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Supplemental Balance Sheet Information (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Accounts Payable and Accrued Liabilities, Current [Abstract]
Salaries and wages	$ 65,310	$ 86,476
Insurance reserves	64,633	63,230
Paid time off	37,848	37,415
Deferred payroll taxes (Note 3)	36,336	0
Real estate taxes	25,495	25,979
Interest	11,453	16,196
Accrued utilities	7,507	7,601
Taxes payable	3,806	1,360
Other	35,463	28,446
Total	287,851	266,703
Other Assets, Noncurrent [Abstract]
Health care licenses	34,060	35,198
Lease security deposit	3,180	49,102
Other	19,019	34,431
Total	$ 56,259	$ 118,731

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