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Revenue - Disaggregation of Revenue (Details) - USD ($) $ in Thousands | 3 Months Ended
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Mar. 31, 2019 | Mar. 31, 2018
Disaggregation of Revenue [Line Items] |  |
Revenue | $ 1,042,044 | $ 1,187,234
Private pay |  |
Disaggregation of Revenue [Line Items] |  |
Revenue | 648,679 | 742,761
Government reimbursement |  |
Disaggregation of Revenue [Line Items] |  |
Revenue | 127,408 | 135,239
Other third-party payor programs |  |
Disaggregation of Revenue [Line Items] |  |
Revenue | 33,392 | 28,266
Resident fees |  |
Disaggregation of Revenue [Line Items] |  |
Revenue | 809,479 | 906,266
Independent Living | Private pay |  |
Disaggregation of Revenue [Line Items] |  |
Revenue | 135,045 | 157,507
Independent Living | Government reimbursement |  |
Disaggregation of Revenue [Line Items] |  |
Revenue | 649 | 890
Independent Living | Other third-party payor programs |  |
Disaggregation of Revenue [Line Items] |  |
Revenue | 0 | 0
Independent Living | Resident fees |  |
Disaggregation of Revenue [Line Items] |  |
Revenue | 135,694 | 158,397
Assisted Living and Memory Care | Private pay |  |
Disaggregation of Revenue [Line Items] |  |
Revenue | 441,911 | 514,264
Assisted Living and Memory Care | Government reimbursement |  |
Disaggregation of Revenue [Line Items] |  |
Revenue | 16,615 | 18,016
Assisted Living and Memory Care | Other third-party payor programs |  |
Disaggregation of Revenue [Line Items] |  |
Revenue | 0 | 0
Assisted Living and Memory Care | Resident fees |  |
Disaggregation of Revenue [Line Items] |  |
Revenue | 458,526 | 532,280
CCRCs | Private pay |  |
Disaggregation of Revenue [Line Items] |  |
Revenue | 71,533 | 70,721
CCRCs | Government reimbursement |  |
Disaggregation of Revenue [Line Items] |  |
Revenue | 21,487 | 23,706
CCRCs | Other third-party payor programs |  |
Disaggregation of Revenue [Line Items] |  |
Revenue | 10,707 | 10,642
CCRCs | Resident fees |  |
Disaggregation of Revenue [Line Items] |  |
Revenue | 103,727 | 105,069
Health Care Services | Private pay |  |
Disaggregation of Revenue [Line Items] |  |
Revenue | 190 | 269
Health Care Services | Government reimbursement |  |
Disaggregation of Revenue [Line Items] |  |
Revenue | 88,657 | 92,627
Health Care Services | Other third-party payor programs |  |
Disaggregation of Revenue [Line Items] |  |
Revenue | 22,685 | 17,624
Health Care Services | Resident fees |  |
Disaggregation of Revenue [Line Items] |  |
Revenue | $ 111,532 | $ 110,520

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