Goodwill and Other Intangible Assets, Net - Intangible Assets (Details) - USD ($) $ in Thousands	Sep. 30, 2018	Dec. 31, 2017
Finite-Lived Intangible Assets, Net [Abstract]
Accumulated Amortization	$ (32,196)	$ (31,643)
Intangible assets, gross carrying amount	91,849	99,620
Intangible assets, net	59,653	67,977
Community purchase options
Indefinite-lived Intangible Assets (Excluding Goodwill) [Abstract]
Indefinite lived assets, gross carrying amount	4,738	9,533
Health care licenses
Indefinite-lived Intangible Assets (Excluding Goodwill) [Abstract]
Indefinite lived assets, gross carrying amount	49,701	50,927
Trade names
Finite-Lived Intangible Assets, Net [Abstract]
Finite lived assets, gross carrying amount	27,800	27,800
Accumulated Amortization	(25,650)	(23,714)
Finite lived assets, net	2,150	4,086
Management contracts
Finite-Lived Intangible Assets, Net [Abstract]
Finite lived assets, gross carrying amount	9,610	11,360
Accumulated Amortization	(6,546)	(7,929)
Finite lived assets, net	$ 3,064	$ 3,431