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Property, Plant and Equipment and Leasehold Intangibles, Net - Property, Plant and Equipment (Details) - USD ($) $ in Thousands | 12 Months Ended
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Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016
Property, Plant and Equipment [Line Items] |  |  |
Property, plant and equipment and leasehold intangibles gross | $ 8,322,802 | $ 8,916,465 |
Accumulated depreciation and amortization | (3,047,375) | (3,064,320) |
Property, plant and equipment and leasehold intangibles, net | 5,275,427 | 5,852,145 |
Depreciation and amortization expense for plant and equipment and leasehold intangibles | 444,300 | 479,400 | $ 514,200
Land |  |  |
Property, Plant and Equipment [Line Items] |  |  |
Property, plant and equipment and leasehold intangibles gross | 456,912 | 449,295 |
Buildings and improvements |  |  |
Property, Plant and Equipment [Line Items] |  |  |
Property, plant and equipment and leasehold intangibles gross | 4,919,789 | 4,923,621 |
Leasehold improvements |  |  |
Property, Plant and Equipment [Line Items] |  |  |
Property, plant and equipment and leasehold intangibles gross | 123,366 | 124,850 |
Furniture and equipment |  |  |
Property, Plant and Equipment [Line Items] |  |  |
Property, plant and equipment and leasehold intangibles gross | 1,036,113 | 1,006,889 |
Resident and leasehold operating intangibles |  |  |
Property, Plant and Equipment [Line Items] |  |  |
Property, plant and equipment and leasehold intangibles gross | 477,827 | 594,748 |
Construction in progress |  |  |
Property, Plant and Equipment [Line Items] |  |  |
Property, plant and equipment and leasehold intangibles gross | 57,636 | 74,678 |
Assets under capital and financing leases |  |  |
Property, Plant and Equipment [Line Items] |  |  |
Property, plant and equipment and leasehold intangibles gross | $ 1,251,159 | $ 1,742,384 |

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- Definition The current period expense charged against earnings on long-lived, physical assets not used in production, to allocate or recognize the cost of such assets over their useful lives; or to record the reduction in book value of an intangible asset over the benefit period of such asset. + References No definition available. + Details
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- Definition Amount of accumulated depreciation, depletion and amortization for physical assets used in the normal conduct of business to produce goods and services. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 360 -SubTopic 10 -Section 50 -Paragraph 1 -Subparagraph (c) -URI http://asc.fasb.org/extlink&oid=6391035&loc=d3e2868-110229 Reference 2: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 210 -SubTopic 10 -Section S99 -Paragraph 1 -Subparagraph (SX 210.5-02.14) -URI http://asc.fasb.org/extlink&oid=6877327&loc=d3e13212-122682 + Details
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- Definition Amount before accumulated depreciation, depletion and amortization of physical assets used in the normal conduct of business and not intended for resale. Examples include, but are not limited to, land, buildings, machinery and equipment, office equipment, and furniture and fixtures. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 360 -SubTopic 10 -Section 50 -Paragraph 1 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=6391035&loc=d3e2868-110229 Reference 2: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 210 -SubTopic 10 -Section S99 -Paragraph 1 -Subparagraph (SX 210.5-02.13) -URI http://asc.fasb.org/extlink&oid=6877327&loc=d3e13212-122682 + Details
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- Definition Amount after accumulated depreciation, depletion and amortization of physical assets used in the normal conduct of business to produce goods and services and not intended for resale. Examples include, but are not limited to, land, buildings, machinery and equipment, office equipment, and furniture and fixtures. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 210 -SubTopic 10 -Section S99 -Paragraph 1 -Subparagraph (SX 210.5-02(14)) -URI http://asc.fasb.org/extlink&oid=6877327&loc=d3e13212-122682 Reference 2: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 360 -SubTopic 10 -Section 50 -Paragraph 1 -URI http://asc.fasb.org/extlink&oid=6391035&loc=d3e2868-110229 Reference 3: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 944 -SubTopic 210 -Section S99 -Paragraph 1 -Subparagraph (SX 210.7-03(a)(8)) -URI http://asc.fasb.org/extlink&oid=6879938&loc=d3e572229-122910 Reference 4: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 210 -SubTopic 10 -Section S99 -Paragraph 1 -Subparagraph (SX 210.5-02(13)) -URI http://asc.fasb.org/extlink&oid=6877327&loc=d3e13212-122682 + Details
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