Property, Plant and Equipment and Leasehold Intangibles, Net - Property, Plant and Equipment (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles	$ 8,589,429	$ 8,718,743
Accumulated depreciation and amortization	(4,053,727)	(3,814,451)
Property, plant and equipment and leasehold intangibles, net	4,535,702	4,904,292
Finance lease, right-of-use asset	98,400	332,300
Depreciation and amortization expense for plant and equipment and leasehold intangibles	347,400	337,600	$ 359,200
Land
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles	506,968	502,610
Buildings and improvements
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles	5,323,736	5,262,136
Furniture and equipment
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles	1,055,304	990,006
Resident and leasehold operating intangibles
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles	286,122	303,737
Construction in progress
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles	41,778	51,037
Assets under financing leases and leasehold improvements
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles	$ 1,375,521	$ 1,609,217