CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Cash Flows from Operating Activities
Net income (loss)	$ (268,492)	$ (528,352)	$ (571,606)
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:
Debt modification and extinguishment costs	5,247	11,677	12,409
Depreciation and amortization, net	383,490	455,212	494,758
Goodwill and asset impairment	49,266	489,893	409,782
Equity in (earnings) loss of unconsolidated ventures	4,544	8,804	14,827
Distributions from unconsolidated ventures from cumulative share of net earnings	3,472	2,896	8,258
Amortization of deferred gain	0	(4,358)	(4,366)
Amortization of entrance fees	1,634	1,670	2,901
Proceeds from deferred entrance fee revenue	3,544	3,218	5,712
Deferred income tax (benefit) provision	(2,654)	(52,367)	(15,309)
Operating lease expense adjustment	(19,453)	(17,218)	(20,990)
Change in fair value of derivatives	213	403	174
Loss (gain) on sale of assets, net	(7,245)	(293,246)	(19,273)
Loss (gain) on facility lease termination and modification, net	3,388	140,957	14,276
Non-cash stock-based compensation expense	23,026	26,067	27,832
Non-cash interest expense on financing lease obligations	0	10,894	17,744
Non-cash management contract termination gain	(969)	(8,724)	0
Other	(8,700)	(1,292)	(8,819)
Changes in operating assets and liabilities:
Accounts receivable, net	292	(4,964)	12,747
Prepaid expenses and other assets, net	55,873	26,762	21,970
Prepaid insurance premiums financed with notes payable	(12,984)	(37,307)	(4,527)
Refundable fees and deferred revenue	(25,117)	(128)	(14,339)
Operating lease assets and liabilities for lessor capital expenditure reimbursements	31,305	10,400	0
Operating lease assets and liabilities for lease termination	0	(33,596)	0
Net cash provided by (used in) operating activities	216,412	203,961	378,359
Cash Flows from Investing Activities
Change in lease security deposits and lease acquisition deposits, net	(859)	1,163	(2,113)
Purchase of marketable securities	(186,224)	(14,823)	(341,187)
Sale and maturities of marketable securities	134,000	293,273	50,000
Capital expenditures, net of related payables	(304,092)	(225,473)	(213,887)
Acquisition of assets, net of related payables and cash received	(497)	(271,771)	(5,196)
Investment in unconsolidated ventures	(4,346)	(9,124)	(199,017)
Distributions received from unconsolidated ventures	9,635	12,850	29,035
Proceeds from sale of assets, net	92,735	499,807	70,507
Proceeds from notes receivable	34,109	1,580	975
Property insurance proceeds	0	1,292	8,550
Net cash provided by (used in) investing activities	(225,539)	288,774	(602,333)
Cash Flows from Financing Activities
Proceeds from debt	321,996	606,921	1,307,205
Repayment of debt and financing lease obligations	(427,923)	(896,744)	(1,054,161)
Proceeds from line of credit	0	200,000	100,000
Repayment of line of credit	0	(200,000)	(100,000)
Purchase of treasury stock, net of related payables	(23,955)	(4,256)	0
Payment of financing costs, net of related payables	(7,309)	(16,317)	(17,269)
Proceeds from refundable entrance fees, net of refunds	0	(422)	(2,179)
Payments for lease termination	0	(12,548)	(552)
Payments of employee taxes for withheld shares	(3,313)	(3,061)	(5,889)
Other	1,110	1,364	2,043
Net cash provided by (used in) financing activities	(139,394)	(325,063)	229,198
Net increase (decrease) in cash, cash equivalents, and restricted cash	(148,521)	167,672	5,224
Cash, cash equivalents, and restricted cash at beginning of period	450,218	282,546	277,322
Cash, cash equivalents, and restricted cash at end of period	$ 301,697	$ 450,218	$ 282,546