Sonida Senior Living (SNDA) 10-K 1 Mar 19 2018 FY Annual report Financial data

Document and Entity Information

Document and Entity Information - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2018	Feb. 22, 2019	Jun. 30, 2018
Document And Entity Information [Abstract]
Document Type	10-K
Amendment Flag	false
Document Period End Date	Dec. 31, 2018
Document Fiscal Year Focus	2,018
Document Fiscal Period Focus	FY
Trading Symbol	CSU
Entity Registrant Name	CAPITAL SENIOR LIVING CORP
Entity Central Index Key	1,043,000
Current Fiscal Year End Date	--12-31
Entity Well-known Seasoned Issuer	No
Entity Current Reporting Status	Yes
Entity Voluntary Filers	No
Entity Filer Category	Accelerated Filer
Entity Shell Company	false
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Common Stock, Shares Outstanding		31,316,105
Entity Public Float			$ 260.7

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Current assets:
Cash and cash equivalents	$ 31,309	$ 17,646
Restricted cash	13,011	13,378
Accounts receivable, net	10,581	12,307
Federal and state income taxes receivable	152
Property tax and insurance deposits	13,173	14,386
Prepaid expenses and other	5,232	6,332
Total current assets	73,458	64,049
Property and equipment, net	1,059,049	1,099,786
Deferred taxes, net	152
Other assets, net	16,485	18,836
Total assets	1,149,144	1,182,671
Current liabilities:
Accounts payable	9,095	7,801
Accrued expenses	41,880	40,751
Current portion of notes payable, net of deferred loan costs	14,342	19,728
Current portion of deferred income	14,892	13,840
Current portion of capital lease and financing obligations	3,113	3,106
Federal and state income taxes payable	406	383
Customer deposits	1,302	1,394
Total current liabilities	85,030	87,003
Deferred income	8,151	10,033
Capital lease and financing obligations, net of current portion	45,647	48,805
Deferred taxes, net		1,941
Other long-term liabilities	15,643	16,250
Notes payable, net of deferred loan costs and current portion	959,408	938,206
Commitments and contingencies
Shareholders’ equity:
Preferred stock, $.01 par value: Authorized shares — 15,000; no shares issued or outstanding
Common stock, $.01 par value: Authorized shares — 65,000; issued and outstanding shares 31,273 and 30,505 in 2018 and 2017, respectively	318	310
Additional paid-in capital	187,879	179,459
Retained deficit	(149,502)	(95,906)
Treasury stock, at cost — 494 shares in 2018 and 2017	(3,430)	(3,430)
Total shareholders’ equity	35,265	80,433
Total liabilities and shareholders’ equity	$ 1,149,144	$ 1,182,671

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - $ / shares	Dec. 31, 2018	Dec. 31, 2017
Statement Of Financial Position [Abstract]
Preferred stock, par value	$ 0.01	$ 0.01
Preferred stock, shares authorized	15,000,000	15,000,000
Preferred stock, shares issued	0	0
Preferred stock, shares outstanding	0	0
Common stock, par value	$ 0.01	$ 0.01
Common stock, shares authorized	65,000,000	65,000,000
Common stock, shares issued	31,273,000	30,505,000
Common stock, shares outstanding	31,273,000	30,505,000
Treasury stock, shares	494,000	494,000

Consolidated Statements of Oper

Consolidated Statements of Operations and Comprehensive Loss - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Revenues:
Resident revenue	$ 460,018	$ 466,997	$ 447,448
Type Of Revenue [Extensible List]	us-gaap:HealthCareResidentServiceMember	us-gaap:HealthCareResidentServiceMember	us-gaap:HealthCareResidentServiceMember
Expenses:
Operating expenses (exclusive of facility lease expense and depreciation and amortization expense shown below)	$ 294,661	$ 290,662	$ 273,899
General and administrative expenses	26,961	23,574	23,671
Facility lease expense	56,551	56,432	61,718
Loss on facility lease termination		12,858
Provision for bad debts	2,990	1,748	1,727
Stock-based compensation expense	8,428	7,682	11,645
Depreciation and amortization expense	62,824	66,199	60,398
Total expenses	452,415	459,155	433,058
Income from operations	7,603	7,842	14,390
Other income (expense):
Interest income	165	73	67
Interest expense	(50,543)	(49,471)	(42,207)
Write-off of deferred loan costs and prepayment premiums	(12,623)
Gain (Loss) on disposition of assets, net	28	(123)	(65)
Other income	3	7	233
Loss before benefit (provision) for income taxes	(55,367)	(41,672)	(27,582)
Benefit (Provision) for income taxes	1,771	(2,496)	(435)
Net loss	$ (53,596)	$ (44,168)	$ (28,017)
Per share data:
Basic net loss per share	$ (1.80)	$ (1.50)	$ (0.97)
Diluted net loss per share	$ (1.80)	$ (1.50)	$ (0.97)
Weighted average shares outstanding — basic	29,812	29,453	28,909
Weighted average shares outstanding — diluted	29,812	29,453	28,909
Comprehensive loss	$ (53,596)	$ (44,168)	$ (28,017)

Consolidated Statements of Shar

Consolidated Statements of Shareholders' Equity - USD ($) $ in Thousands	Total	Common Stock [Member]	Additional Paid-In Capital [Member]	Retained Deficit [Member]	Treasury Stock [Member]
Beginning Balance at Dec. 31, 2015	$ 135,746	$ 299	$ 159,920	$ (23,539)	$ (934)
Beginning Balance, Shares at Dec. 31, 2015		29,539,000
Exercise of stock options	$ 60		60
Exercise of stock options, Shares	3,000	6,000
Restricted stock awards	$ 7	$ 6	1
Restricted stock awards, Shares		611,000
Stock-based compensation	11,645		11,645
Excess tax benefits on stock options exercised	(27)		(27)
Treasury stock	$ (2,496)				(2,496)
Treasury stock, Shares	(144,315)	(144,000)
Net loss	$ (28,017)			(28,017)
Ending Balance at Dec. 31, 2016	116,918	$ 305	171,599	(51,556)	(3,430)
Ending Balance, Shares at Dec. 31, 2016		30,012,000
Restricted stock unit conversions, Shares		3,000
Restricted stock awards	1	$ 5	(4)
Restricted stock awards, Shares		490,000
Stock-based compensation	$ 7,682		7,864	(182)
Treasury stock, Shares	0
Net loss	$ (44,168)			(44,168)
Ending Balance at Dec. 31, 2017	80,433	$ 310	179,459	(95,906)	(3,430)
Ending Balance, Shares at Dec. 31, 2017		30,505,000
Restricted stock awards		$ 8	(8)
Restricted stock awards, Shares		768,000
Stock-based compensation	$ 8,428		8,428
Treasury stock, Shares	0
Net loss	$ (53,596)			(53,596)
Ending Balance at Dec. 31, 2018	$ 35,265	$ 318	$ 187,879	$ (149,502)	$ (3,430)
Ending Balance, Shares at Dec. 31, 2018		31,273,000

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Operating Activities
Net loss	$ (53,596)	$ (44,168)	$ (28,017)
Adjustments to reconcile net loss to net cash provided by operating activities:
Depreciation and amortization	62,824	66,199	60,398
Amortization of deferred financing charges	1,709	1,626	1,193
Amortization of deferred lease costs and lease intangibles, net	849	859	679
Amortization of lease incentives	(2,074)	(1,336)	(710)
Deferred income	(1,391)	(1,397)	(414)
Deferred taxes	(2,245)	1,941
Lease incentives	3,376	5,673	7,530
Loss on facility lease termination		12,858
Write-off of deferred loan costs and prepayment premiums	12,623
(Gain) Loss on disposition of assets, net	(28)	123	65
Provision for bad debts	2,990	1,748	1,727
Stock-based compensation expense	8,428	7,682	11,645
Changes in operating assets and liabilities:
Accounts receivable	(3,173)	(8,159)	(14,519)
Property tax and insurance deposits	1,213	279	(267)
Prepaid expenses and other	1,100	33	(1,995)
Other assets	1,350	4,061	(2,228)
Accounts payable	1,294	2,750	1,695
Accrued expenses	1,129	1,689	4,798
Other liabilities		5,017	12,014
Federal and state income taxes receivable/payable	23	165	107
Deferred resident revenue	561	(1,898)	(1,148)
Customer deposits	(92)	(151)	(274)
Net cash provided by operating activities	36,870	55,594	52,279
Investing Activities
Capital expenditures	(21,965)	(39,959)	(62,371)
Cash paid for acquisitions		(85,000)	(138,750)
Proceeds from disposition of assets	57	19	72
Net cash used in investing activities	(21,908)	(124,940)	(201,049)
Financing Activities
Proceeds from notes payable	208,841	77,197	150,798
Repayments of notes payable	(204,093)	(20,099)	(17,680)
Cash payments for capital lease and financing obligations	(3,151)	(2,869)	(1,314)
Cash proceeds from the issuance of common stock			67
Excess tax benefits on stock options exercised			(27)
Purchases of treasury stock			(2,496)
Deferred financing charges paid	(3,263)	(1,182)	(2,501)
Net cash (used in) provided by financing activities	(1,666)	53,047	126,847
Increase (Decrease) in cash and cash equivalents	13,296	(16,299)	(21,923)
Cash and cash equivalents and restricted cash at beginning of year	31,024	47,323	69,246
Cash and cash equivalents and restricted cash at end of year	44,320	31,024	47,323
Cash paid during the year for:
Interest	49,225	47,022	40,585
Income taxes	$ 555	$ 543	$ 582

Organization

Organization	12 Months Ended
	Dec. 31, 2018
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Organization	1. Organization Capital Senior Living Corporation, a Delaware corporation (together with its subsidiaries, the “Company”), is one of the largest operators of senior housing communities in the United States in terms of resident capacity. The Company owns, operates, develops and manages senior housing communities throughout the United States. As of December 31, 2018, the Company operated 129 senior housing communities in 23 states with an aggregate capacity of approximately 16,500 residents, including 83 senior housing communities which the Company owned and 46 senior housing communities that the Company leased. The accompanying consolidated financial statements include the financial statements of Capital Senior Living Corporation and its wholly owned subsidiaries. All material intercompany balances and transactions have been eliminated in consolidation.

