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Revenue - Disaggregation of Revenue (Details) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended
--- | --- | ---
Sep. 30, 2019 | Sep. 30, 2018 | Sep. 30, 2019 | Sep. 30, 2018
Disaggregation of Revenue [Line Items] |  |  |  |
Revenue | $ 1,008,949 | $ 1,120,062 | $ 3,070,450 | $ 3,462,496
Private pay |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Revenue | 642,165 | 682,408 | 1,931,066 | 2,160,929
Government reimbursement |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Revenue | 126,795 | 129,075 | 383,252 | 395,407
Other third-party payor programs |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Revenue | 32,277 | 28,696 | 98,261 | 86,078
Total resident fee revenue |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Revenue | 801,237 | 840,179 | 2,412,579 | 2,642,414
Independent Living | Private pay |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Revenue | 136,274 | 143,963 | 406,667 | 459,875
Independent Living | Government reimbursement |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Revenue | 600 | 668 | 1,852 | 2,446
Independent Living | Other third-party payor programs |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Revenue | 0 | 0 | 0 | 0
Independent Living | Total resident fee revenue |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Revenue | 136,874 | 144,631 | 408,519 | 462,321
Assisted Living and Memory Care | Private pay |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Revenue | 435,367 | 464,719 | 1,310,867 | 1,482,789
Assisted Living and Memory Care | Government reimbursement |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Revenue | 17,107 | 18,406 | 50,358 | 54,643
Assisted Living and Memory Care | Other third-party payor programs |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Revenue | 0 | 0 | 0 | 0
Assisted Living and Memory Care | Total resident fee revenue |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Revenue | 452,474 | 483,125 | 1,361,225 | 1,537,432
CCRCs | Private pay |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Revenue | 70,353 | 73,567 | 212,978 | 217,680
CCRCs | Government reimbursement |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Revenue | 19,931 | 20,901 | 61,614 | 65,986
CCRCs | Other third-party payor programs |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Revenue | 9,820 | 9,679 | 30,492 | 30,346
CCRCs | Total resident fee revenue |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Revenue | 100,104 | 104,147 | 305,084 | 314,012
Health Care Services | Private pay |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Revenue | 171 | 159 | 554 | 585
Health Care Services | Government reimbursement |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Revenue | 89,157 | 89,100 | 269,428 | 272,332
Health Care Services | Other third-party payor programs |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Revenue | 22,457 | 19,017 | 67,769 | 55,732
Health Care Services | Total resident fee revenue |  |  |  |
Disaggregation of Revenue [Line Items] |  |  |  |
Revenue | $ 111,785 | $ 108,276 | $ 337,751 | $ 328,649

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