Derivative Instruments (Details 1) - USD ($) $ in Thousands		12 Months Ended
		Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Derivative [Line Items]
Derivative Gain Loss On Derivative Net		$ (2,284)	$ 2,448	$ 58,427
Interest Rate Swap [Member]
Derivative [Line Items]
Gain (loss) on forward exchange contracts recognized in income.		(2,476)	8,544	14,474
Foreign Exchange Contract [Member]
Derivative [Line Items]
Gain (loss) recognized in OCI		(252,168)	357,021	298,116
Gain on release of cumulative translation adjustment related to ineffectiveness on net investment hedge		0	(2,516)	0
Foreign Exchange Option [Member]
Derivative [Line Items]
Derivative Gain Loss On Derivative Net	[1]	$ 0	$ 0	$ (58,427)

[1] In April 2011, we completed the acquisition of substantially all of the real estate assets of privately-owned Genesis. In conjunction with this transaction, we received the option to acquire an ownership interest in Genesis. In February 2015, Genesis closed on a transaction to merge with Skilled Healthcare Group to become a publicly traded company which required us to record the value of the derivative asset due to the net settlement feature.