Summary of Significant Accounti

Summary of Significant Accounting Policies	12 Months Ended
	Dec. 31, 2018
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	2. Summary of Significant Accounting Policies Cash and Cash Equivalents and Restricted Cash The Company considers all highly liquid investments with original maturities of three months or less at the date of acquisition to be cash equivalents. The Company has deposits in banks that exceed Federal Deposit Insurance Corporation insurance limits. Management believes that credit risk related to these deposits is minimal. Restricted cash consists of deposits required by certain lenders as collateral pursuant to letters of credit. The deposit must remain so long as the letter of credit is outstanding which is subject to renewal annually. The following table sets forth our cash and cash equivalents and restricted cash (in thousands): Year Ended December 31, 2018 2017 Cash and cash equivalents $ 31,309 $ 17,646 Restricted cash 13,011 13,378 $ 44,320 $ 31,024 Long-Lived Assets Property and equipment are stated at cost and depreciated on a straight-line basis over the estimated useful lives of the assets. At each balance sheet date, the Company reviews the carrying value of its property and equipment to determine if facts and circumstances suggest that they may be impaired or that the depreciation period may need to be changed. The Company considers internal factors such as net operating losses along with external factors relating to each asset, including contract changes, local market developments, and other publicly available information. If an indicator of impairment is identified, the carrying value of a long-lived asset is considered impaired when the anticipated undiscounted cash flows from such asset is separately identifiable and is less than its carrying value. In that event, a loss is recognized based on the amount the carrying value exceeds the fair market value, generally based on discounted cash flows, of the long-lived asset. For property and equipment where indicators of impairment were identified, tests of recoverability were performed and the Company has concluded its property and equipment is recoverable and does not warrant adjustment to the carrying value or remaining useful lives as of December 31, 2018. The Company does not believe there were any indicators of impairment that would require an adjustment to the carrying value of the property and equipment or their remaining useful lives as of December 31, 2017. Off-Balance Sheet Arrangements The Company had no material off-balance sheet arrangements at December 31, 2018. Income Taxes Income taxes are computed using the asset and liability method and current income taxes are recorded based on amounts refundable or payable. Deferred income taxes are recorded based on the estimated future tax effects of loss carryforwards and temporary differences between financial statement carrying amounts of existing assets and liabilities and their respective tax basis. Deferred tax assets and liabilities are measured using enacted tax rates that are expected to apply to taxable income in the years in which we expect those carryforwards and temporary differences to be recovered or settled. Management regularly evaluates the future realization of deferred tax assets and provides a valuation allowance, if considered necessary, based on such evaluation. As part of the evaluation, management has evaluated taxable income in carryback years, future reversals of taxable temporary differences, feasible tax planning strategies, and future expectations of income. The Company evaluates uncertain tax positions through consideration of accounting and reporting guidance on criteria, measurement, derecognition, classification, interest and penalties, accounting in interim periods, disclosure, and transition that is intended to provide better financial-statement comparability among different companies. The Company is required to recognize a tax benefit in its financial statements for an uncertain tax position only if management’s assessment is that its position is “more likely than not” (i.e., a greater than 50 percent likelihood) to be upheld on audit based only on the technical merits of the tax position. The Company’s policy is to recognize interest related to unrecognized tax benefits as interest expense and penalties as income tax expense. Revenue Recognition Resident revenue consists of fees for basic housing and certain support services and fees associated with additional housing and expanded support requirements such as assisted living care, memory care, and ancillary services. Basic housing and certain support services revenue is recorded when services are rendered and amounts billed are Residency agreements are generally short term in nature with durations of one year or less and are typically terminable by either party, under certain circumstances, upon providing 30 days’ notice, unless state law provides otherwise, with resident fees billed monthly in advance. Revenue for certain ancillary services is recognized as services are provided, and includes fees for services such as medication management, daily living activities, beautician/barber, laundry, television, guest meals, pets, and parking which are generally billed monthly in arrears. Deferred fees totaled approximately $4.7 million and $5.1 million, respectively, for the fiscal years ended December 31, 2018 and 2017, and were recognized as a component of resident revenue within the Company’s Consolidated Statements of Operations and Comprehensive Loss. The Company's senior housing communities have residency agreements which generally require the resident to pay a community fee prior to moving into the community and are recorded initially by the Company as deferred revenue. At each of December 31, 2018 and 2017, the Company had contract liabilities for deferred community fees totaling approximately $1.1 million and $1.3 million, respectively, which are included as a component of deferred income within current liabilities of the Company’s Consolidated Balance Sheets. The Company recognized community fees as a component of resident revenue within the Company’s Consolidated Statements of Operations and Comprehensive Loss of approximately $2.8 million and $3.6 million, respectively, during the fiscal years ended December 31, 2018 and 2017. Revenues from the Medicaid program accounted for approximately 5.4% of the Company’s revenue in fiscal 2018, 5.6% of the Company’s revenue in fiscal 2017, and 5.5% of the Company’s revenue in fiscal 2016. During fiscal 2018, 2017, and 2016, 40, 41, and 40, respectively, of the Company’s communities were providers of services under the Medicaid program. Accordingly, these communities were entitled to reimbursement under the foregoing program at established rates that were lower than private pay rates. Patient service revenue for Medicaid patients was recorded at the reimbursement rates as the rates were set prospectively by the applicable state upon the filing of an annual cost report. None of the Company’s communities were providers of services under the Medicare program during fiscal 2018, 2017, or 2016. Laws and regulations governing the Medicaid program are complex and subject to interpretation. The Company believes that it is in compliance with all applicable laws and regulations and is not aware of any pending or threatened investigations involving allegations of potential wrongdoing. While no such regulatory inquiries have been made, compliance with such laws and regulations can be subject to future government review and interpretation as well as significant regulatory action including fines, penalties, and exclusion from the Medicaid program. Purchase Accounting In determining the allocation of the purchase price of senior housing communities acquired to net tangible and identified intangible assets acquired and liabilities assumed, if any, the Company makes estimates of fair value using information obtained as a result of pre-acquisition due diligence, leasing activities and/or independent appraisals. The Company assigns the purchase price for senior living communities to assets acquired and liabilities assumed based on their estimated fair values. The determination of fair value involves the use of significant judgments and estimates which is generally assessed as follows: The Company allocates the fair values of buildings acquired on an as-if-vacant basis and depreciates the building values over the estimated remaining lives of the buildings, not to exceed 40 years. The Company The fair value of acquired lease-related intangibles reflects the estimated fair value of existing resident in-place leases as represented by the cost to obtain residents and an estimated absorption period to reflect the value of the rent and recovery costs foregone during a reasonable lease-up period as if the property acquired was vacant. The Company amortizes any acquired resident in-place lease intangibles to depreciation and amortization expense over the estimated remaining useful life of the respective resident operating leases. Credit Risk and Allowance for Doubtful Accounts The Company’s resident receivables are generally due within 30 days from the date billed. Accounts receivable are reported net of an allowance for doubtful accounts of $6.8 million and $4.9 million at December 31, 2018 and 2017, respectively, and represent the Company’s estimate of the amount that ultimately will be collected. The adequacy of the Company’s allowance for doubtful accounts is reviewed on an ongoing basis, using historical payment trends, write-off experience, analyses of receivable portfolios by payor source and aging of receivables, as well as a review of specific accounts, and adjustments are made to the allowance as necessary. Credit losses on resident receivables have historically been within management’s estimates, and management believes that the allowance for doubtful accounts adequately provides for expected losses. Lease Accounting The Company determines whether to account for its leases as operating, capital or financing leases depending on the underlying terms of the lease agreement. This determination of classification requires significant judgment relating to certain information, including the estimated fair value and remaining economic life of the community, the Company’s cost of funds, minimum lease payments and other lease terms. The lease rates under the Company’s lease agreements are subject to certain conditional escalation clauses which are recognized when probable or incurred and are based on changes in the consumer price index or certain operational performance measures. As of December 31, 2018 and 2017, the Company leased 46 communities, two of which the Company classified as capital lease and financing obligations with the remaining classified as operating leases. The Company incurs lease acquisition costs and amortizes these costs over the term of the lease agreement. Certain leases entered into by the Company qualified as sale/leaseback transactions, and as such, any related gains have been deferred and are being amortized over the respective lease term. No new communities were leased by the Company during fiscal 2018 or 2017. Effective January 31, 2017, the Company acquired from Ventas the underlying real estate associated with four of its operating leases. For additional information refer to Note 3, “Acquisitions”. Facility lease expense in the Company’s Consolidated Statements of Operations and Comprehensive loss includes rent expense plus amortization expense relating to leasehold acquisition costs offset by the amortization of deferred gains and lease incentives. Employee Health and Dental Benefits, Workers’ Compensation, and Insurance Reserves The Company offers full-time employees an option to participate in its health and dental plans. The Company is self-insured up to certain limits and is insured if claims in excess of these limits are incurred. The cost of employee health and dental benefits, net of employee contributions, is shared between the corporate office and the senior housing communities based on the respective number of plan participants. Funds collected are used to pay the actual program costs, including estimated annual claims, third-party administrative fees, network provider fees, communication costs, and other related administrative costs incurred by the plans. Claims are paid as they are submitted to the Company’s third-party administrator. The Company records a liability for outstanding claims and claims that have been incurred but not yet reported. This liability is based on the historical claim reporting lag and payment trends of health insurance claims. Management believes that the liability for outstanding losses and expenses is adequate to cover the ultimate cost of losses and expenses incurred at December 31, 2018; however, actual claims and expenses may differ. Any subsequent changes in estimates are recorded in the period in which they are determined. The Company uses a combination of insurance and self-insurance for workers’ compensation. Determining the reserve for workers’ compensation losses and costs that the Company has incurred as of the end of a reporting period involves significant judgments based on projected future events, including potential settlements for pending claims, known incidents which may result in claims, estimates of incurred but not yet reported claims, changes in insurance premiums, estimated litigation costs and other factors. The Company regularly adjusts these estimates to reflect changes in the foregoing factors. However, since this reserve is based on estimates, the actual expenses incurred may differ from the amounts reserved. Any subsequent changes in estimates are recorded in the period in which they are determined. Net Loss Per Share Basic net loss per common share is computed by dividing net loss by the weighted average number of common shares outstanding for the period. Potentially dilutive securities consist of unvested restricted shares and shares that could be issued under outstanding stock options. Potentially dilutive securities are excluded from the computation of net loss per common share if their effect is antidilutive. The following table sets forth the computation of basic and diluted net loss per share (in thousands, except for per share amounts): Year Ended December 31, 2018 2017 2016 Net loss $ (53,596 ) $ (44,168 ) $ (28,017 ) Net loss allocated to unvested restricted shares — — — Undistributed net loss allocated to common shares $ (53,596 ) $ (44,168 ) $ (28,017 ) Weighted average shares outstanding — basic 29,812 29,453 28,909 Effects of dilutive securities: Employee equity compensation plans — — — Weighted average shares outstanding — diluted 29,812 29,453 28,909 Basic net loss per share $ (1.80 ) $ (1.50 ) $ (0.97 ) Diluted net loss per share $ (1.80 ) $ (1.50 ) $ (0.97 ) Awards of unvested restricted stock representing approximately 1.3 million, 0.9 million, and 0.8 million shares were outstanding for the fiscal years ended December 31, 2018, 2017, and 2016, respectively, and are antidilutive. Treasury Stock The Company accounts for treasury stock under the cost method and includes treasury stock as a component of shareholders’ equity until it is canceled. There were no repurchases of the Company’s common stock during fiscal 2018 or 2017. Stock-Based Compensation The Company recognizes compensation expense for share-based payment awards to certain employees and directors, including grants of stock options and awards of restricted stock, in the Consolidated Statements of Operations and Comprehensive Loss based on their fair values. On May 8, 2007, the Company’s stockholders approved the 2007 Omnibus Stock and Incentive Plan for Capital Senior Living Corporation (as amended, the “2007 Plan”) which provides for, among other things, the grant of restricted stock awards and stock options to purchase shares of the Company’s common stock. The 2007 Plan authorizes the Company to issue up to 4.6 million shares of common stock and the Company currently has 286,000 shares of common stock reserved for future issuance pursuant to awards under the 2007 Plan. Segment Information The Company evaluates the performance and allocates resources of its senior living facilities based on current operations and market assessments on a property-by-property basis. The Company does not have a concentration of operations geographically or by product or service as its management functions are integrated at the property level. The Company has determined that all of its operating units meet the criteria in Accounting Standards Codification (“ASC”) Topic 280, Segment Reporting Recently Issued Accounting Guidance In January 2017, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2017-01, Business Combinations – Clarifying the Definition of a Business In November 2016, the FASB issued ASU 2016-18, Statement of Cash Flows (Topic 230): Restricted Cash (a consensus of the FASB Emerging Issues Task Force). In August 2016, the FASB issued ASU 2016-15, Classification of Certain Cash Receipts and Cash Payments. In June 2016, the FASB issued ASU 2016-13, Financial Instruments - Credit Losses: Measurement of Credit Losses on Financial Instruments In February 2016, the FASB issued ASU 2016-02, Leases Leases, Targeted Improvements In May 2014, the FASB issued ASU 2014-09, Revenue from Contracts with Customers (Topic 606) Use of Estimates and Critical Accounting Policies The preparation of financial statements in conformity with U.S. generally accepted accounting principles requires management to make estimates and assumptions that affect the amounts reported in the accompanying financial statements and related footnotes. Management bases its estimates and assumptions on historical experience, observance of industry trends and various other sources of information and factors, the results of which form the basis for making judgments about the carrying value of assets and liabilities that are not readily apparent from other sources. Actual results could differ from these estimates. Critical accounting policies are defined as those that are reflective of significant judgments and uncertainties, and potentially could result in materially different results under different assumptions and conditions. The Company believes revenue recognition, purchase accounting, credit risk and allowance for doubtful accounts, lease accounting, employee health and dental benefits, workers’ compensation and insurance reserves, long-lived assets, and income taxes are its most critical accounting policies and/or require management’s most subjective judgments. Reclassifications Certain reclassifications have been made to prior period amounts to conform to current period presentation.

