Loans Receivable - Credit Loss Roll Forward (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($) loan
Financing Receivable, Allowance for Credit Loss [Roll Forward]
Balance at beginning of period	$ 166,785	$ 224,036	$ 68,372
Provision for loan losses, net	(1,394)	7,270	94,436
Loan write-offs	0	(64,075)	(7,000)
Foreign currency translation	(1,142)	(446)	197
Reclassification of deferred gain as credit loss	0	0	62,819
Balance at end of period	164,249	166,785	224,036
Provision for loss on held-to-maturity debt securities	11,714
Loan writeoff	$ 0	64,075	$ 7,000
HC-One Group (5)
Financing Receivable, Allowance for Credit Loss [Roll Forward]
Loan write-offs		(64,075)
Loan writeoff		$ 64,075
Genesis healthcare receivable
Financing Receivable, Allowance for Credit Loss [Roll Forward]
Number of loans | loan			2
Loan Carrying Value			$ 62,753
Accounting Standards Update 2016-13
Financing Receivable, Allowance for Credit Loss [Roll Forward]
Accounting standards update [Extensible List]			Accounting Standards Update 2016-13
Accounting Standards Update 2016-13 | Cumulative Effect, Period of Adoption, Adjustment
Financing Receivable, Allowance for Credit Loss [Roll Forward]
Balance at beginning of period			$ 5,212