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BUSINESS SEGMENTS
 9 Months Ended
Sep. 30, 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 September 30, 2025, the skilled services segment includes 314 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 142 owned real estate properties.

The Company also reports an “All Other” category that includes results from its senior living operations, which includes 16 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 is defined as income 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 for each operating segment to evaluate performance and allocate capital resources. The CODM uses segment income 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 September 30, 2025
 Skilled ServicesStandard BearerTotal
Service revenue(1)
$1,239,096 $— $1,239,096 
Rental revenue— 32,610 32,610 
Segment revenue$1,239,096 $32,610 $1,271,706 
Reconciliation of revenue:
All other revenue(2)
60,578 
Elimination of intercompany revenue(3)
(35,879)
TOTAL CONSOLIDATED REVENUE
$1,296,405 
Less:
Other segment items(4)
1,071,815 2,959 
Depreciation and amortization14,155 9,709 
Interest expense(5)
— 10,320 
Segment income
$153,126 $9,622 $162,748 
Reconciliation of profit or loss:
All other not included in segment income
(56,148)
INCOME BEFORE PROVISION FOR INCOME TAXES$106,600 
(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 $57,377 of service revenue and $3,201 of rental revenue for the three months ended September 30, 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 $29,185 and intercompany service revenue of $6,694 for the three months ended September 30, 2025.
(4) Other segment items include 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 $35,879 during the three months ended September 30, 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 $9,090 during the three months ended September 30, 2025, which is eliminated in consolidation.
 Three Months Ended September 30, 2024
 Skilled ServicesStandard BearerTotal
Service revenue(1)
$1,033,113 $— $1,033,113 
Rental revenue— 24,429 24,429 
Segment revenue$1,033,113 $24,429 $1,057,542 
Reconciliation of revenue:
All other revenue(2)
51,144 
Elimination of intercompany revenue(3)
(26,910)
TOTAL CONSOLIDATED REVENUE
$1,081,776 
Less:
Other segment items(4)
893,083 2,420 
Depreciation and amortization11,541 7,484 
Interest expense(5)
— 7,251 
Segment income
$128,489 $7,274 $135,763 
Reconciliation of profit or loss:
All other not included in segment income
(37,089)
INCOME BEFORE PROVISION FOR INCOME TAXES$98,674 
(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 $48,209 of service revenue and $2,935 of rental revenue for the three months ended September 30, 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 $21,680 and intercompany service revenue of $5,230 for the three months ended September 30, 2024.
(4) Other segment items include 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 $26,910 during the three months ended September 30, 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 $5,535 during the three months ended September 30, 2024, which is eliminated in consolidation.
 Nine Months Ended September 30, 2025
 Skilled ServicesStandard Bearer
Total
Service revenue(1)
$3,536,226 $— $3,536,226 
Rental revenue
— 92,479 92,479 
Segment revenue
$3,536,226 $92,479 $3,628,705 
Reconciliation of revenue:
All other revenue(2)
170,336 
Elimination of intercompany revenue(3)
(101,826)
TOTAL CONSOLIDATED REVENUE
$3,697,215 
Less:
Other segment items(4)
3,048,047 8,331 
Depreciation and amortization41,118 27,450 
Interest expense(5)
— 29,367 
Segment income
$447,061 $27,331 $474,392 
Reconciliation of profit or loss:
All other not included in segment income
(148,854)
INCOME BEFORE PROVISION FOR INCOME TAXES
$325,538 
(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 $160,978 of service revenue and $9,358 of rental revenue for the nine months ended September 30, 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 $82,855 and intercompany service revenue of $18,971 for the nine months ended September 30, 2025.
(4) Other segment items include 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 $101,826 during the nine months ended September 30, 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 $25,153 during the nine months ended September 30, 2025, which is eliminated in consolidation.
 Nine Months Ended September 30, 2024
 Skilled ServicesStandard BearerTotal
Service revenue(1)
$2,994,000 $— $2,994,000 
Rental revenue
— 69,984 69,984 
Segment revenue
$2,994,000 $69,984 $3,063,984 
Reconciliation of revenue:
All other revenue(2)
141,055 
Elimination of intercompany revenue(3)
(76,806)
TOTAL CONSOLIDATED REVENUE
$3,128,233 
Less:
Other segment items(4)
2,583,529 6,686 
Depreciation and amortization32,988 21,479 
Interest expense(5)
— 19,927 
Segment income$377,483 $21,892 $399,375 
Reconciliation of profit or loss:
All other not included in segment income
(119,039)
INCOME BEFORE PROVISION FOR INCOME TAXES
$280,336 
(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 $132,175 of service revenue and $8,880 of rental revenue for the nine months ended September 30, 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 $61,782 and intercompany service revenue of $15,024 for the nine months ended September 30, 2024.
(4) Other segment items include 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 $76,806 during the nine months ended September 30, 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 $14,818 during the nine months ended September 30, 2024, which is eliminated in consolidation.
Service revenue by major payor source were as follows:

 Three Months Ended September 30, 2025
 Skilled Services
All Other (3)
Total Service RevenueRevenue %
Medicaid(1)
$501,722 $13,435 $515,157 39.9 %
Medicare303,281 — 303,281 23.5 
Medicaid-skilled78,450 — 78,450 6.1 
Subtotal$883,453 $13,435 $896,888 69.5 %
Managed care237,978 — 237,978 18.5 
Private and other(2)
117,665 37,248 154,913 12.0 
TOTAL SERVICE REVENUE$1,239,096 $50,683 $1,289,779 100.0 %
 Three Months Ended September 30, 2024
 Skilled Services
All Other (3)
Total Service RevenueRevenue %
Medicaid(1)
$416,190 $9,452 $425,642 39.6 %
Medicare263,594 — 263,594 24.5 
Medicaid-skilled65,907 — 65,907 6.1 
Subtotal$745,691 $9,452 $755,143 70.2 %
Managed care202,528 — 202,528 18.8 
Private and other(2)
84,894 33,527 118,421 11.0 
TOTAL SERVICE REVENUE$1,033,113 $42,979 $1,076,092 100.0 %
 Nine Months Ended September 30, 2025
 Skilled Services
All Other (3)
Total Service RevenueRevenue %
Medicaid(1)
$1,419,037 $35,808 $1,454,845 39.6 %
Medicare882,149 — 882,149 24.0 
Medicaid-skilled223,208 — 223,208 6.0 
Subtotal$2,524,394 $35,808 $2,560,202 69.6 %
Managed care694,690 — 694,690 18.9 
Private and other(2)
317,142 106,199 423,341 11.5 
TOTAL SERVICE REVENUE$3,536,226 $142,007 $3,678,233 100.0 %

 Nine Months Ended September 30, 2024
 Skilled Services
All Other (3)
Total Service RevenueRevenue %
Medicaid(1)
$1,201,435 $26,130 $1,227,565 39.5 %
Medicare788,046 — 788,046 25.3 
Medicaid-skilled192,185 — 192,185 6.2 
Subtotal$2,181,666 $26,130 $2,207,796 71.0 %
Managed care581,654 — 581,654 18.7 
Private and other(2)
230,680 91,021 321,701 10.3 
TOTAL SERVICE REVENUE$2,994,000 $117,151 $3,111,151 100.0 %
(1) Medicaid payor includes revenue generated from senior living operations.
(2) Private and other includes revenue for skilled services (private, Veteran Affairs and hospice payors), senior living and ancillary operations.
(3) All Other incorporates intercompany eliminations.