Acquisitions

Acquisitions	12 Months Ended
	Dec. 31, 2018
Business Combinations [Abstract]
Acquisitions	3 . Acquisitions Fiscal 2017 Effective January 31, 2017 (the “Closing Date”), the Company acquired the underlying real estate through an asset acquisition associated with four of the senior housing communities previously leased from Ventas, Inc. (“Ventas”) for an acquisition price of $85.0 million (the “Four Property Lease Transaction”). The Company obtained interest only, bridge financing from Berkadia Commercial Mortgage LLC (“Berkadia”) for $65.0 million of the acquisition price with an initial variable interest rate of LIBOR plus 4.0% and a 36-month term, with an option to extend 6 months, and the balance of the acquisition price paid from the Company’s existing cash resources. Additionally, the Company agreed to continue paying $2.3 million of the annual rents associated with the four communities acquired over the remaining lease term of the seven communities remaining in the Ventas Lease Portfolio. As such, the total additional lease payments to be paid over the remaining lease term were discounted back to the Closing Date utilizing a credit-adjusted risk-free rate to determine the fair value of the lease termination financing obligation of $16.0 million. The fair value of the four communities acquired was determined to approximate $88.1 million. The fair values of the property, plant, and equipment of the acquired communities were determined utilizing a direct capitalization method considering facility net operating income and market capitalization rates. These fair value measurements were based on current market conditions as of the acquisition date and are considered Level 3 measurements (fair value measurements using significant unobservable inputs) within the fair value hierarchy of ASC 820-10, Fair Value Measurement. The range of capitalization rates utilized was 7.25% to 8.50%, depending upon the property type, geographical location, and overall quality of each respective community. The acquisition price of $85.0 million and lease termination obligation of $16.0 million resulted in total aggregate consideration by the Company for the acquisition of the four communities of $101.0 million. The Company recorded the difference between the total aggregate consideration ($101.0 million) and the estimated fair value of the four communities acquired ($88.1 million) of $12.9 million as a loss on facility lease termination during the first quarter of fiscal 2017. Additionally, the Company incurred approximately $0.4 million in transaction costs related to this acquisition which have been capitalized as a component of the cost of the assets acquired. As a result of this asset acquisition, the Company recorded additions to property and equipment of approximately $88.1 million within the Company’s Consolidated Balance Sheets which is being depreciated or amortized over the estimated useful lives.

Property and Equipment

Property and Equipment	12 Months Ended
	Dec. 31, 2018
Property Plant And Equipment [Abstract]
Property and Equipment	4 . Property and Equipment Property and equipment consists of the following (in thousands): December 31, Asset Lives 2018 2017 Land $ 69,842 $ 69,842 Land improvements 5 to 20 years 25,373 24,665 Buildings and building improvements 10 to 40 years 1,158,577 1,148,816 Furniture and equipment 5 to 10 years 66,202 62,614 Automobiles 5 to 7 years 6,344 6,236 Leasehold improvements (1) 98,396 85,384 Construction in progress NA 421 5,711 1,425,155 1,403,268 Less accumulated depreciation and amortization (366,106 ) (303,482 ) Property and equipment, net $ 1,059,049 $ 1,099,786 (1) Leasehold improvements are amortized over the shorter of the useful life of the asset or the remaining lease term. At December 31, 2018 and 2017, furniture and equipment included $3.8 million and $3.2 million of capitalized computer software development costs of which $3.1 million and $3.0 million, respectively, has been amortized and is included as a component of accumulated depreciation and amortization. Property and equipment includes $31.8 million of assets under capital lease in connection with the Ventas Lease Transaction, as discussed at Note 15, “Leases,” of which $16.3 million and $15.4 million has been amortized and is included as a component of accumulated depreciation and amortization at December 31, 2018 and 2017, respectively.

Other Assets

Other Assets	12 Months Ended
	Dec. 31, 2018
Deferred Costs Capitalized Prepaid And Other Assets Disclosure [Abstract]
Other Assets	5 . Other Assets Other assets consist of the following (in thousands): December 31, 2018 2017 Deferred lease costs, net $ 4,715 $ 5,555 Security and other deposits 9,889 10,234 Other 1,881 3,047 $ 16,485 $ 18,836 In connection with the Company’s acquisitions and certain of its lease transactions, subject to final valuation adjustments, the Company records additions to in-place lease intangibles in order to reflect the value associated with the resident operating leases acquired. In-place lease intangibles are being amortized over the estimated remaining useful life of the respective resident operating leases. The value of in-place leases includes lost revenue that would be realized if the resident operating leases were to be replaced by the Company.

Accrued Expenses

Accrued Expenses	12 Months Ended
	Dec. 31, 2018
Text Block [Abstract]
Accrued Expenses	6 . Accrued expenses consist of the following (in thousands): December 31, 2018 2017 Accrued salaries, bonuses and related expenses $ 11,996 $ 13,015 Accrued property taxes 14,079 14,208 Accrued interest 3,066 3,757 Accrued health claims and workers comp 4,845 4,547 Accrued professional fees 1,012 763 Other 6,882 4,461 $ 41,880 $ 40,751

