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Revenue - Disaggregation of Revenue (Details) - USD ($) $ in Thousands | 12 Months Ended
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Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018
Disaggregation of Revenue [Line Items] |  |  |
Revenue | $ 3,540,195 | $ 4,057,088 | $ 4,531,426
Private pay |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Revenue | 2,368,295 | 2,572,426 | 2,809,903
Government reimbursement |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Revenue | 418,629 | 509,037 | 522,209
Other third-party payor programs |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Revenue | 105,643 | 128,468 | 117,099
Resident fees |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Revenue | 2,892,567 | 3,209,931 | 3,449,211
Independent Living | Private pay |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Revenue | 510,254 | 542,112 | 596,852
Independent Living | Government reimbursement |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Revenue | 2,344 | 2,446 | 3,125
Independent Living | Other third-party payor programs |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Revenue | 0 | 0 | 0
Independent Living | Resident fees |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Revenue | 512,598 | 544,558 | 599,977
Assisted Living and Memory Care | Private pay |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Revenue | 1,622,117 | 1,748,364 | 1,923,676
Assisted Living and Memory Care | Government reimbursement |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Revenue | 69,159 | 67,574 | 72,175
Assisted Living and Memory Care | Other third-party payor programs |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Revenue | 0 | 0 | 0
Assisted Living and Memory Care | Resident fees |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Revenue | 1,691,276 | 1,815,938 | 1,995,851
CCRCs | Private pay |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Revenue | 235,018 | 281,197 | 288,682
CCRCs | Government reimbursement |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Revenue | 59,614 | 81,054 | 87,028
CCRCs | Other third-party payor programs |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Revenue | 27,251 | 39,924 | 40,698
CCRCs | Resident fees |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Revenue | 321,883 | 402,175 | 416,408
Health Care Services | Private pay |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Revenue | 906 | 753 | 693
Health Care Services | Government reimbursement |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Revenue | 287,512 | 357,963 | 359,881
Health Care Services | Other third-party payor programs |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Revenue | 78,392 | 88,544 | 76,401
Health Care Services | Resident fees |  |  |
Disaggregation of Revenue [Line Items] |  |  |
Revenue | $ 366,810 | $ 447,260 | $ 436,975

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