CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Cash Flows from Operating Activities
Net income (loss)	$ (42,606)	$ (457,234)
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:
Debt modification and extinguishment costs	67	35
Depreciation and amortization, net	97,719	118,211
Goodwill and asset impairment	391	430,363
Equity in loss of unconsolidated ventures	526	4,243
Distributions from unconsolidated ventures from cumulative share of net earnings	749	408
Amortization of deferred gain	0	(1,090)
Amortization of entrance fees	(398)	(501)
Proceeds from deferred entrance fee revenue	436	1,109
Deferred income tax (benefit) provision	170	15,037
Operating lease expense adjustment	(4,383)	(8,103)
Change in fair value of derivatives	148	(74)
Loss (gain) on sale of assets, net	702	(43,431)
Loss on facility lease termination and modification, net	209	0
Non-cash stock-based compensation expense	6,356	8,406
Non-cash interest expense on financing lease obligations	0	3,383
Non-cash management contract termination gain	(353)	(2,242)
Other	(2,495)	(156)
Changes in operating assets and liabilities:
Accounts receivable, net	(4,550)	3,488
Prepaid expenses and other assets, net	12,358	(6,174)
Prepaid insurance premiums financed with notes payable	(18,842)	(18,633)
Trade accounts payable and accrued expenses	(41,358)	(21,370)
Refundable fees and deferred revenue	(9,855)	12,289
Net cash provided by (used in) operating activities	(5,009)	37,964
Cash Flows from Investing Activities
Change in lease security deposits and lease acquisition deposits, net	(320)	(2,015)
Purchase of marketable securities	(68,348)	0
Sale of marketable securities	0	118,273
Capital expenditures, net of related payables	(60,055)	(66,592)
Acquisition of assets, net of related payables and cash received	0	(27,330)
Investment in unconsolidated ventures	(3,986)	(8,434)
Distributions received from unconsolidated ventures	3,178	2,037
Proceeds from sale of assets, net	29,458	75,060
Property insurance proceeds	0	156
Net cash provided by (used in) investing activities	(100,073)	91,155
Cash Flows from Financing Activities
Proceeds from debt	25,178	30,168
Repayment of debt and financing lease obligations	(28,400)	(44,001)
Purchase of treasury stock, net of related payables	(9,956)	0
Payment of financing costs, net of related payables	(759)	(248)
Proceeds from refundable entrance fees, net of refunds	0	223
Payments of employee taxes for withheld shares	(2,997)	(2,618)
Other	298	372
Net cash provided by (used in) financing activities	(16,636)	(16,104)
Net increase (decrease) in cash, cash equivalents and restricted cash	(121,718)	113,015
Cash, cash equivalents and restricted cash at beginning of period	450,218	282,546
Cash, cash equivalents and restricted cash at end of period	$ 328,500	$ 395,561