Notes Payable

Notes Payable	12 Months Ended
	Dec. 31, 2018
Debt Disclosure [Abstract]
Notes Payable	7 . Notes Payable Notes payable consists of the following (in thousands): Average Monthly Net Book Value Interest Maturity Notes Payable December 31, Lender Payment Of Collateral (1) Rate Date 2018 2017 Fannie Mae $ — $ — 5.69 August 2021 $ — $ 12,283 Fannie Mae — — 4.97 October 2021 — 4,331 Fannie Mae — — 4.92 October 2021 — 17,097 Fannie Mae — — 5.19 October 2021 — 4,839 Fannie Mae — — 4.92 November 2021 — 19,886 Fannie Mae — — 4.38 March 2022 — 4,831 Fannie Mae — — 4.76 April 2022 — 10,403 Fannie Mae — — 4.85 April 2022 — 3,470 Fannie Mae 135 25,781 4.69 April 2022 23,127 23,637 Fannie Mae 11 4,140 4.97 April 2022 1,991 2,022 Fannie Mae 60 14,707 4.48 May 2022 10,462 10,699 Fannie Mae 20 14,707 4.85 May 2022 3,640 3,697 Fannie Mae — — 4.34 November 2022 — 26,382 Fannie Mae — — 4.50 November 2022 — 5,881 Fannie Mae — — 5.49 November 2022 — 7,403 Fannie Mae 84 16,577 4.32 January 2023 15,194 15,532 Fannie Mae 49 16,577 5.39 January 2023 8,327 8,453 Fannie Mae 39 7,943 4.58 January 2023 6,808 6,953 Fannie Mae 17 7,943 5.49 January 2023 2,990 3,029 Fannie Mae — — 4.66 April 2023 — 15,131 Fannie Mae — — 5.46 April 2023 — 3,068 Fannie Mae 45 8,166 5.93 October 2023 7,092 7,205 Fannie Mae 67 12,893 5.50 November 2023 10,992 11,180 Fannie Mae 67 12,202 5.38 November 2023 11,042 11,236 Fannie Mae 282 50,722 5.56 January 2024 45,892 46,662 Fannie Mae 632 109,519 4.24 July 2024 118,715 121,141 Fannie Mae 120 25,091 4.48 July 2024 21,963 22,394 Fannie Mae 81 19,891 4.30 July 2024 15,156 15,462 Fannie Mae 91 65,624 4.98 July 2024 16,322 16,579 Fannie Mae 11 9,290 6.30 July 2024 1,796 — Fannie Mae 134 26,589 4.59 September 2024 24,342 24,805 Fannie Mae 22 13,433 5.72 September 2024 3,634 3,682 Fannie Mae 54 10,256 4.70 September 2024 9,683 9,864 Fannie Mae 53 11,808 4.50 January 2025 9,731 9,915 Fannie Mae 95 6,351 4.46 January 2025 17,686 18,023 Fannie Mae 70 15,106 4.35 February 2025 13,179 13,434 Fannie Mae 109 8,496 3.85 March 2025 21,633 22,086 Fannie Mae 102 23,648 3.84 April 2025 20,324 20,749 Fannie Mae 31 23,648 5.53 April 2025 5,300 5,372 Fannie Mae — — 4.55 June 2025 — 8,794 Fannie Mae — — 4.79 June 2025 — 10,753 Fannie Mae 81 15,219 5.30 June 2025 13,335 13,580 Fannie Mae — — 5.71 June 2025 — 4,079 Fannie Mae 58 12,481 4.69 October 2025 10,595 10,780 Fannie Mae 44 9,256 4.70 October 2025 8,008 8,147 Fannie Mae 273 38,141 4.68 December 2025 50,295 51,163 Fannie Mae 9 7,577 5.81 December 2025 1,426 1,445 Fannie Mae — — 5.43 April 2026 — 10,443 Fannie Mae — — 5.84 April 2026 — 4,903 Fannie Mae 98 21,982 4.10 October 2026 19,498 19,854 Fannie Mae 108 24,350 4.24 December 2026 21,243 21,617 Fannie Mae 652 160,096 5.13 January 2029 150,782 — Fannie Mae 194 160,096 (3 ) January 2029 50,261 — Protective Life 96 24,088 3.55 April 2025 19,787 20,234 Protective Life 49 10,994 4.25 August 2025 9,350 9,535 Protective Life 78 17,506 4.25 September 2025 14,871 15,163 Protective Life 138 32,096 4.25 November 2025 26,478 26,993 Protective Life 57 13,460 4.50 February 2026 10,761 10,959 Protective Life 187 41,379 4.38 March 2026 32,920 33,705 Protective Life 70 15,019 4.13 October 2031 12,326 12,645 Berkadia 378 93,631 (4 ) February 2020 65,000 65,000 Berkadia 18 7,292 (5 ) July 2020 3,500 — Berkadia 97 18,785 (6 ) October 2021(5) 11,255 11,505 HUD 16 5,356 4.48 September 2045 2,933 2,989 Insurance Financing — — 2.76 May 2018 — 725 Insurance Financing — — 3.04 November 2018 — 3,505 Insurance Financing 160 — 3.64 May 2019 799 — Insurance Financing 70 — 4.40 November 2019 763 — $ 5,412 4.64% (2) $ 983,207 $ 967,332 Less deferred loan costs, net 9,457 9,398 $ 973,750 $ 957,934 Less current portion 14,342 19,728 $ 959,408 $ 938,206 (1) 80 (2) Weighted average interest rate on current fixed interest rate debt outstanding. (3) Variable interest rate of LIBOR plus 2.14%, which was 4.57% at December 31, 2018. (4) Variable interest rate of LIBOR plus 4.00%, which was 6.89% at December 31, 2018. ( 5 ) Variable interest rate of LIBOR plus 3.75%, which was 6.21% at December 31, 2018. ( 6 ) Variable interest rate of LIBOR plus 5.00%, which was 7.89% at December 31, 2018. Effective June 29, 2018, the Company extended the maturity date with Berkadia to October 10, 2021. The aggregate scheduled maturities of notes payable at December 31, 2018 are as follows (in thousands): 2019 $ 16,050 2020 83,595 2021 26,254 2022 54,381 2023 74,729 Thereafter 728,198 $ 983,207 On December 18, 2018, the Company repaid certain mortgage loans associated with 21 of its senior living communities totaling approximately $170.6 million from Fannie Mae which were scheduled to mature on various dates beginning August 2021 through April 2026. The repayment of these mortgage loans facilitated the establishment of a Master Credit Facility (“MCF”) with Berkadia whereby the Company obtained approximately $201.0 million of new mortgage financing. The MCF will allow the Company to make future advances, should the Company decide to do so, assuming certain borrowing conditions are satisfied. The MCF consists of two separate loans which are cross-defaulted and cross-collateralized. Approximately $150.8 million of the new financing is long-term fixed interest rate debt at a fixed interest rate of 5.13% with a 10-year term and interest only for the first 36 months and the principal amortized over a 30-year term thereafter. Approximately $50.3 million of the new financing is long-term variable interest rate debt at a variable interest rate of LIBOR plus 2.14% with a 10-year term and interest only for the first 36 months and a fixed monthly principal component of $67,000 thereafter. The Company incurred approximately $3.0 million in deferred financing costs related to the MCF, which are being amortized over 10 years. As a result of the early repayment of the Fannie Mae mortgage debt, the Company accelerated the amortization of approximately $1.5 million in unamortized deferred financing costs and incurred prepayment premiums of approximately $11.1 million. The MCF was subsequently assigned to Fannie Mae on December 28, 2018, and is reported as such in preceding notes payable summary table. On December 18, 2018, the Company completed mortgage financing of $3.5 million from Berkadia at a variable interest rate of LIBOR plus 3.75% on one community located in Kokomo, Indiana. The mortgage loan is interest-only and has an 18-month term maturing in July 2020. The Company incurred approximately $91,000 in deferred financing costs related to this loan, which are being amortized over 18 months. On December 1, 2018, the Company renewed certain insurance policies and entered into a finance agreement totaling approximately $0.8 million. The finance agreement has a fixed interest rate of 4.40% with the principal being repaid over an 11-month term. On November 30, 2018, the Company completed supplemental mortgage financing of approximately $1.8 million from Fannie Mae at a fixed interest rate of 6.30% on one community located in Mesquite, Texas. The supplemental mortgage loan is coterminous, cross-collateralized and cross-defaulted with the original existing mortgage debt maturing in July 2024. The Company incurred approximately $0.1 million in deferred financing costs related to this loan, which are being amortized over the remaining initial loan term. Effective June 29, 2018, the Company extended its mortgage loan with Berkadia on one of its senior living communities located in Canton, Ohio. The maturity date was extended to October 10, 2021 with an initial variable interest rate of LIBOR plus 5.0% with principal amortized over 25 years. Effective May 31, 2018, the Company renewed certain insurance policies and entered into a finance agreement totaling approximately $1.7 million. The finance agreement has a fixed interest rate of 3.64% with the principal being repaid over an 11-month term. The Company issued standby letters of credit with Wells Fargo Bank (“Wells Fargo”), totaling approximately $3.4 million, for the benefit of Hartford Financial Services (“Hartford”) associated with the administration of workers compensation which remain outstanding as of December 31, 2018. The Company issued standby letters of credit with JPMorgan Chase Bank (“Chase”), totaling approximately $6.7 million, for the benefit of Welltower, Inc. (“Welltower”), formerly Healthcare REIT, Inc. on certain leases between Welltower and the Company which remain outstanding as of December 31, 2018. The Company issued standby letters of credit with Chase, totaling approximately $2.9 million, for the benefit of HCP, Inc. (“HCP”) on certain leases between HCP and the Company which remain outstanding as of December 31, 2018. On December 15, 2017, the Company completed supplemental mortgage financing of approximately $4.1 million from Fannie Mae at a fixed interest rate of 5.71% on one community located in Oneonta, New York. The supplemental mortgage loan is coterminous, cross-collateralized and cross-defaulted with the original existing mortgage debt maturing in June 2025. The Company incurred approximately $0.2 million in deferred financing costs related to this loan, which are being amortized over the remaining initial loan term. On December 1, 2017, the Company renewed certain insurance policies and entered into a finance agreement totaling approximately $3.5 million. The finance agreement has a fixed interest rate of 3.04% with the principal being repaid over an 11-month term. On November 30, 2017, the Company completed supplemental mortgage financing of approximately $3.0 million from Fannie Mae at a fixed interest rate of 5.49% on one community located in Rocky River, Ohio. The supplemental mortgage loan is coterminous, cross-collateralized and cross-defaulted with the original existing mortgage debt maturing in January 2023. The Company incurred approximately $0.1 million in deferred financing costs related to this loan, which are being amortized over the remaining initial loan term. On May 31, 2017, the Company renewed certain insurance policies and entered into a finance agreement totaling approximately $1.6 million. The finance agreement has a fixed interest rate of 2.76% with the principal being repaid over an 11-month term. On January 31, 2017, in conjunction with the Four Property Lease Transaction, the Company obtained $65.0 million of mortgage debt from Berkadia. The new mortgage loan is interest-only and has a three-year term, with an option to extend 6 months, and an initial variable interest rate of LIBOR plus 4.00%. The Company incurred approximately $0.9 million in deferred financing costs related to this loan, which are being amortized over three years. In connection with the Company’s loan commitments described above, the Company incurred financing charges that were deferred and amortized over the life of the notes. At December 31, 2018 and 2017, the Company had gross deferred loan costs of $14.1 million and $14.0 million, respectively. Accumulated amortization was $4.7 million and $4.6 million at December 31, 2018 and 2017, respectively. Amortization expense is expected to be approximately $1.7 million in each of the next five fiscal years. The Company was in compliance with all aspects of its outstanding indebtedness at December 31, 2018 and 2017.

Equity

Equity	12 Months Ended
	Dec. 31, 2018
Equity [Abstract]
Equity	8 . Equity Preferred Stock The Company is authorized to issue preferred stock in series and to fix and state the voting powers and such designations, preferences and relative participating, optional or other special rights of the shares of each such series and the qualifications, limitations and restrictions thereof. Such action may be taken by the Board without stockholder approval. The rights, preferences and privileges of holders of common stock are subject to the rights of the holders of preferred stock. No preferred stock was outstanding as of December 31, 2018 and 2017. Share Repurchases On January 22, 2009, the Company’s board of directors approved a share repurchase program that authorized the Company to purchase up to $10.0 million of the Company’s common stock. Purchases may be made from time to time using a variety of methods, which may include open market purchases, privately negotiated transactions or block trades, or by any combination of such methods, in accordance with applicable insider trading and other securities laws and regulations. The size, scope and timing of any purchases will be based on business, market and other conditions and factors, including price, regulatory and contractual requirements or consents, and capital availability. The repurchase program does not obligate the Company to acquire any particular amount of common stock and the share repurchase authorization has no stated expiration date. Shares of stock repurchased under the program will be held as treasury shares. Pursuant to this authorization, during fiscal 2009, the Company purchased 349,800 shares at an average cost of $2.67 per share for a total cost to the Company of approximately $0.9 million. On January 14, 2016, the Company announced that its board of directors approved a continuation of the share repurchase program. Pursuant to this authorization, during fiscal 2016, the Company purchased 144,315 shares of its common stock at an average cost of $17.29 per share for a total cost to the Company of approximately $2.5 million. All such purchases were made in open market transactions. There were no repurchases of the Company’s common stock during fiscal 2018 or 2017.

