Goodwill and Other Intangible Assets, Net - Other Intangible Assets (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Assets, Accumulated Amortization	$ (32,999)	$ (31,643)
Finite-Lived Intangible Assets, Net	4,411
Intangible Assets, Gross (Excluding Goodwill)	84,471	99,620
Intangible Assets, Net (Excluding Goodwill)	51,472	67,977
Amortization expense related to definite-lived intangible assets	3,100	5,600	$ 9,200
Community purchase options
Indefinite-lived Intangible Assets [Line Items]
Indefinite-lived Intangible Assets (Excluding Goodwill)	4,738	9,533
Health care licenses
Indefinite-lived Intangible Assets [Line Items]
Indefinite-lived Intangible Assets (Excluding Goodwill)	42,323	50,927
Trade names
Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Assets, Gross	27,800	27,800
Finite-Lived Intangible Assets, Accumulated Amortization	(26,295)	(23,714)
Finite-Lived Intangible Assets, Net	$ 1,505	4,086
Weighted average useful life	5 years
Management contracts
Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Assets, Gross	$ 9,610	11,360
Finite-Lived Intangible Assets, Accumulated Amortization	(6,704)	(7,929)
Finite-Lived Intangible Assets, Net	$ 2,906	$ 3,431
Weighted average useful life	9 years