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Segment Reporting (Details)
$ in Thousands
 3 Months Ended 12 Months Ended
Dec. 31, 2018
USD ($)
Sep. 30, 2018
USD ($)
Jun. 30, 2018
USD ($)
Mar. 31, 2018
USD ($)
Dec. 31, 2017
USD ($)
Sep. 30, 2017
USD ($)
Jun. 30, 2017
USD ($)
Mar. 31, 2017
USD ($)
Dec. 31, 2018
USD ($)
segment
Dec. 31, 2017
USD ($)
Dec. 31, 2016
USD ($)
Segment reporting                      
Number of operating segments | segment                 4    
Number of reportable segments | segment                 3    
Total revenues $ 285,222 $ 278,969 $ 277,202 $ 275,770 $ 278,543 $ 266,673 $ 264,992 $ 264,521 $ 1,117,164 $ 1,074,729 $ 1,058,022
Expenses:                      
Property operating expenses                 451,581 413,492 399,790
Depreciation and amortization                 286,235 276,861 287,831
General and administrative                 85,885 103,694 46,559
Acquisition and certain other transaction related costs                 194 403 2,085
Impairment of assets                 66,346 5,082 18,674
Total expenses                 890,241 799,532 754,939
Gain on sale of properties                 261,916 46,055 4,061
Dividend income                 2,901 2,637 2,108
Unrealized losses on equity securities                 (20,724) 0 0
Interest and other income                 667 406 430
Interest expense                 (179,287) (165,019) (167,574)
Gain (loss) on early extinguishment of debt                 (22) (7,627) (526)
Income (loss) from continuing operations before income tax expense and equity in earnings of an investee                 292,374 151,649 141,582
Income tax expense                 (476) (454) (424)
Equity in earnings of an investee                 516 608 137
Net income (loss)                 292,414 151,803 141,295
Net income attributable to noncontrolling interest                 (5,542) (4,193) 0
Net income attributable to common shareholders (118,543) $ 45,805 $ 123,587 $ 236,022 65,000 $ 34,414 $ 16,042 $ 32,155 286,872 147,610 141,295
Total assets 7,160,426       7,294,019       7,160,426 7,294,019 7,227,754
MOBs                      
Segment reporting                      
Total revenues                 412,813 382,127 372,233
Expenses:                      
Property operating expenses                 127,732 112,930 105,762
Depreciation and amortization                 141,477 128,827 124,196
General and administrative                 0 0 0
Acquisition and certain other transaction related costs                 0 0 0
Impairment of assets                 46,797 0 7,122
Total expenses                 316,006 241,757 237,080
Gain on sale of properties                 0 0 0
Dividend income                   0 0
Unrealized losses on equity securities                 0    
Interest and other income                 0 0 0
Interest expense                 (24,360) (24,919) (13,852)
Gain (loss) on early extinguishment of debt                 0 (59) 0
Income (loss) from continuing operations before income tax expense and equity in earnings of an investee                 72,447 115,392 121,301
Income tax expense                 0 0 0
Equity in earnings of an investee                 0 0 0
Net income (loss)                 72,447 115,392 121,301
Net income attributable to noncontrolling interest                 (5,542) (4,193)  
Net income attributable to common shareholders                 66,905 111,199  
Total assets 3,344,581       3,367,485       3,344,581 3,367,485 3,333,141
Triple Net Leased Senior Living Communities                      
Segment reporting                      
Total revenues                 269,512 280,641 275,697
Expenses:                      
Property operating expenses                 0 0 833
Depreciation and amortization                 80,277 81,976 78,361
General and administrative                 0 0 0
Acquisition and certain other transaction related costs                 0 0 0
Impairment of assets                 19,549 0 6,583
Total expenses                 99,826 81,976 85,777
Gain on sale of properties                 261,916 45,901 4,061
Dividend income                 0 0 0
Unrealized losses on equity securities                 0    
Interest and other income                 0 0 0
Interest expense                 (1,641) (8,855) (24,795)
Gain (loss) on early extinguishment of debt                 76 (7,294) (467)
Income (loss) from continuing operations before income tax expense and equity in earnings of an investee                 430,037 228,417 168,719
Income tax expense                 0 0 0
Equity in earnings of an investee                 0 0 0