Stock-Based Compensation

Stock-Based Compensation	12 Months Ended
	Dec. 31, 2018
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Stock-Based Compensation	9 . Stock-Based Compensation Stock Options The Company’s stock option program is a long-term retention program that is intended to attract, retain and provide incentives for employees, officers and directors and to more closely align stockholder and employee interests. The Company’s stock options generally vest over one to five years and the related expense is amortized on a straight-line basis over the vesting period. A summary of the Company’s stock option activity and related information for the years ended December 31, 2018, 2017, and 2016 is presented below: Outstanding Beginning of Year Granted Exercised Forfeited Outstanding End of Year Options Exercisable December 31, 2018 Shares — — — — — — Weighted average price $ — — $ — — $ — $ — December 31, 2017 Shares — — — — — — Weighted average price $ — — $ — — $ — $ — December 31, 2016 Shares 3,000 — 3,000 — — — Weighted average price $ 10.97 — $ 10.97 — $ — $ — No stock options were outstanding at December 31, 2018 and 2017, as all outstanding options have fully vested and have been exercised or forfeited. Restricted Stock The Company may grant restricted stock awards and units to employees, officers, and directors in order to attract, retain, and provide incentives for such individuals and to more closely align stockholder and employee interests. For restricted stock awards and units without performance and market-based vesting conditions, the Company records compensation expense for the entire award on a straight-line basis over the requisite service period, which is generally a period of one to four years, unless the award is subject to certain accelerated vesting requirements. Restricted stock awards are considered outstanding at the time of grant since the holders thereof are entitled to dividends, upon vesting, and voting rights. For restricted stock awards with performance and market-based vesting conditions, total compensation expense is recognized over the requisite service period once the performance target is deemed probable of achievement. Performance goals are evaluated periodically and if such goals are not ultimately met or it is not probable the goals will be achieved, no compensation expense is recognized and any previously recognized compensation expense is reversed. If the achievement of a market condition varies from initial estimates on the date of grant, compensation expense will not be adjusted to reflect the difference since the grant date fair value of the performance award gave consideration to the probability of market condition achievement. The Company recognizes compensation expense of a restricted stock award over its respective vesting or performance period based on the fair value of the award on the grant date, net of actual forfeitures. A summary of the Company’s restricted common stock awards activity and related information for the years ended December 31, 2018, 2017, and 2016 is presented below: Outstanding Beginning of Year Issued Vested Forfeited Outstanding End of Year December 31, 2018 Shares 964,484 830,794 (386,900 ) (63,219 ) 1,345,159 December 31, 2017 Shares 829,766 565,745 (355,400 ) (75,627 ) 964,484 December 31, 2016 Shares 783,310 666,883 (565,224 ) (55,203 ) 829,766 The restricted stock outstanding at December 31, 2018, 2017, and 2016, had an aggregate intrinsic value of $9.1 million, $13.0 million, and $13.3 million, respectively. During fiscal 2018, the Company awarded 830,794 shares of restricted common stock to certain employees and directors of the Company, of which 237,840 shares were subject to performance and market-based vesting conditions. The average market value of the common stock on the date of grant was $11.08. These awards of restricted shares vest over a one to four-year period, unless the award is subject to certain accelerated vesting requirements, and had an intrinsic value of $9.2 million on the date of grant. Additionally, during fiscal 2018, the Company awarded 67,356 restricted stock units to certain directors of the Company with average market value of $10.69 on the date of grant. These awards of restricted units vest over a one-year period and had an intrinsic value of approximately $0.7 million on the date of grant. Stock Based Compensation The Company uses the Black-Scholes option pricing model to estimate the grant date fair value of its stock options. The Black-Scholes model requires the input of certain assumptions including expected volatility, expected dividend yield, expected life of the option and the risk-free interest rate. The expected volatility used by the Company is based primarily on an analysis of historical prices of the Company’s common stock. The expected term of options granted is based primarily on historical exercise patterns on the Company’s outstanding stock options. The risk-free rate is based on zero-coupon U.S. Treasury yields in effect at the date of grant with the same period as the expected option life. The Company does not expect to pay dividends on its common stock and therefore has used a dividend yield of zero in determining the fair value of its awards. The option forfeiture rate assumption used by the Company is based primarily on the Company’s historical option forfeiture patterns. At December 31, 2018, the Company had no stock options outstanding. The Company uses the Monte-Carlo simulation model to determine the fair value of performance awards which include market-based vesting conditions. The Monte-Carlo simulation model uses the same input assumptions as the Black-Scholes model, however, it also further incorporates into the fair-value determination the possibility that the market condition may not be satisfied. Compensation costs related to awards with a market-based condition are recognized regardless of whether the market condition is satisfied, provided that the requisite service has been provided. During fiscal 2018, in accordance with the Company’s long-term incentive compensation plan, the Company granted 237,840 shares of restricted common stock with performance and market-based vesting conditions to certain employees of the Company. These performance awards are subject to a market-based condition that may increase or decrease the number of shares vested if the Company’s 2020 Total Stockholder Return (“TSR”) exceeds or falls below certain achievement level parameters when ranked against the Company’s designated Peer Group. These restricted performance shares vest over a three-year period based on the Company’s Earnings before Interest, Taxes, Depreciation, Amortization, and Rent (“EBITDAR”) financial performance target set by the Company’s compensation committee for the fiscal year ending December 31, 2020. The number of shares of restricted common stock ultimately issued will be prorated between performance level targets achieved. The Company recognized $8.4 million, $7.7 million, and $11.6 million in stock-based compensation expense during fiscal 2018, 2017, and 2016, respectively, which primarily is associated with employees whose corresponding salaries and wages are included in general and administrative expenses within the Company’s Consolidated Statements of Operations and Comprehensive Loss. Unrecognized stock-based compensation expense is $9.5 million at December 31, 2018. The Company expects stock-based compensation expense to be recognized over a one to three-year period for performance restricted stock awards and a one to four-year period for nonperformance-based restricted stock awards and units.

Income Taxes

Income Taxes	12 Months Ended
	Dec. 31, 2018
Income Tax Disclosure [Abstract]
Income Taxes	10. The (benefit) provision for income taxes consists of the following (in thousands): Year Ended December 31, 2018 2017 2016 Current: Federal $ (152 ) $ 6 $ — State 474 550 435 Deferred: Federal (2,093 ) 1,940 — State — — — (Benefit) Provision for income taxes $ (1,771 ) $ 2,496 $ 435 The (benefit) provision for income taxes differed from the amounts of income tax (benefit) provision determined by applying the U.S. federal statutory income tax rate to income before (benefit) provision for income taxes as a result of the following (in thousands): Year Ended December 31, 2018 2017 2016 Tax benefit at federal statutory rates $ (11,627 ) $ (14,168 ) $ (9,335 ) State income tax benefit, net of federal effects (665 ) (648 ) (550 ) Change in deferred tax asset valuation allowance 9,543 7,857 8,569 Tax reform impact on deferred income taxes — 13,959 — Share based compensation ASU 2016-09 adoption — (5,326 ) — Other 978 822 1,751 (Benefit) Provision for income taxes $ (1,771 ) $ 2,496 $ 435 The Company is impacted by the Texas Margin Tax (“TMT”), which effectively imposes tax on modified gross revenues for communities within the State of Texas and accounts for the majority of the Company’s current state tax expense. During each of fiscal 2018, 2017, and 2016 the Company consolidated 38 Texas communities and the TMT increased the overall provision for income taxes. The effective tax rate for fiscal 2018 differs from the statutory tax rate primarily due to state income taxes, changes in the deferred tax asset valuation allowance, and other permanent tax differences. The effective tax rate for fiscal 2017 differs from the statutory tax rate primarily due to state income taxes, changes in the deferred tax asset valuation allowance, tax reform impact on deferred income taxes, adoption of ASU 2016-09, and other permanent tax differences. The effective tax rate for fiscal 2016 differs from the statutory tax rate primarily due to state income taxes, changes in the deferred tax asset valuation allowance, and other permanent tax differences. The Company is generally no longer subject to federal and state tax audits for years before 2015. A summary of the Company’s deferred tax assets and liabilities, are as follows (in thousands): December 31, 2018 2017 Deferred tax assets: Deferred gains on sale/leaseback transactions $ 2,440 $ 2,890 Net operating loss carryforward 33,252 25,441 Compensation costs 3,087 2,245 Depreciation and amortization 5,323 4,367 Other 2,330 2,099 Total deferred tax assets 46,432 37,042 Deferred tax asset valuation allowance (46,280 ) (36,737 ) Total deferred tax assets, net 152 305 Deferred tax liabilities: Depreciation and amortization — (2,246 ) Total deferred tax liabilities $ — $ (2,246 ) Deferred taxes, net $ 152 $ (1,941 ) Income taxes are computed using the asset and liability method and current income taxes are recorded based on amounts refundable or payable. Deferred income taxes are recorded based on the estimated future tax effects of loss carryforwards and temporary differences between financial statement carrying amounts of existing assets and liabilities and their respective tax basis. Deferred tax assets and liabilities are measured using enacted tax rates that are expected to apply to taxable income in the years in which we expect those carryforwards and temporary differences to be recovered or settled. Management regularly evaluates the future realization of deferred tax assets and provides a valuation allowance, if considered necessary, based on such evaluation. As part of the evaluation, management has evaluated taxable income in carryback years, future reversals of taxable temporary differences, feasible tax planning strategies, and future expectations of income. Based upon this evaluation, a valuation allowance has been recorded to reduce the Company’s net deferred tax assets to the amount that is more likely than not to be realized. A significant component of objective evidence evaluated was the cumulative losses before income taxes incurred by the Company over the past several fiscal years. Such objective evidence severely limits the ability to consider other subjective evidence such as the Company’s ability to generate sufficient taxable income in future periods to fully recover the deferred tax assets. However, in the event that we were to determine that it would be more likely than not that the Company would realize the benefit of deferred tax assets in the future in excess of their net recorded amounts, adjustments to deferred tax assets would increase net income in the period we made such a determination . At December 31, 2017, the Company completed an analysis determining its best estimate for provisional tax adjustments based on the revised tax legislation associated with the Tax Cuts and Jobs Act (“TCJA”), which was enacted on December 22, 2017. Additionally, the Securities and Exchange Commission issued Staff Accounting Bulletin 118 (“SAB 118”), to address the accounting and reporting of the Act. SAB 118 allowed companies to take a reasonable period, which should not extent beyond one year from enactment of the TCJA, to measure and recognize the effects of the new tax law. Based upon the Company’s analysis of the TCJA and consideration of SAB 118, the Company remeasured its deferred income taxes on a provisional basis as of December 31, 2017, which resulted in a net $14.0 million reduction in the Company’s deferred tax assets and liabilities. The remeasurement consisted of a $15.9 million reduction to the Company’s deferred tax assets for the change in the corporate statutory tax rate from 34% to 21% and a $0.3 million reduction to the Company’s deferred tax asset valuation allowance for the repeal of the corporate Alternative Minimum Tax (“AMT”), partially offset by a $2.2 million increase to the Company’s deferred tax asset valuation allowance for maximum deduction limits for future net operating loss (“NOL”) carryforwards to 80% of taxable income for losses arising in tax years beginning after December 31, 2017. The Company completed its assessment of the TCJA under SAB 118 as of December 31, 2018, resulting in a net $2.2 million reduction to the Company’s deferred tax asset valuation allowance. The $2.2million reduction was primarily related to guidance released in December 2018 for companies electing real property trade or business under Section 163(j)(7)(B) of the Internal Revenue Code to opt out of the interest expense limitation. This guidance requires residential rental property to be depreciated under the Alternative Depreciation System (“ADS”), including assets placed in service prior to 2018. As of December 31, 2018, the Company has federal and state NOL carryforwards of $147.2 million and $121.2 million and related deferred tax assets of $30.9 million and $6.7 million, respectively, and a federal AMT credit carryforward of $0.2 million. The federal and state NOL carryforwards in the income tax returns filed included unrecognized tax benefits. The deferred tax assets recognized for those NOLs are presented net of the unrecognized benefits. If not used, the federal NOL generated prior to fiscal 2018 will expire during fiscal 2033 to 2037 and state NOL’s will expire during fiscal 2019 to 2038. Federal NOL’s generated in fiscal 2018 and beyond currently have no expiration due to changes to tax laws enacted with the TCJA. The Company evaluates uncertain tax positions through consideration of accounting and reporting guidance on criteria, measurement, derecognition, classification, interest and penalties, accounting in interim periods, disclosure, and transition that is intended to provide better financial-statement comparability among different companies. The Company is required to recognize a tax benefit in its financial statements for an uncertain tax position only if management’s assessment is that its position is “more likely than not” (i.e., a greater than 50 percent likelihood) to be upheld on audit based only on the technical merits of the tax position. The Company’s policy is to recognize interest related to unrecognized tax benefits as interest expense and penalties as income tax expense. As of December 31, 2018, the Company has unrecognized tax benefits of $4.6 million for an uncertain tax position associated with a change in accounting method. The unrecognized tax benefits as of December 31, 2018 are timing-related uncertainties that if recognized would not impact the effective tax rate of the Company. A summary of the Company’s unrecognized tax benefits activity and related information for the years ended December 31, 2018, 2017, and 2016 is presented below (in thousands): 2018 2017 2016 Beginning balance, January 1 $ 3,416 $ 3,786 $ — Gross increases – tax positions in prior period 1,228 — 2,451 Gross decreases – tax positions in prior period — (370 ) — Gross increases – tax positions in current period — — 1,335 Settlements — — — Lapse of statute of limitations — — — Ending balance, December 31 $ 4,644 $ 3,416 $ 3,786

Employee Benefit Plans

Employee Benefit Plans	12 Months Ended
	Dec. 31, 2018
Compensation And Retirement Disclosure [Abstract]
Employee Benefit Plans	1 1 . Employee Benefit Plans The Company has a 401(k) salary deferral plan (the “Plan”) in which certain employees of the Company meeting minimum service and age requirements are eligible to participate. Contributions to the Plan are in the form of employee salary deferrals, which are subject to employer matching contributions of 50% of up to 4% of the employee’s annual salary. The Company’s contributions are funded semi-monthly to the Plan administrator. Matching contributions of $0.5 million were contributed to the Plan in each of fiscal 2018, 2017 and 2016. The Company incurred administrative expenses related to the Plan of $25,000, $21,300, and $24,600 in fiscal 2018, 2017, and 2016, respectively.

