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Summary of Significant Accounting Policies (Details) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended
--- | --- | ---
Sep. 30, 2018 | Sep. 30, 2017 | Sep. 30, 2018 | Sep. 30, 2017
Revenue Recognition [Abstract] |  |  |  |
Term of residency agreements- minimum |  |  | 30 days |
Term of residency agreements - maximum |  |  | 1 year |
Self Insurance Liability Accruals [Abstract] |  |  |  |
Decrease in facility operating expense | $ (1,800) | $ (3,700) | $ (9,300) | $ (9,300)
New Accounting Pronouncements and Changes in Accounting Principles [Abstract] |  |  |  |
Decrease in net cash used in investing activities |  |  | 13,027 | 523,378
Increase in net cash provided by operating activities |  |  | 170,508 | 294,323
Decrease in net cash used in financing activities |  |  | 239,929 | (310,552)
Revenue | 840,179 |  | $ 2,642,414 |
Trade names | Minimum |  |  |  |
Finite-Lived Intangible Assets, Net [Abstract] |  |  |  |
Useful lives of definite lived assets |  |  | 2 years |
Trade names | Maximum |  |  |  |
Finite-Lived Intangible Assets, Net [Abstract] |  |  |  |
Useful lives of definite lived assets |  |  | 5 years |
Management contracts | Minimum |  |  |  |
Finite-Lived Intangible Assets, Net [Abstract] |  |  |  |
Useful lives of definite lived assets |  |  | 3 years |
Management contracts | Maximum |  |  |  |
Finite-Lived Intangible Assets, Net [Abstract] |  |  |  |
Useful lives of definite lived assets |  |  | 9 years |
ASU 2016-18 |  |  |  |
New Accounting Pronouncements and Changes in Accounting Principles [Abstract] |  |  |  |
Decrease in net cash used in investing activities |  | 4,600 |  | 6,300
ASU 2016-15 |  |  |  |
New Accounting Pronouncements and Changes in Accounting Principles [Abstract] |  |  |  |
Increase in net cash provided by operating activities |  | 10,600 |  | 11,200
Decrease in net cash used in financing activities |  | 10,600 |  | 11,200
ASU 2014-09 |  |  |  |
New Accounting Pronouncements and Changes in Accounting Principles [Abstract] |  |  |  |
Decrease in resident fee revenue and facility operating expenses | 2,100 |  | $ 5,200 |
Increase in revenue | 11,200 |  | 34,900 |
Resident fees |  |  |  |
New Accounting Pronouncements and Changes in Accounting Principles [Abstract] |  |  |  |
Revenue | 840,179 | 922,892 | 2,642,414 | 2,873,889
Facility operating expense |  |  |  |
New Accounting Pronouncements and Changes in Accounting Principles [Abstract] |  |  |  |
Costs of services | 607,076 | 650,654 | 1,866,477 | 1,967,601
Reimbursed costs incurred on behalf of managed communities |  |  |  |
New Accounting Pronouncements and Changes in Accounting Principles [Abstract] |  |  |  |
Revenue | 261,355 | 236,958 | 765,802 | 650,863
Costs of services | $ 261,355 | $ 236,958 | $ 765,802 | $ 650,863

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