Commitments and Contingencies - Narrative (Details)			1 Months Ended	12 Months Ended			32 Months Ended	114 Months Ended
	Oct. 01, 2018 center extension	Nov. 01, 2016 USD ($)	Jan. 31, 2013 USD ($) center	Dec. 31, 2018 USD ($) center bed lawsuit Multiple $ / Bed	Dec. 31, 2017 USD ($)	Dec. 31, 2016 USD ($)	Feb. 29, 2016 civil_investigative_demand	Dec. 31, 2017 USD ($)	Oct. 01, 2016 center	Oct. 31, 2014 facility
Commitments and Contingencies [Line Items]
Lease and rent expense				$ 57,073,000	$ 54,988,000	$ 33,364,000
Accrued liability related to straightline rent				$ 6,877,000	6,983,000			$ 6,983,000
Number of nursing center facilities leased | center	34			57
Number of skilled nursing centers under lease | center	23
Operating lease, initial term	12 years
Operating lease, number of lease extensions allowed | extension	2
Operating lease, extension period	10 years
Operating lease, annual lease fixed escalators, percent	2.15%
Number of licensed nursing beds | bed				8,214
Estimated insurance recoveries				$ 5,478	1,579			1,579
Cash expenditures for self-insured professional liability costs				6,540,000	6,593,000	$ 4,456,000
Liability for workers compensation claims				618,000	867,000			867,000
Workers compensation insurance, non current receivable for excess premiums paid				1,258,000	1,113,000			1,113,000
Health insurance, maximum self-insured annual amount per individual				$ 200,000
Salary multiple | Multiple				2
Renewal period for employee agreements				1 year
Number of professional liability lawsuits | lawsuit				78
Duration of alleged breaches of statutory and contractual obligations to patents				5 years
Unfavorable regulatory action | Potential violations of false claims act
Commitments and Contingencies [Line Items]
Number of facilities | facility										2
New separate actions | civil_investigative_demand							3
Loss contingency accrual				$ 6,400,000
Leases, acquired-in-place
Commitments and Contingencies [Line Items]
Number of nursing center facilities leased | center				7
Scheduled for trial or arbitration over next 12 months
Commitments and Contingencies [Line Items]
Number of professional liability lawsuits | lawsuit				18
Professional malpractice liability insurance
Commitments and Contingencies [Line Items]
Insurance policy coverage limits per claim				$ 1,000,000
Workers compensation insurance, maximum annual aggregate self-insured amount				3,000,000
Maximum claim amount on insurance				5,000,000
Liability for reported and estimated future claims				27,201,000	20,057,000			20,057,000
Prefunded deductible policy
Commitments and Contingencies [Line Items]
Insurance policy coverage limits per claim								500,000
Professional liability insurance, annual coverage limit per facility								3,000,000
Liability for reported claims and estimates for incurred but unreported claims				$ 1,396,000	$ 1,326,000			$ 1,326,000
Minimum
Commitments and Contingencies [Line Items]
Employee termination agreement term				1 year
Maximum
Commitments and Contingencies [Line Items]
Maximum contingent liability				$ 1,692,000
Employee termination agreement term				3 years
Omega Healthcare Investors, Inc
Commitments and Contingencies [Line Items]
Annual capital expenditures related to leased facilities per licensed bed | $ / Bed				400
Total required capital expenditures during remaining lease term				$ 18,611,000
Letters of credit security deposit for a lease				$ 6,909,000
Omega Healthcare Investors, Inc | Leases, acquired-in-place
Commitments and Contingencies [Line Items]
Renovation funding amount			$ 5,000,000
Percentage of amount financed			10.25%
Number of licensed nursing beds | bed				15
Golden Living master lease
Commitments and Contingencies [Line Items]
Annual capital expenditures related to leased facilities per licensed bed | $ / Bed				510
Total required capital expenditures during remaining lease term				$ 7,955,000
Leased | Omega Healthcare Investors, Inc | Leases, acquired-in-place
Commitments and Contingencies [Line Items]
Number of nursing center facilities leased | center			2
Number of nursing center facilities under renovation | center				1
Golden Living | Mississippi
Commitments and Contingencies [Line Items]
Number of nursing center facilities leased | center									8
Golden Living | Alabama
Commitments and Contingencies [Line Items]
Number of nursing center facilities leased | center									12
Golden Living | Amended lease
Commitments and Contingencies [Line Items]
First year rent		$ 24,675,000
Annual rent increase, as a percent		2.00%
Term of lease		10 years
Letter of credit | Golden Living master lease
Commitments and Contingencies [Line Items]
Letters of credit security deposit for a lease				$ 6,354,000
Golden Living
Commitments and Contingencies [Line Items]
Operating lease, extension period		5 years
Omega Healthcare Investors, Inc
Commitments and Contingencies [Line Items]
Number of nursing center facilities leased | center	11