Contingencies

Contingencies	12 Months Ended
	Dec. 31, 2018
Commitments And Contingencies Disclosure [Abstract]
Contingencies	1 2 . Contingencies The Company has claims incurred in the normal course of its business. Most of these claims are believed by management to be covered by insurance, subject to normal reservations of rights by the insurance companies and possibly subject to certain exclusions in the applicable insurance policies. Whether or not covered by insurance, these claims, in the opinion of management, based on advice of legal counsel, should not have a material effect on the consolidated financial statements of the Company if determined adversely to the Company. The Company had two of its senior housing communities located in southeast Texas impacted by Hurricane Harvey during the third quarter of fiscal 2017. We maintain insurance coverage on these communities which includes damage caused by flooding. The insurance claim for this incident required a deductible of $100,000 that was expensed as a component of operating expenses in the Company’s Consolidated Statement of Operations and Comprehensive Loss in the third quarter of fiscal 2017. Physical repairs have been substantially completed to restore the communities to their condition prior to the incident and these communities reopened and began accepting residents in July 2018. Through December 31, 2018, we have incurred approximately $6.9 million in clean-up and physical repair costs which we believe are probable of being recovered through insurance proceeds. In addition to the repairs of physical damage to the buildings, the Company’s insurance coverage includes loss of business income (“Business Interruption”). Business Interruption includes reimbursement for lost revenue as well as incremental expenses incurred as a result of the hurricane. The Company received payments from our insurance underwriters during fiscal 2018 totaling approximately $9.2 million and during fiscal 2017 totaling approximately $2.7 million, of which approximately $5.1 million and $2.2 million, respectively, related to Business Interruption which has been included as a reduction to operating expenses in the Company’s Consolidated Statements of Operations and Comprehensive Loss. In July 2018, the Company received notifications from the Internal Revenue Service (“IRS”) pursuant to the Affordable Care Act (“ACA”) that the Company may be liable for an Employer Shared Responsibility Payment (“ESRP”) in the amount of approximately $2.1 million for the year ended December 31, 2015. The ESRP is applicable to employers that had 50 or more full-time equivalent employees, did not offer minimum essential coverage (“MEC”) to at least 70% of full-time employees and their dependents, or did offer MEC to at least 70% of full-time employees and their dependents which did not meet the affordable or minimum value criteria and had one or more full-time employees certified as being allowed the premium tax credit (“PTC”). The IRS determines the amount of the proposed ESRP from information returns completed by employers and from income tax returns completed by employees. Based upon the Company’s review of the notifications provided by the IRS, the Company initially concluded it would be liable for approximately $0.2 million of the ESRP assessments which was accrued within certain employee benefit reserves. The Company formally responded to the notifications from the IRS and received favorable decisions revising the ESRP to $83,200 during the fourth quarter of fiscal 2018.

Fair Value of Financial Instrum

Fair Value of Financial Instruments	12 Months Ended
	Dec. 31, 2018
Fair Value Disclosures [Abstract]
Fair Value of Financial Instruments	13. The carrying amounts and fair values of financial instruments at December 31, 2018 and 2017 are as follows (in thousands): 2018 2017 Carrying Amount Fair Value Carrying Amount Fair Value Cash and cash equivalents $ 31,309 $ 31,309 $ 17,646 $ 17,646 Restricted cash 13,011 13,011 13,378 13,378 Notes payable, excluding deferred loan costs 983,207 945,318 967,332 929,000 The following methods and assumptions were used in estimating its fair value disclosures for financial instruments: Cash and cash equivalents and Restricted cash: The carrying amounts reported in the balance sheet for cash and cash equivalents and restricted cash equal fair value, which represent level 1 inputs as defined in the accounting standards codification. Notes payable: The fair value of notes payable is estimated using discounted cash flow analysis, based on current incremental borrowing rates for similar types of borrowing arrangements, which represent level 2 inputs as defined in the accounting standards codification. The estimated fair value of these assets and liabilities could be affected by market changes and this effect could be material.

Allowance for Doubtful Accounts

Allowance for Doubtful Accounts	12 Months Ended
	Dec. 31, 2018
Text Block [Abstract]
Allowance for Doubtful Accounts	1 4 . Allowance for Doubtful Accounts The components of the allowance for doubtful accounts are as follows (in thousands): December 31, 2018 2017 2016 Balance at beginning of year $ 4,881 $ 4,253 $ 3,188 Provision for bad debts, net of recoveries 2,990 1,748 1,727 Write-offs and other (1,078 ) (1,120 ) (662 ) Balance at end of year $ 6,793 $ 4,881 $ 4,253

Leases

Leases	12 Months Ended
	Dec. 31, 2018
Leases [Abstract]
Leases	15. Leases As of December 31, 2018, the Company leased 46 senior housing communities from certain real estate investment trusts (“REITs”). The lease terms are generally for 10-15 years with renewal options for 5-20 years at the Company’s option. Under these lease agreements, the Company is responsible for all operating costs, maintenance and repairs, insurance and property taxes. No new facility leases were entered into by the Company during fiscal 2018. The following table summarizes each of the Company’s facility lease agreements as of December 31, 2018 (dollars in millions): Landlord Initial Date of Lease Number of Communities Value of Transaction Current Expiration and Renewal Term Initial Lease Rate (1) Lease Acquisition and Modification Costs (2) Deferred Gains /Lease Concessions (3) Ventas September 30, 2005 4 $ 61.4 September 30, 2025 (4) (Two five-year renewals) 8 % $ 7.7 $ 4.2 Ventas January 31, 2008 1 5.0 September 30, 2025 (4) (Two five-year renewals) 7.75 % 0.2 — Ventas June 27, 2012 2 43.3 September 30, 2025 (4) (Two five-year renewals) 6.75 % 0.8 — HCP May 1, 2006 3 54.0 October 31, 2020 (5) (Two 10-year renewals) 8 % 0.3 12.8 HCP May 31, 2006 6 43.0 April 30, 2026 (6) (One 10-year renewal) 8 % 0.2 0.6 HCP December 1, 2006 4 51.0 October 31, 2020 (5) (Two 10-year renewals) 8 % 0.7 — HCP December 14, 2006 1 18.0 October 31, 2020 (5) (Two 10-year renewals) 7.75 % 0.3 — HCP April 11, 2007 1 8.0 October 31, 2020 (5) (Two 10-year renewals) 7.25 % 0.1 — Welltower April 16, 2010 5 48.5 April 30, 2025 (15 years) (One 15-year renewal) 8.25 % 0.6 0.8 Welltower May 1, 2010 3 36.0 April 30, 2025 (15 years) (One 15-year renewal) 8.25 % 0.2 0.4 Welltower September 10, 2010 12 104.6 September 30, 2025 (15 years) (One 15-year renewal) 8.50 % 0.4 2.0 Welltower April 8, 2011 4 141.0 April 30, 2026 (15 years) (One 15-year renewal) 7.25 % 0.9 16.3 Subtotal 12.4 37.1 Accumulated amortization through December 31, 2018 (7.9 ) — Accumulated deferred gains / lease concessions recognized through December 31, 2018 — (26.2 ) Net lease acquisition costs / deferred gains / lease concessions as of December 31, 2018 $ 4.5 $ 10.9 (1) Initial lease rates are measured against agreed upon fair market values and are subject to conditional lease escalation provisions as set forth in each respective lease agreement. (2) Lease acquisition and modification costs are being amortized over the respective lease terms. (3) Deferred gains of $34.5 million and lease concessions of $2.6 million are being recognized in the Company’s Consolidated Statements of Operations and Comprehensive Loss as a reduction in facility lease expense over the respective initial lease terms. Lease concessions of $0.6 million relate to the transaction with HCP on May 31, 2006, and $2.0 million relate to the transaction with Welltower on September 10, 2010 (4) Effective June 17, 2015, the Company executed amendments to the master lease agreements with Ventas to facilitate leasehold improvements for 10 of the leased communities, of which the underlying real estate associated with four of its operating leases was acquired by the Company upon closing the Four Property Lease Transaction on January 31, 2017, and extend the lease terms through September 30, 2025, with two five-year renewal extensions available at the Company’s option (5) On November 11, 2013, the Company executed a third amendment to the master lease agreement associated with nine of its leased communities with HCP to facilitate leasehold improvements for one of the leased communities and extend the respective lease terms through October 31, 2020, with two 10-year renewal extensions available at the Company’s option (6) On April 24, 2015, the Company exercised its right to extend the lease term with HCP through April 30, 2026, with one 10-year renewal extension remaining available at the Company’s option Ventas As of December 31, 2018, the Company leased seven senior housing communities from Ventas. Effective January 31, 2017, the Company closed the Four Property Lease Transaction and acquired four of the senior housing communities leased from Ventas for a total acquisition price of $85.0 million. The Company obtained interim, interest only, bridge financing from Berkadia for $65.0 million of the acquisition price with an initial variable interest rate of LIBOR plus 4.0% and a 36-month term, with an option to extend the term 6 months, and the balance of the acquisition price paid from the Company’s existing cash resources. For additional information refer to Note 3, “Acquisitions.” Prior to the Four Property Lease Transaction, the Company previously leased 11 senior housing communities from Ventas. During the second quarter of fiscal 2015, the Company executed amendments to the master lease agreements with Ventas to facilitate up to $24.5 million of leasehold improvements for 10 communities within the Ventas lease portfolio and extend the lease terms until September 30, 2025, with two five-year renewal extension available at the Company’s option. Additionally, during the second quarter of fiscal 2016, the Company executed amendments to the master lease agreements with Ventas to increase the Special Project Funds for leasehold improvements from $24.5 million to $28.5 million and extend the date for completion of the leasehold improvements to June 30, 2017. During the second quarter of fiscal 2017, the Company executed amendments to the master lease agreements with Ventas to decrease the Special Project Funds for leasehold improvements from $28.5 million to approximately $17.0 million due to the Four Property Lease Transaction and extend the date for completion of the leasehold improvements to June 30, 2018. During the second quarter of fiscal 2018, the Company executed amendments to the master lease agreements with Ventas to increase the Special Project Funds for leasehold improvements from approximately $17.0 million to approximately $20.0 million and extend the date for completion of the leasehold improvements to June 30, 2019. The initial lease rates under each of the Ventas Lease Agreements range from 6.75% to 8% and are subject to certain conditional escalation clauses that will be recognized when probable or incurred. The Company initially incurred $11.4 million in lease acquisition and modification costs related to the Ventas Lease Agreements, of which a portion of these costs were written-off upon closing the Four Property Lease Transaction leaving $8.7 million in lease acquisition and modification costs associated with the remaining properties. These deferred lease acquisition and modification costs are being amortized over the lease terms and are included in facility lease expense in the Company’s Consolidated Statement of Operations and Comprehensive loss. The Company accounts for five of the Ventas Lease Agreements as an operating lease and two as a Capital lease and financing obligation. Effective June 27, 2012, the Company closed a lease modification transaction with Ventas which resulted in the Company exchanging two of its owned communities for one of the communities in the existing Ventas lease portfolio and simultaneously leasing back the two communities exchanged (the “Ventas Lease Transaction”). This transaction was the result of negotiations for a solution to the anticipation of the Company not meeting certain lease coverage ratio requirements for its lease portfolio of ten properties with Ventas. The two communities previously owned by the Company are located in East Lansing, Michigan (the “East Lansing Community”) and Raleigh, North Carolina (the “Raleigh Community”) and were exchanged for a community located in Merrillville, Indiana (the “Towne Centre Community”). All three communities continue to be operated by the Company. In conjunction with this transaction, Ventas assumed approximately $18.3 million of existing mortgage debt from Berkadia and the Company received the Towne Centre Community unencumbered. All of the leased communities in the Ventas lease portfolio were modified to be coterminous with the East Lansing and Raleigh Community leases expiring on September 30, 2020, which were extended to September 30, 2025 during fiscal 2015, with two 5-year renewal extensions available at the Company’s option, eliminate property-level lease covenants, and contain substantially similar terms and conditions. These leases were re-evaluated by the Company at the modification date and continue to be treated as operating leases. Under the terms of the original lease agreements with Ventas, the Company had previously deposited additional cash collateral of approximately $3.4 million, which was returnable to the Company once certain performance targets were reached. However, due to the rebalanced lease portfolio meeting the lease coverage ratio requirements, the Company negotiated the return of these deposits as a condition to the lease modification. Additionally, due to the extension of the lease terms for the Ventas lease portfolio to fiscal 2020, the rights of Ventas to reset the underlying values of the leased communities were deferred for five years. Pursuant to ASC 840, Leases HCP As of December 31, 2018, the Company leased 15 senior housing communities from HCP. During the fourth quarter of fiscal 2013, the Company executed an amendment to the master lease agreement with HCP to facilitate up to $3.3 million of leasehold improvements for one community within the HCP lease portfolio and extend the initial lease terms for nine communities until October 31, 2020, with two 10-year renewal extensions available at the Company’s option. During the second quarter of fiscal 2015, the Company exercised its right to extend the lease term with HCP for the remaining six communities in the HCP lease portfolio until April 30, 2026, with one 10-year renewal extension available at the Company’s option. The initial lease rates under the HCP Lease Agreements range from 7.25% to 8% and are subject to certain conditional escalation clauses, which will be recognized when probable or incurred. The Company incurred $1.6 million in lease acquisition and modification costs related to the HCP Lease Agreements. These deferred lease acquisition and modification costs are being amortized over the lease terms and are included in facility lease expense in the Company’s Consolidated Statements of Operations and Comprehensive Loss. The Company accounts for each of the HCP Lease Agreements as an operating lease. Welltower As of December 31, 2018, the Company leased 24 senior housing communities from Welltower. The Welltower Lease Agreements each have an initial term of 15 years, with one 15-year renewal extension available at the Company’s option. The initial lease rates under the Welltower Lease Agreements range from 7.25% to 8.5% and are subject to certain conditional escalation clauses, which will be recognized when probable or incurred. The initial terms on the Welltower Lease Agreements expire on various dates from April 2025 through April 2026. The Company incurred $2.1 million in lease acquisition costs related to the Welltower Lease Agreements. These deferred lease acquisition costs are being amortized over the lease terms and are included in facility lease expense in the Company’s Consolidated Statements of Operations and Comprehensive Loss. The Company accounts for each of the Welltower Lease Agreements as an operating lease. Facility lease expense in the Company’s Consolidated Statements of Operations and Comprehensive Loss includes rent expense plus amortization expense relating to leasehold acquisition costs offset by the amortization of deferred gains and lease incentives. The Company leases its corporate headquarters in Dallas, Texas, and has various lease contracts for a duration of 5 years or less on automobiles, buses and office equipment. The lease on the corporate headquarters currently expires on September 30, 2020. The Company incurred $60.6 million, $59.7 million, and $64.5 million in lease expense during fiscal 2018, 2017, and 2016, respectively. Future minimum lease commitments as of December 31, 2018, are as follows (in thousands): 2019 $ 66,455 2020 63,929 2021 52,093 2022 52,062 2023 52,026 Thereafter 97,165 $ 383,730 At each of December 31, 2018 and 2017, the Company had gross deferred lease costs of $12.4 million. Accumulated amortization at December 31, 2018 and 2017 was $8.0 million and $7.2 million, respectively, and amortization expense is expected to be approximately $0.8 million in each of the next five fiscal years. There are various financial covenants and other restrictions in the Company’s lease agreements. The Company was in compliance with all of its lease covenants at December 31, 2018 and 2017.

