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Summary of Significant Accounting Policies - Additional Information (Details) - USD ($) $ in Thousands | 12 Months Ended
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Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015
Revenue Recognition |  |  |
Term of residency agreements - minimum | 30 days |  |
Term of residency agreements - maximum | 1 year |  |
Accounts Receivable |  |  |
Allowance for doubtful accounts | $ 23,100 | $ 27,000 |
Self Insurance Reserves |  |  |
Accrued reserves decreased facility operating expense | (9,900) | (35,400) |
ASU Adoption |  |  |
Increase (decrease) to net cash used in investing activities | (601,307) | 176,825 | $ (568,977)
Cash paid for debt modification and extinguishment costs | 11,700 | 7,900 |
Increase to net cash provided by operating activities | 366,664 | 365,732 | 292,366
Increase (decrease) to net cash used in financing activities | 240,893 | (414,189) | $ 260,557
Cash lease payments | 365,100 |  |
ASU 2016-18 |  |  |
ASU Adoption |  |  |
Increase (decrease) to net cash used in investing activities | 1,000 | (5,000) |
ASU 2016-15 |  |  |
ASU Adoption |  |  |
Increase to net cash provided by operating activities | 11,700 | 7,900 |
Increase (decrease) to net cash used in financing activities | $ (11,700) | $ 7,900 |

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