Property, Plant and Equipment and Leasehold Intangibles, Net (Details) (USD $)	12 Months Ended
	Dec. 31, 2011	Dec. 31, 2010	Dec. 31, 2009
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	$ 5,105,676,000	$ 4,914,760,000
Accumulated depreciation and amortization	(1,411,612,000)	(1,177,918,000)
Property, plant and equipment and leasehold intangibles, net	3,694,064,000	3,736,842,000
Impaired Long-Lived Assets Held and Used [Line Items]
Asset impairment, non-cash charge	16,892,000	13,075,000	10,073,000
Depreciation and amortization expense on property, plant and equipment and leasehold intangibles	247,100,000	258,000,000	233,900,000
Resident And Leasehold Operating Intangibles Future Amortization Expense [Abstract]
2012	43,191,000
2013	41,105,000
2014	35,775,000
2015	33,768,000
2016	31,971,000
Thereafter	68,131,000
Total	253,941,000
Land [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	275,277,000	273,214,000
Buildings, improvements, and leasehold improvements [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	3,080,882,000	3,003,788,000
Furniture and equipment [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	450,179,000	382,488,000
Resident and leasehold operating intangibles [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	592,499,000	588,633,000
Construction in Progress [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	39,600,000	16,463,000
Assets under capital and financing leases [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	$ 667,239,000	$ 650,174,000