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Acquisitions, Dispositions and Other Significant Transactions - Dispositions of Owned Communities and Assets Held for Sale (Details) $ in Thousands |  | 3 Months Ended | 9 Months Ended | 12 Months Ended
--- | --- | --- | --- | ---
Nov. 01, 2018 USD ($) community | Sep. 30, 2018 USD ($) | Sep. 30, 2017 USD ($) | Sep. 30, 2018 USD ($) community | Sep. 30, 2017 USD ($) | Dec. 31, 2017 USD ($) community
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] |  |  |  |  |  |
Gain (loss) on sale of assets, net |  | $ 9,833 | $ (233) | $ 76,586 | $ (1,383) |
Assets held for sale |  | 241,854 |  | 241,854 |  | $ 106,435
Revenue |  | 840,179 |  | $ 2,642,414 |  |
Sale of 3 communities |  |  |  |  |  |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] |  |  |  |  |  |
Number of communities disposed of | community |  |  |  |  |  | 3
Net cash proceeds |  |  |  |  |  | $ 8,200
43 Communities Disposed Of By Lease Terminations |  |  |  |  |  |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] |  |  |  |  |  |
Number of communities disposed of | community |  |  |  |  |  | 43
26 Communities Disposed Of By Lease Terminations |  |  |  |  |  |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] |  |  |  |  |  |
Number of communities disposed of | community |  |  |  |  |  | 26
Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations |  |  |  |  |  |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] |  |  |  |  |  |
Number of additional communities held for sale | community |  |  |  | 18 |  |
Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations | 15 Communities Held For Sale |  |  |  |  |  |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] |  |  |  |  |  |
Number of communities classified as held for sale | community |  |  |  |  |  | 15
Impairment of assets held for sale |  | 3,000 |  | $ 15,000 |  |
Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations | Three Communities |  |  |  |  |  |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] |  |  |  |  |  |
Number of communities disposed of | community |  |  |  | 3 |  |
Number of communities not previously held for sale | community |  |  |  | 2 |  |
Net cash proceeds |  |  |  | $ 12,800 |  |
Gain (loss) on sale of assets, net |  |  |  | $ 1,900 |  |
Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations | 32 Communities Held For Sale |  |  |  |  |  |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] |  |  |  |  |  |
Number of communities classified as held for sale | community |  |  |  | 32 |  |
Assets held for sale |  | 241,900 |  | $ 241,900 |  |
Retirement Centers |  |  |  |  |  |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] |  |  |  |  |  |
Revenue |  | 144,631 |  | $ 462,321 |  |
Retirement Centers | Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations | 32 Communities Held For Sale |  |  |  |  |  |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] |  |  |  |  |  |
Number of communities classified as held for sale | community |  |  |  | 4 |  |
Assisted Living |  |  |  |  |  |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] |  |  |  |  |  |
Revenue |  | 483,125 |  | $ 1,537,432 |  |
Assisted Living | Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations | 32 Communities Held For Sale |  |  |  |  |  |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] |  |  |  |  |  |
Number of communities classified as held for sale | community |  |  |  | 26 |  |
CCRCs Rental |  |  |  |  |  |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] |  |  |  |  |  |
Revenue |  | 104,147 |  | $ 314,012 |  |
CCRCs Rental | Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations | 32 Communities Held For Sale |  |  |  |  |  |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] |  |  |  |  |  |
Number of communities classified as held for sale | community |  |  |  | 2 |  |
Mortgage notes payable | Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations | 15 Communities Held For Sale |  |  |  |  |  |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] |  |  |  |  |  |
Mortgage debt |  |  |  |  |  | $ 30,100
Mortgage notes payable | Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations | 32 Communities Held For Sale |  |  |  |  |  |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] |  |  |  |  |  |
Mortgage debt |  | 158,600 |  | $ 158,600 |  |
Resident fees |  |  |  |  |  |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] |  |  |  |  |  |
Revenue |  | 840,179 | 922,892 | 2,642,414 | 2,873,889 |
Resident fees | Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations | 32 Communities Held For Sale |  |  |  |  |  |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] |  |  |  |  |  |
Revenue |  | 26,400 | 27,000 | 81,100 | 81,700 |
Facility operating expense |  |  |  |  |  |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] |  |  |  |  |  |
Costs of services |  | 607,076 | 650,654 | 1,866,477 | 1,967,601 |
Facility operating expense | Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations | 32 Communities Held For Sale |  |  |  |  |  |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] |  |  |  |  |  |
Costs of services |  | $ 20,000 | $ 19,100 | $ 58,900 | $ 56,600 |
Subsequent event | Sale Of One Community |  |  |  |  |  |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] |  |  |  |  |  |
Number of communities disposed of | community | 1 |  |  |  |  |
Net cash proceeds | $ 144,000 |  |  |  |  |

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