Goodwill and Other Intangible Assets, Net - Other Intangible Assets (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Assets, Accumulated Amortization	$ (31,643)	$ (28,188)
Finite-Lived Intangible Assets, Net	7,517
Intangible Assets, Gross (Excluding Goodwill)	99,620	111,195
Intangible Assets, Net (Excluding Goodwill)	67,977	83,007
Amortization expense related to definite-lived intangible assets	5,600	9,200	$ 12,200
Community purchase options
Indefinite-lived Intangible Assets [Line Items]
Indefinite-Lived Intangible Assets (Excluding Goodwill)	9,533	4,738
Health care licenses
Indefinite-lived Intangible Assets [Line Items]
Indefinite-Lived Intangible Assets (Excluding Goodwill)	50,927	65,126
Trade names
Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Assets, Gross	27,800	27,800
Finite-Lived Intangible Assets, Accumulated Amortization	(23,714)	(21,135)
Finite-Lived Intangible Assets, Net	$ 4,086	6,665
Weighted average useful life	3 years
Management contracts
Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Assets, Gross	$ 11,360	13,531
Finite-Lived Intangible Assets, Accumulated Amortization	(7,929)	(7,053)
Finite-Lived Intangible Assets, Net	$ 3,431	$ 6,478
Weighted average useful life	9 years