Property, Plant and Equipment and Leasehold Intangibles, Net (Details) (USD $) In Thousands, unless otherwise specified	3 Months Ended
	Mar. 31, 2012	Mar. 31, 2011	Dec. 31, 2011
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles, gross	$ 5,253,537		$ 5,105,676
Accumulated depreciation and amortization	(1,460,153)		(1,411,612)
Property, plant and equipment and leasehold intangibles, net	3,793,384		3,694,064
Asset impairment, non-cash charge	1,083	14,846
Land [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles, gross	285,703		275,277
Building and Building Improvements [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles, gross	3,207,881		3,080,882
Furniture and Equipment
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles, gross	464,098		450,179
Resident and Leasehold Operating Intangibles [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles, gross	163,366		163,366
Construction in Progress [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles, gross	50,300		39,600
Assets Held under Capital and Financing Leases [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles, gross	674,337		667,239
Leasehold Improvements [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles, gross	$ 407,852		$ 429,133