Property, Plant and Equipment and Leasehold Intangibles, Net - Property, Plant and Equipment (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles	$ 8,718,743	$ 8,558,158
Accumulated depreciation and amortization	(3,814,451)	(3,490,098)
Property, plant and equipment and leasehold intangibles, net	4,904,292	5,068,060
Finance lease, right-of-use asset	332,300	363,100
Depreciation and amortization expense for plant and equipment and leasehold intangibles	337,600	359,200	$ 377,600
Land
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles	502,610	505,298
Buildings and improvements
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles	5,262,136	5,215,460
Furniture and equipment
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles	990,006	945,783
Resident and leasehold operating intangibles
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles	303,737	307,071
Construction in progress
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles	51,037	61,491
Assets under financing leases and leasehold improvements
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles	$ 1,609,217	$ 1,523,055