Summary of Significant Accounting Policies - Additional Information (Details) - USD ($) $ in Thousands	12 Months Ended
Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Revenue Recognition
Term of residency agreements - minimum	30 days
Term of residency agreements - maximum	1 year
Accounts Receivable
Allowance for doubtful accounts	$ 23,100	$ 27,000
Self Insurance Reserves
Accrued reserves decreased facility operating expense	(9,900)	(35,400)
ASU Adoption
Increase (decrease) to net cash used in investing activities	(601,307)	176,825	$ (568,977)
Cash paid for debt modification and extinguishment costs	11,700	7,900
Increase to net cash provided by operating activities	366,664	365,732	292,366
Increase (decrease) to net cash used in financing activities	240,893	(414,189)	$ 260,557
Cash lease payments	365,100
ASU 2016-18
ASU Adoption
Increase (decrease) to net cash used in investing activities	1,000	(5,000)
ASU 2016-15
ASU Adoption
Increase to net cash provided by operating activities	11,700	7,900
Increase (decrease) to net cash used in financing activities	$ (11,700)	$ 7,900

Payments For Debt Extinguishment And Debt Modification

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Term Of Residency Agreements Maximum

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A valuation allowance for trade and other receivables due to an Entity within one year (or the normal operating cycle, whichever is longer) that are expected to be uncollectible.

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Amount of increase (decrease) in liability to reflect the estimated ultimate cost of settling claims relating to insured events that have occurred on or before the balance sheet date, whether or not reported to the insurer at that date.

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Amount of cash inflow (outflow) from financing activities, including discontinued operations. Financing activity cash flows include obtaining resources from owners and providing them with a return on, and a return of, their investment; borrowing money and repaying amounts borrowed, or settling the obligation; and obtaining and paying for other resources obtained from creditors on long-term credit.

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Amount of cash outflow from operating lease, excluding payments to bring another asset to condition and location necessary for its intended use.

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