Property, Plant and Equipment and Leasehold Intangibles, Net - Property, Plant and Equipment (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	$ 8,346,845	$ 8,322,802
Accumulated depreciation and amortization	(3,237,011)	(3,047,375)
Property, plant and equipment and leasehold intangibles, net	5,109,834	5,275,427
Finance lease, right-of-use asset	600,000	700,000
Depreciation and amortization expense for plant and equipment and leasehold intangibles	377,600	444,300	$ 479,400
Land
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	450,894	455,623
Buildings and improvements
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	4,790,769	4,749,877
Furniture and equipment
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	859,849	805,190
Resident and leasehold operating intangibles
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	317,111	477,827
Construction in progress
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	80,729	57,636
Assets under financing leases and leasehold improvements
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles gross	$ 1,847,493	$ 1,776,649