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Allowance for Doubtful Accounts | 12 Months Ended
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Dec. 31, 2019
Receivables [Abstract] |
Allowance for Doubtful Accounts | Note 8 — Allowance for Doubtful Accounts The allowance for doubtful accounts is established when the Company determines that receivables have been impaired and the Company can reasonably estimate the amount of the incurred loss. The related provision for bad debts is charged to costs of services provided in the Company’s Consolidated Statements of Comprehensive Income. The allowance for doubtful accounts is evaluated based on the Company’s ongoing review of accounts and notes receivable and is inherently subjective as it requires estimates susceptible to significant revision as more information becomes available. The Company has had varying collections experience with respect to its accounts and notes receivable. The Company has sometimes extended the period of payment for certain clients beyond contractual terms. Such clients include those who have terminated service agreements and slow payers experiencing financial difficulties. In order to provide for these collection problems and the general risk associated with the granting of credit terms, the Company recorded the following bad debt provisions (in an Allowance for Doubtful Accounts):
| Year Ended December 31, |  |  |  |
| 2019 |  | 2018 |  | 2017
| (in thousands) |  |  |  |  |
Bad debt provision | $ | 25,480 |  |  | $ | 51,387 |  |  | $ | 6,250 |
In making the Company’s credit evaluations, in addition to analyzing and anticipating, where possible, the specific cases described above, management considers the general collection risk associated with trends in the long-term care industry. The Company establishes credit limits through payment terms with customers, performs ongoing credit evaluations and monitors accounts to minimize the risk of loss. Despite the Company’s efforts to minimize credit risk exposure, clients could be adversely affected if future industry trends change in such a manner as to negatively impact their cash flows. If the Company’s clients experience a negative impact on their cash flows, it could have a material adverse effect on the Company’s results of operations and financial condition. Impaired Notes Receivable The Company evaluates its notes receivable for impairment quarterly and on an individual client basis. Notes receivable are generally evaluated for impairment when the respective clients are in bankruptcy, are subject to collections activity or are slow payers that are experiencing financial difficulties. In the event that the evaluation results in a determination that a note receivable is impaired, it is valued at the present value of expected future cash flows or at the market value of related collateral. Summary schedules of impaired notes receivable, and the related reserve, for the years ended December 31, 2019, 2018 and 2017 was as follows:
|  | Impaired Notes Receivable |  |  |  |  |  |  |  |
Year Ended December 31, |  | Balance Beginning of Year |  | Additions |  | Deductions |  | Balance End of Year |  | Average Outstanding Balance
|  | (in thousands) |  |  |  |  |  |  |  |
2019 |  | $ | 25,704 |  |  | $ | 3,763 |  |  | $ | 4,830 |  |  | $ | 24,637 |  |  | $ | 27,554 |
2018 |  | $ | 6,854 |  |  | $ | 23,382 |  |  | $ | 4,532 |  |  | $ | 25,704 |  |  | $ | 15,448 |
2017 |  | $ | 5,685 |  |  | $ | 1,169 |  |  | $ | — |  |  | $ | 6,854 |  |  | $ | 6,270 |
|  | Reserve for Impaired Notes Receivable |  |  |  |  |  |
Year Ended December 31, |  | Balance Beginning of Year |  | Additions |  | Deductions |  | Balance End of Year
|  | (in thousands) |  |  |  |  |  |
2019 |  | $ | 13,472 |  |  | $ | 3,575 |  |  | $ | 4,557 |  |  | $ | 12,490 |
2018 |  | $ | 2,884 |  |  | $ | 12,526 |  |  | $ | 1,938 |  |  | $ | 13,472 |
2017 |  | $ | 2,419 |  |  | $ | 465 |  |  | $ | — |  |  | $ | 2,884 |
The Company follows an income recognition policy on all notes receivables to defer the recognition of interest income until cash payments are received. This policy was established, recognizing the environment of the long-term care industry, and not because such notes receivable are necessarily impaired. The difference between income recognition on a full accrual basis and cash basis, for notes receivable that are not considered impaired, is not material.

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- Definition The entire disclosure for allowance for credit losses. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 310 -URI http://asc.fasb.org/topic&trid=2196771 + Details
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- References No definition available. + Details
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