Quarterly Financial Information

Quarterly Financial Information (Unaudited)	12 Months Ended
	Dec. 31, 2018
Quarterly Financial Information Disclosure [Abstract]
Quarterly Financial Information (Unaudited)	1 6 . Quarterly Financial Information (Unaudited) The following table presents certain unaudited quarterly financial information for each of the four quarters ended December 31, 2018 and 2017. This information has been prepared on the same basis as the audited consolidated financial statements of the Company and include, in the opinion of the Company’s management, all adjustments (consisting of normal recurring adjustments) necessary to present fairly the quarterly results when read in conjunction with the audited consolidated financial statements of the Company. 2018 Calendar Quarters First Second Third Fourth (1) (In thousands, except per share amounts) Total revenues $ 114,643 $ 114,627 $ 115,650 $ 115,098 Income (Loss) from operations 5,386 3,643 1,696 (3,122 ) Net loss and comprehensive loss (7,156 ) (9,060 ) (11,089 ) (26,291 ) Net loss per share, basic $ (0.24 ) $ (0.30 ) $ (0.37 ) $ (0.88 ) Net loss per share, diluted $ (0.24 ) $ (0.30 ) $ (0.37 ) $ (0.88 ) Weighted average shares outstanding, basic 29,627 29,831 29,877 29,908 Weighted average shares outstanding, fully diluted 29,627 29,831 29,877 29,908 (1) The fourth quarter of calendar 2018 was impacted by $4.2 million of additional general and administrative expenses for separation and placement costs primarily associated with the retirement and replacement of the Company’s CEO and $12.6 million for write-off of deferred loan costs and prepayment premiums from the early repayment of certain mortgage debt on the Company’s owned properties due to the opportunity to establish a MCF with Berkadia and extend scheduled maturities. 2017 Calendar Quarters First Second Third Fourth (In thousands, except per share amounts) Total revenues $ 115,990 $ 116,718 $ 117,318 $ 116,971 (Loss) Income from operations (9,610 ) 4,691 4,513 8,248 Net loss and comprehensive loss (21,842 ) (7,835 ) (8,132 ) (6,359 ) Net loss per share, basic $ (0.75 ) $ (0.27 ) $ (0.28 ) $ (0.22 ) Net loss per share, diluted $ (0.75 ) $ (0.27 ) $ (0.28 ) $ (0.22 ) Weighted average shares outstanding, basic 29,288 29,478 29,512 29,531 Weighted average shares outstanding, fully diluted 29,288 29,478 29,512 29,531

