months ended March 31, 2024, which is eliminated in consolidation.
Service revenue by major payor source were as follows:

 Three Months Ended March 31, 2025
 Skilled Services
All Other (3)
Total Service RevenueRevenue %
Medicaid(1)
$443,411 $10,429 $453,840 38.9 %
Medicare287,751 — 287,751 24.7 
Medicaid-skilled69,551 — 69,551 5.9 
Subtotal$800,713 $10,429 $811,142 69.5 %
Managed care227,217 — 227,217 19.5 
Private and other(2)
95,624 33,057 128,681 11.0 
TOTAL SERVICE REVENUE$1,123,554 $43,486 $1,167,040 100.0 %
(1) Medicaid payor includes revenue generated from senior living operations.
(2) Private and other payors also includes revenue from senior living operations and all revenue generated in other ancillary services.
(3) All Other incorporates intercompany eliminations.
 Three Months Ended March 31, 2024
 Skilled Services
All Other (3)
Total Service RevenueRevenue %
Medicaid(1)
$382,118 $8,045 $390,163 38.8 %
Medicare265,583 — 265,583 26.4 
Medicaid-skilled63,309 — 63,309 6.4 
Subtotal$711,010 $8,045 $719,055 71.6 %
Managed care188,104 — 188,104 18.7 
Private and other(2)
70,488 26,838 97,326 9.7 
TOTAL SERVICE REVENUE$969,602 $34,883 $1,004,485 100.0 %
(1) Medicaid payor includes revenue generated from senior living operations.
(2) Private and other payors also includes revenue from senior living operations and all revenue generated in other ancillary services.
(3) All Other incorporates intercompany eliminations.