Net income (loss)                 430,037 228,417 168,719
Net income attributable to noncontrolling interest                 0 0  
Net income attributable to common shareholders                 430,037 228,417  
Total assets 2,044,939       2,251,756       2,044,939 2,251,756 2,289,045
Managed Senior Living Communities                      
Segment reporting                      
Total revenues                 416,523 393,707 391,822
Expenses:                      
Property operating expenses                 323,849 300,562 293,195
Depreciation and amortization                 60,689 62,266 81,482
General and administrative                 0 0 0
Acquisition and certain other transaction related costs                 0 0 0
Impairment of assets                 0 0 2,174
Total expenses                 384,538 362,828 376,851
Gain on sale of properties                 0 0 0
Dividend income                 0 0 0
Unrealized losses on equity securities                 0    
Interest and other income                 0 0 0
Interest expense                 (4,477) (4,685) (8,540)
Gain (loss) on early extinguishment of debt                 (98) 0 (59)
Income (loss) from continuing operations before income tax expense and equity in earnings of an investee                 27,410 26,194 6,372
Income tax expense                 0 0 0
Equity in earnings of an investee                 0 0 0
Net income (loss)                 27,410 26,194 6,372
Net income attributable to noncontrolling interest                 0 0  
Net income attributable to common shareholders                 27,410 26,194  
Total assets 1,395,657       1,273,757       1,395,657 1,273,757 1,260,032
All Other Operations                      
Segment reporting                      
Total revenues                 18,316 18,254 18,270
Expenses:                      
Property operating expenses                 0 0 0
Depreciation and amortization                 3,792 3,792 3,792
General and administrative                 85,885 103,694 46,559
Acquisition and certain other transaction related costs                 194 403 2,085
Impairment of assets                 0 5,082 2,795
Total expenses                 89,871 112,971 55,231
Gain on sale of properties                 0 154 0
Dividend income                 2,901 2,637 2,108
Unrealized losses on equity securities                 (20,724)    
Interest and other income                 667 406 430
Interest expense                 (148,809) (126,560) (120,387)
Gain (loss) on early extinguishment of debt                 0 (274) 0
Income (loss) from continuing operations before income tax expense and equity in earnings of an investee                 (237,520) (218,354) (154,810)
Income tax expense                 (476) (454) (424)
Equity in earnings of an investee                 516 608 137
Net income (loss)                 (237,480) (218,200) (155,097)
Net income attributable to noncontrolling interest                 0 0  
Net income attributable to common shareholders                 (237,480) (218,200)  
Total assets $ 375,249       $ 401,021       375,249 401,021 345,536
Rental income                      
Segment reporting                      
Total revenues                 700,641 681,022 666,200
Rental income | MOBs                      
Segment reporting                      
Total revenues                 412,813 382,127 372,233
Rental income | Triple Net Leased Senior Living Communities                      
Segment reporting                      
Total revenues                 269,512 280,641 275,697
Rental income | Managed Senior Living Communities                      
Segment reporting                      
Total revenues                 0 0 0
Rental income | All Other Operations                      
Segment reporting                      
Total revenues                 18,316 18,254 18,270
Residents fees and services                      
Segment reporting                      
Total revenues                 416,523 393,707 391,822
Residents fees and services | MOBs                      
Segment reporting                      
Total revenues                 0 0 0
Residents fees and services | Triple Net Leased Senior Living Communities                      
Segment reporting                      
Total revenues                 0 0 0
Residents fees and services | Managed Senior Living Communities                      
Segment reporting                      
Total revenues                 416,523 393,707 391,822
Residents fees and services | All Other Operations                      
Segment reporting                      
Total revenues                 $ 0 $ 0 $ 0