Property, Plant and Equipment and Leasehold Intangibles, Net (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018	Dec. 31, 2018
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	$ 8,235,495		$ 8,322,802
Accumulated depreciation and amortization	(2,999,301)		(3,047,375)
Property, plant and equipment and leasehold intangibles, net	5,236,194		5,275,427
Finance lease, right-of-use asset	700,000		700,000
Depreciation and amortization expense	96,100	$ 113,400
Land
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	455,590		456,912
Buildings and improvements
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	4,773,632		4,919,789
Furniture and equipment
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	820,253		1,036,113
Resident and leasehold operating intangibles
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	320,812		477,827
Construction in progress
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	72,241		57,636
Assets under financing leases and leasehold improvements
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	$ 1,792,967		$ 1,374,525