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Summary of Significant Accounting Policies - Additional Information (Details) - USD ($) $ in Thousands | 12 Months Ended |
--- | --- | ---
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | Jan. 01, 2019
Revenue Recognition |  |  |  |
Term of residency agreements - minimum | 30 days |  |  |
Term of residency agreements - maximum | 1 year |  |  |
Accounts Receivable |  |  |  |
Allowance for doubtful accounts | $ 24,800 | $ 23,100 |  |
Self Insurance Reserves |  |  |  |
Accrued reserves decreased facility operating expense | 14,600 | 9,900 | $ 35,400 |
ASU Adoption |  |  |  |
Increase (decrease) to net cash used in investing activities | 288,774 | (602,333) | 171,798 |
Increase to net cash provided by operating activities | 203,961 | 378,359 | 373,651 |
Increase (decrease) to net cash used in financing activities | (325,063) | 229,198 | (422,108) |
Revenue | 3,449,211 |  |  |
ASU 2016-18 |  |  |  |
ASU Adoption |  |  |  |
Increase (decrease) to net cash used in investing activities |  | 1,000 | (5,000) |
ASU 2016-15 |  |  |  |
ASU Adoption |  |  |  |
Increase to net cash provided by operating activities |  | 11,700 | 7,900 |
Increase (decrease) to net cash used in financing activities |  | (11,700) | 7,900 |
Resident fees |  |  |  |
ASU Adoption |  |  |  |
Revenue | 3,449,211 | 3,780,140 | 4,168,621 |
Facility operating expense |  |  |  |
ASU Adoption |  |  |  |
Costs incurred | 2,453,328 | 2,602,155 | 2,799,402 |
Reimbursed costs incurred on behalf of managed communities |  |  |  |
ASU Adoption |  |  |  |
Revenue | 1,010,229 | 891,131 | 737,597 |
Costs incurred | 1,010,229 | $ 891,131 | $ 737,597 |
ASU 2014-09 |  |  |  |
ASU Adoption |  |  |  |
Decrease in resident fee revenue | 8,400 |  |  |
Decrease in facility operating expense | 8,400 |  |  |
Increase in reimbursable revenue | 46,100 |  |  |
Increase in reimbursed costs | 46,100 |  |  |
ASU 2016-02 |  |  |  |
ASU Adoption |  |  |  |
Net liabilities | $ 200,000 |  |  |
Buildings |  |  |  |
Revenue Recognition |  |  |  |
Estimated Useful Life | 40 years |  |  |
Subsequent event | ASU 2016-02 |  |  |  |
ASU Adoption |  |  |  |
Lease liabilities |  |  |  | $ 1,600,000
ROU assets |  |  |  | $ 200,000

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