Goodwill and Other Intangible Assets, Net - Intangible Assets (Details) - USD ($) $ in Thousands	Sep. 30, 2019	Dec. 31, 2018
Finite-Lived Intangible Assets, Net [Abstract]
Accumulated Amortization	$ (27,800)	$ (32,999)
Intangible assets, gross carrying amount	70,576	84,471
Intangible assets, net	42,776	51,472
Community purchase options
Indefinite-lived Intangible Assets (Excluding Goodwill) [Abstract]
Indefinite lived assets, gross carrying amount		4,738
Health care licenses
Indefinite-lived Intangible Assets (Excluding Goodwill) [Abstract]
Indefinite lived assets, gross carrying amount	42,776	42,323
Trade names
Finite-Lived Intangible Assets, Net [Abstract]
Finite lived assets, gross carrying amount	27,800	27,800
Accumulated Amortization	(27,800)	(26,295)
Finite lived assets, net	$ 0	1,505
Management contracts
Finite-Lived Intangible Assets, Net [Abstract]
Finite lived assets, gross carrying amount		9,610
Accumulated Amortization		(6,704)
Finite lived assets, net		$ 2,906