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Fair Value Measurements - Narrative (Details) - USD ($) | 3 Months Ended | 12 Months Ended
--- | --- | ---
Dec. 31, 2018 | Sep. 30, 2018 | Jun. 30, 2018 | Mar. 31, 2018 | Dec. 31, 2017 | Sep. 30, 2017 | Jun. 30, 2017 | Mar. 31, 2017 | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] |  |  |  |  |  |  |  |  |  |  |
Marketable securities | $ 14,855,000 |  |  |  | $ 291,796,000 |  |  |  | $ 14,855,000 | $ 291,796,000 |
Gains related to trading securities |  |  |  |  |  |  |  |  | 1,400,000 | 600,000 |
Debt | 4,514,656,000 |  |  |  | 5,142,291,000 |  |  |  | 4,514,656,000 | 5,142,291,000 |
Goodwill | 154,131,000 |  |  |  | 505,783,000 |  |  |  | 154,131,000 | 505,783,000 |
Goodwill and asset impairment | 37,927,000 | $ 5,500,000 | $ 16,103,000 | $ 430,363,000 | 18,966,000 | $ 368,551,000 | $ 1,559,000 | $ 20,706,000 | 489,893,000 | 409,782,000 | $ 248,515,000
Level 2 |  |  |  |  |  |  |  |  |  |  |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] |  |  |  |  |  |  |  |  |  |  |
Marketable securities | 14,900,000 |  |  |  |  |  |  |  | 14,900,000 |  |
Reported Value Measurement |  |  |  |  |  |  |  |  |  |  |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] |  |  |  |  |  |  |  |  |  |  |
Debt | 3,600,000,000 |  |  |  | 3,900,000,000 |  |  |  | 3,600,000,000 | 3,900,000,000 |
Assisted Living and Memory Care |  |  |  |  |  |  |  |  |  |  |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] |  |  |  |  |  |  |  |  |  |  |
Amount of carrying amount in excess of fair value |  |  |  | 351,700,000 |  | 205,000,000 |  |  |  |  |
Goodwill impairment |  |  |  | $ 351,700,000 |  | $ 205,000,000 |  |  |  |  |
Goodwill | 0 |  |  |  | 351,652,000 |  |  |  | 0 | 351,652,000 |
Independent Living |  |  |  |  |  |  |  |  |  |  |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] |  |  |  |  |  |  |  |  |  |  |
Goodwill | 27,321,000 |  |  |  | 27,321,000 |  |  |  | 27,321,000 | 27,321,000 |
Health Care Services |  |  |  |  |  |  |  |  |  |  |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] |  |  |  |  |  |  |  |  |  |  |
Goodwill | $ 126,810,000 |  |  |  | $ 126,810,000 |  |  |  | 126,810,000 | 126,810,000 |
Goodwill and asset impairment |  |  |  |  |  |  |  |  | 9,100,000 | 14,600,000 |
Nonrecurring |  |  |  |  |  |  |  |  |  |  |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] |  |  |  |  |  |  |  |  |  |  |
Goodwill impairment |  |  |  |  |  |  |  |  | 351,700,000 | 205,000,000 | 0
Property, plant and equipment impairment |  |  |  |  |  |  |  |  | 78,000,000 | 164,400,000 | 166,200,000
Equity method investment impairment |  |  |  |  |  |  |  |  | 33,400,000 | 25,800,000 | 36,800,000
Goodwill and asset impairment |  |  |  |  |  |  |  |  | 489,900,000 | 409,800,000 | 248,500,000
Impairment of assets held for sale |  |  |  |  |  |  |  |  | $ 15,600,000 | 0 | 15,800,000
Minimum | Level 3 |  |  |  |  |  |  |  |  |  |  |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] |  |  |  |  |  |  |  |  |  |  |
Capitalization rate | 6.50% |  |  |  |  |  |  |  | 6.50% |  |
Maximum | Level 3 |  |  |  |  |  |  |  |  |  |  |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] |  |  |  |  |  |  |  |  |  |  |
Capitalization rate | 9.00% |  |  |  |  |  |  |  | 9.00% |  |
Health care licenses |  |  |  |  |  |  |  |  |  |  |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] |  |  |  |  |  |  |  |  |  |  |
Goodwill and asset impairment |  |  |  |  |  |  |  |  | $ 9,100,000 | $ 14,600,000 |
Community purchase options |  |  |  |  |  |  |  |  |  |  |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] |  |  |  |  |  |  |  |  |  |  |
Goodwill and asset impairment |  |  |  |  |  |  |  |  |  |  | $ 28,200,000

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