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Summary of Significant Accounting Policies (Details) - USD ($)
$ in Thousands
 3 Months Ended
Mar. 31, 2018
Mar. 31, 2017
Fair Value of Financial Instruments [Line Items]    
Term of residency agreements- minimum 30 days  
Term of residency agreements - maximum 1 year  
Decrease in facility operating expense $ 1,200 $ 3,700
Decrease in net cash used in investing activities (91,155) 199,743
Resident fees 906,266 1,016,927
Facility operating expenses 632,325 674,542
Reimbursed costs incurred on behalf of managed communities 262,287 183,945
Costs incurred on behalf of managed communities 262,287 183,945
Cash lease payments $ 89,593 94,604
Trade names [Member] | Minimum [Member]    
Fair Value of Financial Instruments [Line Items]    
Useful lives of definite lived assets 2 years  
Trade names [Member] | Maximum [Member]    
Fair Value of Financial Instruments [Line Items]    
Useful lives of definite lived assets 5 years  
Other Intangible Assets [Member] | Minimum [Member]    
Fair Value of Financial Instruments [Line Items]    
Useful lives of definite lived assets 3 years  
Other Intangible Assets [Member] | Maximum [Member]    
Fair Value of Financial Instruments [Line Items]    
Useful lives of definite lived assets 9 years  
Accounting Standards Update 2016-18 [Member]    
Fair Value of Financial Instruments [Line Items]    
Decrease in net cash used in investing activities   $ 600
Accounting Standards Update 2014-09 [Member]    
Fair Value of Financial Instruments [Line Items]    
Decrease in resident fee revenue and facility operating expenses $ 1,100  
Increase in revenue $ 12,400