Facility Operating Leases (Details) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018 USD ($) lease	Sep. 30, 2017 USD ($)	Sep. 30, 2018 USD ($) lease	Sep. 30, 2017 USD ($)
Commitments and Contingencies Disclosure [Abstract]
Number of communities operated under long-term leases | lease	366		366
Number of operating leases | lease	258		258
Number of capital and financing leases | lease	108		108
Schedule of facility operating lease expense [Abstract]
Cash basis payment	$ 73,969	$ 90,303	$ 250,677	$ 275,506
Straight-line (income) expense	(1,815)	(3,078)	(10,410)	(9,204)
Amortization of (above) below market lease, net	(672)	(1,697)	(4,246)	(5,091)
Amortization of deferred gain	(1,090)	(1,091)	(3,269)	(3,277)
Facility lease expense	$ 70,392	$ 84,437	$ 232,752	$ 257,934