Real Estate Investments - Types of property Development and Improvement (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Real estate investments
Invested in projects	$ 33,467
Developments | Development and Improvement Commitments
Real estate investments
Invested in projects	35,279	$ 22,901	$ 42,342
Improvements | Development and Improvement Commitments
Real estate investments
Invested in projects	3,249	2,899	6,792
ALF | Developments | Development and Improvement Commitments
Real estate investments
Invested in projects	27,505	17,667	41,859
ALF | Improvements | Development and Improvement Commitments
Real estate investments
Invested in projects	2,292	1,152	3,034
SNF | Developments | Development and Improvement Commitments
Real estate investments
Invested in projects	7,774	5,234	483
SNF | Improvements | Development and Improvement Commitments
Real estate investments
Invested in projects	500	1,356	$ 3,758
Other | Improvements | Development and Improvement Commitments
Real estate investments
Invested in projects	$ 457	$ 391