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Fair Value Measurements - Additional Information (Details) - USD ($)
$ in Thousands
3 Months Ended 9 Months Ended
Sep. 30, 2018
Mar. 31, 2018
Sep. 30, 2017
Sep. 30, 2018
Sep. 30, 2017
Dec. 31, 2017
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]            
Proceeds from sale of marketable securities       $ 293,300    
Gains related to trading securities     $ 200 1,400 $ 200  
Debt $ 4,632,959     4,632,959   $ 5,142,291
Goodwill impairment       351,652    
Property, plant and equipment and leasehold intangibles, net 2,500   $ 149,900 50,200 152,400  
Investment in unconsolidated ventures       33,400 $ 19,700  
Reported Value Measurement            
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]            
Debt $ 3,700,000     3,700,000   $ 3,900,000
Assisted Living            
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]            
Amount of carrying amount in excess of fair value   $ 351,700        
Goodwill impairment   $ 351,700   $ 351,652