Property, Plant and Equipment and Leasehold Intangibles, Net (Details) (USD $) In Thousands, unless otherwise specified	3 Months Ended		6 Months Ended
	Jun. 30, 2013	Jun. 30, 2012	Jun. 30, 2013	Jun. 30, 2012	Dec. 31, 2012
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	$ 5,582,423		$ 5,582,423		$ 5,481,266
Accumulated depreciation and amortization	1,726,770		1,726,770		1,601,289
Property, plant and equipment and leasehold intangibles, net	3,855,653		3,855,653		3,879,977
Asset impairment, non-cash charge	2,154	7,246	2,154	8,329
Land [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	298,260		298,260		296,314
Buildings and improvements [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	3,434,525		3,434,525		3,391,667
Leasehold Improvements [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	69,434		69,434		60,186
Furniture and equipment [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	584,640		584,640		541,585
Resident and leasehold operating intangibles [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	441,657		441,657		441,603
Construction in Progress [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	71,892		71,892		75,419
Assets under capital and financing leases [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	$ 682,015		$ 682,015		$ 674,492