Property, Plant and Equipment and Leasehold Intangibles, Net (Details) (USD $) In Thousands, unless otherwise specified	3 Months Ended		9 Months Ended
	Sep. 30, 2013	Sep. 30, 2012	Sep. 30, 2013	Sep. 30, 2012	Dec. 31, 2012
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	$ 5,639,889		$ 5,639,889		$ 5,481,266
Accumulated depreciation and amortization	1,794,148		1,794,148		1,601,289
Property, plant and equipment and leasehold intangibles, net	3,845,741		3,845,741		3,879,977
Asset impairment, non-cash charge	504	0	2,658	8,329
Land [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	297,992		297,992		296,314
Buildings and improvements [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	3,454,304		3,454,304		3,391,667
Leasehold Improvements [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	73,832		73,832		60,186
Furniture and equipment [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	608,728		608,728		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	75,678		75,678		75,419
Assets under capital and financing leases [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	$ 687,698		$ 687,698		$ 674,492