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Supplemental Disclosure of Cash Flow Information (Details) - USD ($)
$ in Thousands
 3 Months Ended 9 Months Ended
Sep. 30, 2016
Sep. 30, 2015
Sep. 30, 2016
Sep. 30, 2015
Dec. 31, 2015
Supplemental Cash Flow Information [Abstract]          
Interest paid     $ 260,504 $ 270,352  
Income taxes paid     2,195 2,806  
Acquisition of assets, net of related payables [Line Items]          
Gain on sale of assets     2,126 1,723  
Assets held for sale $ 173,481   173,481   $ 110,620
Goodwill 697,128   697,128   $ 725,696
Asset impairment 19,111 $ 0 26,638 0  
Additions to property, plant and equipment and leasehold intangibles, net     263,950 301,778  
Acquisition of assets, net of related payables     12,157 193,451  
Proceeds from sale of assets, net     219,471 8,072  
Acquisition of Assets, Net of Related Payables and Cash Received [Member]          
Acquisition of assets, net of related payables [Line Items]          
Prepaid expenses and other current assets     0 (50,756)  
Property, plant and equipment and leasehold intangibles, net     19,457 196,196  
Other intangible assets, net     (7,300) (7,293)  
Other liabilities     0 (315)  
Long-term debt     0 (20,000)  
Capital and Financing Lease Obligations     0 75,619  
Acquisition of assets, net of related payables     12,157 193,451  
Additions to property, plant and equipment and leasehold improvements [Member]          
Acquisition of assets, net of related payables [Line Items]          
Property, plant and equipment and leasehold intangibles, net     230,837 301,778  
Increase (Decrease) in Accounts Payable, Total     33,113 0  
Additions to property, plant and equipment and leasehold intangibles, net     263,950 301,778  
Capital and financing leases [Member]          
Acquisition of assets, net of related payables [Line Items]          
Property, plant and equipment and leasehold intangibles, net     0 24,535  
Other intangible assets, net     0 (5,202)  
Other liabilities     0 2,296  
Capital and Financing Lease Obligations     0 (21,629)  
Net     0 0  
Proceeds from sale of assets, net [Member]          
Acquisition of assets, net of related payables [Line Items]          
Prepaid expenses and other current assets     1,036 7,434  
Property, plant and equipment and leasehold intangibles, net     0 7,516  
Gain on sale of assets     2,126 0  
Other liabilities     (2,034) 2,029  
Capital and Financing Lease Obligations     0 (8,907)  
Assets held for sale 218,343 0 218,343 0  
Proceeds from sale of assets, net     219,471 8,072  
Contribution to CCRC venture with HCP [Member]          
Acquisition of assets, net of related payables [Line Items]          
Property, plant and equipment and leasehold intangibles, net     0 (25,459)  
Long-term debt     0 18,115  
Transfer to Investments     0 7,344  
Net     0 0  
Assets held for sale [Member]          
Acquisition of assets, net of related payables [Line Items]          
Prepaid expenses and other current assets     (2,130) 0  
Property, plant and equipment and leasehold intangibles, net     (261,639) 0  
Assets held for sale 280,604 0 280,604 0  
Goodwill $ (28,568) $ 0 (28,568) 0  
Asset impairment     11,733 0  
Net     $ 0 $ 0