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2018
Accounting Policies [Abstract]
Cash and Cash Equivalents and Restricted Cash	Cash and Cash Equivalents and Restricted Cash The Company considers all highly liquid investments with original maturities of three months or less at the date of acquisition to be cash equivalents. The Company has deposits in banks that exceed Federal Deposit Insurance Corporation insurance limits. Management believes that credit risk related to these deposits is minimal. Restricted cash consists of deposits required by certain lenders as collateral pursuant to letters of credit. The deposit must remain so long as the letter of credit is outstanding which is subject to renewal annually. The following table sets forth our cash and cash equivalents and restricted cash (in thousands): Year Ended December 31, 2018 2017 Cash and cash equivalents $ 31,309 $ 17,646 Restricted cash 13,011 13,378 $ 44,320 $ 31,024
Long-Lived Assets	Long-Lived Assets Property and equipment are stated at cost and depreciated on a straight-line basis over the estimated useful lives of the assets. At each balance sheet date, the Company reviews the carrying value of its property and equipment to determine if facts and circumstances suggest that they may be impaired or that the depreciation period may need to be changed. The Company considers internal factors such as net operating losses along with external factors relating to each asset, including contract changes, local market developments, and other publicly available information. If an indicator of impairment is identified, the carrying value of a long-lived asset is considered impaired when the anticipated undiscounted cash flows from such asset is separately identifiable and is less than its carrying value. In that event, a loss is recognized based on the amount the carrying value exceeds the fair market value, generally based on discounted cash flows, of the long-lived asset. For property and equipment where indicators of impairment were identified, tests of recoverability were performed and the Company has concluded its property and equipment is recoverable and does not warrant adjustment to the carrying value or remaining useful lives as of December 31, 2018. The Company does not believe there were any indicators of impairment that would require an adjustment to the carrying value of the property and equipment or their remaining useful lives as of December 31, 2017.
Off-Balance Sheet Arrangements	Off-Balance Sheet Arrangements The Company had no material off-balance sheet arrangements at December 31, 2018.
Income Taxes	Income Taxes Income taxes are computed using the asset and liability method and current income taxes are recorded based on amounts refundable or payable. Deferred income taxes are recorded based on the estimated future tax effects of loss carryforwards and temporary differences between financial statement carrying amounts of existing assets and liabilities and their respective tax basis. Deferred tax assets and liabilities are measured using enacted tax rates that are expected to apply to taxable income in the years in which we expect those carryforwards and temporary differences to be recovered or settled. Management regularly evaluates the future realization of deferred tax assets and provides a valuation allowance, if considered necessary, based on such evaluation. As part of the evaluation, management has evaluated taxable income in carryback years, future reversals of taxable temporary differences, feasible tax planning strategies, and future expectations of income. The Company evaluates uncertain tax positions through consideration of accounting and reporting guidance on criteria, measurement, derecognition, classification, interest and penalties, accounting in interim periods, disclosure, and transition that is intended to provide better financial-statement comparability among different companies. The Company is required to recognize a tax benefit in its financial statements for an uncertain tax position only if management’s assessment is that its position is “more likely than not” (i.e., a greater than 50 percent likelihood) to be upheld on audit based only on the technical merits of the tax position. The Company’s policy is to recognize interest related to unrecognized tax benefits as interest expense and penalties as income tax expense.
Revenue Recognition	Revenue Recognition Resident revenue consists of fees for basic housing and certain support services and fees associated with additional housing and expanded support requirements such as assisted living care, memory care, and ancillary services. Basic housing and certain support services revenue is recorded when services are rendered and amounts billed are Residency agreements are generally short term in nature with durations of one year or less and are typically terminable by either party, under certain circumstances, upon providing 30 days’ notice, unless state law provides otherwise, with resident fees billed monthly in advance. Revenue for certain ancillary services is recognized as services are provided, and includes fees for services such as medication management, daily living activities, beautician/barber, laundry, television, guest meals, pets, and parking which are generally billed monthly in arrears. Deferred fees totaled approximately $4.7 million and $5.1 million, respectively, for the fiscal years ended December 31, 2018 and 2017, and were recognized as a component of resident revenue within the Company’s Consolidated Statements of Operations and Comprehensive Loss. The Company's senior housing communities have residency agreements which generally require the resident to pay a community fee prior to moving into the community and are recorded initially by the Company as deferred revenue. At each of December 31, 2018 and 2017, the Company had contract liabilities for deferred community fees totaling approximately $1.1 million and $1.3 million, respectively, which are included as a component of deferred income within current liabilities of the Company’s Consolidated Balance Sheets. The Company recognized community fees as a component of resident revenue within the Company’s Consolidated Statements of Operations and Comprehensive Loss of approximately $2.8 million and $3.6 million, respectively, during the fiscal years ended December 31, 2018 and 2017. Revenues from the Medicaid program accounted for approximately 5.4% of the Company’s revenue in fiscal 2018, 5.6% of the Company’s revenue in fiscal 2017, and 5.5% of the Company’s revenue in fiscal 2016. During fiscal 2018, 2017, and 2016, 40, 41, and 40, respectively, of the Company’s communities were providers of services under the Medicaid program. Accordingly, these communities were entitled to reimbursement under the foregoing program at established rates that were lower than private pay rates. Patient service revenue for Medicaid patients was recorded at the reimbursement rates as the rates were set prospectively by the applicable state upon the filing of an annual cost report. None of the Company’s communities were providers of services under the Medicare program during fiscal 2018, 2017, or 2016. Laws and regulations governing the Medicaid program are complex and subject to interpretation. The Company believes that it is in compliance with all applicable laws and regulations and is not aware of any pending or threatened investigations involving allegations of potential wrongdoing. While no such regulatory inquiries have been made, compliance with such laws and regulations can be subject to future government review and interpretation as well as significant regulatory action including fines, penalties, and exclusion from the Medicaid program.
Purchase Accounting	Purchase Accounting In determining the allocation of the purchase price of senior housing communities acquired to net tangible and identified intangible assets acquired and liabilities assumed, if any, the Company makes estimates of fair value using information obtained as a result of pre-acquisition due diligence, leasing activities and/or independent appraisals. The Company assigns the purchase price for senior living communities to assets acquired and liabilities assumed based on their estimated fair values. The determination of fair value involves the use of significant judgments and estimates which is generally assessed as follows: The Company allocates the fair values of buildings acquired on an as-if-vacant basis and depreciates the building values over the estimated remaining lives of the buildings, not to exceed 40 years. The Company The fair value of acquired lease-related intangibles reflects the estimated fair value of existing resident in-place leases as represented by the cost to obtain residents and an estimated absorption period to reflect the value of the rent and recovery costs foregone during a reasonable lease-up period as if the property acquired was vacant. The Company amortizes any acquired resident in-place lease intangibles to depreciation and amortization expense over the estimated remaining useful life of the respective resident operating leases.
Credit Risk and Allowance for Doubtful Accounts	Credit Risk and Allowance for Doubtful Accounts The Company’s resident receivables are generally due within 30 days from the date billed. Accounts receivable are reported net of an allowance for doubtful accounts of $6.8 million and $4.9 million at December 31, 2018 and 2017, respectively, and represent the Company’s estimate of the amount that ultimately will be collected. The adequacy of the Company’s allowance for doubtful accounts is reviewed on an ongoing basis, using historical payment trends, write-off experience, analyses of receivable portfolios by payor source and aging of receivables, as well as a review of specific accounts, and adjustments are made to the allowance as necessary. Credit losses on resident receivables have historically been within management’s estimates, and management believes that the allowance for doubtful accounts adequately provides for expected losses.
Lease Accounting	Lease Accounting The Company determines whether to account for its leases as operating, capital or financing leases depending on the underlying terms of the lease agreement. This determination of classification requires significant judgment relating to certain information, including the estimated fair value and remaining economic life of the community, the Company’s cost of funds, minimum lease payments and other lease terms. The lease rates under the Company’s lease agreements are subject to certain conditional escalation clauses which are recognized when probable or incurred and are based on changes in the consumer price index or certain operational performance measures. As of December 31, 2018 and 2017, the Company leased 46 communities, two of which the Company classified as capital lease and financing obligations with the remaining classified as operating leases. The Company incurs lease acquisition costs and amortizes these costs over the term of the lease agreement. Certain leases entered into by the Company qualified as sale/leaseback transactions, and as such, any related gains have been deferred and are being amortized over the respective lease term. No new communities were leased by the Company during fiscal 2018 or 2017. Effective January 31, 2017, the Company acquired from Ventas the underlying real estate associated with four of its operating leases. For additional information refer to Note 3, “Acquisitions”. Facility lease expense in the Company’s Consolidated Statements of Operations and Comprehensive loss includes rent expense plus amortization expense relating to leasehold acquisition costs offset by the amortization of deferred gains and lease incentives.
Employee Health and Dental Benefits, Workers' Compensation, and Insurance Reserves	Employee Health and Dental Benefits, Workers’ Compensation, and Insurance Reserves The Company offers full-time employees an option to participate in its health and dental plans. The Company is self-insured up to certain limits and is insured if claims in excess of these limits are incurred. The cost of employee health and dental benefits, net of employee contributions, is shared between the corporate office and the senior housing communities based on the respective number of plan participants. Funds collected are used to pay the actual program costs, including estimated annual claims, third-party administrative fees, network provider fees, communication costs, and other related administrative costs incurred by the plans. Claims are paid as they are submitted to the Company’s third-party administrator. The Company records a liability for outstanding claims and claims that have been incurred but not yet reported. This liability is based on the historical claim reporting lag and payment trends of health insurance claims. Management believes that the liability for outstanding losses and expenses is adequate to cover the ultimate cost of losses and expenses incurred at December 31, 2018; however, actual claims and expenses may differ. Any subsequent changes in estimates are recorded in the period in which they are determined. The Company uses a combination of insurance and self-insurance for workers’ compensation. Determining the reserve for workers’ compensation losses and costs that the Company has incurred as of the end of a reporting period involves significant judgments based on projected future events, including potential settlements for pending claims, known incidents which may result in claims, estimates of incurred but not yet reported claims, changes in insurance premiums, estimated litigation costs and other factors. The Company regularly adjusts these estimates to reflect changes in the foregoing factors. However, since this reserve is based on estimates, the actual expenses incurred may differ from the amounts reserved. Any subsequent changes in estimates are recorded in the period in which they are determined.
Net Loss Per Share	Net Loss Per Share Basic net loss per common share is computed by dividing net loss by the weighted average number of common shares outstanding for the period. Potentially dilutive securities consist of unvested restricted shares and shares that could be issued under outstanding stock options. Potentially dilutive securities are excluded from the computation of net loss per common share if their effect is antidilutive. The following table sets forth the computation of basic and diluted net loss per share (in thousands, except for per share amounts): Year Ended December 31, 2018 2017 2016 Net loss $ (53,596 ) $ (44,168 ) $ (28,017 ) Net loss allocated to unvested restricted shares — — — Undistributed net loss allocated to common shares $ (53,596 ) $ (44,168 ) $ (28,017 ) Weighted average shares outstanding — basic 29,812 29,453 28,909 Effects of dilutive securities: Employee equity compensation plans — — — Weighted average shares outstanding — diluted 29,812 29,453 28,909 Basic net loss per share $ (1.80 ) $ (1.50 ) $ (0.97 ) Diluted net loss per share $ (1.80 ) $ (1.50 ) $ (0.97 ) Awards of unvested restricted stock representing approximately 1.3 million, 0.9 million, and 0.8 million shares were outstanding for the fiscal years ended December 31, 2018, 2017, and 2016, respectively, and are antidilutive.
Treasury Stock	Treasury Stock The Company accounts for treasury stock under the cost method and includes treasury stock as a component of shareholders’ equity until it is canceled. There were no repurchases of the Company’s common stock during fiscal 2018 or 2017.
Stock-Based Compensation	Stock-Based Compensation The Company recognizes compensation expense for share-based payment awards to certain employees and directors, including grants of stock options and awards of restricted stock, in the Consolidated Statements of Operations and Comprehensive Loss based on their fair values. On May 8, 2007, the Company’s stockholders approved the 2007 Omnibus Stock and Incentive Plan for Capital Senior Living Corporation (as amended, the “2007 Plan”) which provides for, among other things, the grant of restricted stock awards and stock options to purchase shares of the Company’s common stock. The 2007 Plan authorizes the Company to issue up to 4.6 million shares of common stock and the Company currently has 286,000 shares of common stock reserved for future issuance pursuant to awards under the 2007 Plan.
Segment Information	Segment Information The Company evaluates the performance and allocates resources of its senior living facilities based on current operations and market assessments on a property-by-property basis. The Company does not have a concentration of operations geographically or by product or service as its management functions are integrated at the property level. The Company has determined that all of its operating units meet the criteria in Accounting Standards Codification (“ASC”) Topic 280, Segment Reporting
Recently Issued Accounting Guidance	Recently Issued Accounting Guidance In January 2017, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2017-01, Business Combinations – Clarifying the Definition of a Business In November 2016, the FASB issued ASU 2016-18, Statement of Cash Flows (Topic 230): Restricted Cash (a consensus of the FASB Emerging Issues Task Force). In August 2016, the FASB issued ASU 2016-15, Classification of Certain Cash Receipts and Cash Payments. In June 2016, the FASB issued ASU 2016-13, Financial Instruments - Credit Losses: Measurement of Credit Losses on Financial Instruments In February 2016, the FASB issued ASU 2016-02, Leases Leases, Targeted Improvements In May 2014, the FASB issued ASU 2014-09, Revenue from Contracts with Customers (Topic 606)
Use of Estimates and Critical Accounting Policies	Use of Estimates and Critical Accounting Policies The preparation of financial statements in conformity with U.S. generally accepted accounting principles requires management to make estimates and assumptions that affect the amounts reported in the accompanying financial statements and related footnotes. Management bases its estimates and assumptions on historical experience, observance of industry trends and various other sources of information and factors, the results of which form the basis for making judgments about the carrying value of assets and liabilities that are not readily apparent from other sources. Actual results could differ from these estimates. Critical accounting policies are defined as those that are reflective of significant judgments and uncertainties, and potentially could result in materially different results under different assumptions and conditions. The Company believes revenue recognition, purchase accounting, credit risk and allowance for doubtful accounts, lease accounting, employee health and dental benefits, workers’ compensation and insurance reserves, long-lived assets, and income taxes are its most critical accounting policies and/or require management’s most subjective judgments.
Reclassifications	Reclassifications Certain reclassifications have been made to prior period amounts to conform to current period presentation.

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Tables)	12 Months Ended
	Dec. 31, 2018
Accounting Policies [Abstract]
Schedule of Cash and Cash Equivalents and Restricted Cash	The following table sets forth our cash and cash equivalents and restricted cash (in thousands): Year Ended December 31, 2018 2017 Cash and cash equivalents $ 31,309 $ 17,646 Restricted cash 13,011 13,378 $ 44,320 $ 31,024
Computation of Basic and Diluted Net Loss Per Share	The following table sets forth the computation of basic and diluted net loss per share (in thousands, except for per share amounts): Year Ended December 31, 2018 2017 2016 Net loss $ (53,596 ) $ (44,168 ) $ (28,017 ) Net loss allocated to unvested restricted shares — — — Undistributed net loss allocated to common shares $ (53,596 ) $ (44,168 ) $ (28,017 ) Weighted average shares outstanding — basic 29,812 29,453 28,909 Effects of dilutive securities: Employee equity compensation plans — — — Weighted average shares outstanding — diluted 29,812 29,453 28,909 Basic net loss per share $ (1.80 ) $ (1.50 ) $ (0.97 ) Diluted net loss per share $ (1.80 ) $ (1.50 ) $ (0.97 )

Property and Equipment (Tables)

Property and Equipment (Tables)	12 Months Ended
	Dec. 31, 2018
Property Plant And Equipment [Abstract]
Schedule of Property and Equipment	Property and equipment consists of the following (in thousands): December 31, Asset Lives 2018 2017 Land $ 69,842 $ 69,842 Land improvements 5 to 20 years 25,373 24,665 Buildings and building improvements 10 to 40 years 1,158,577 1,148,816 Furniture and equipment 5 to 10 years 66,202 62,614 Automobiles 5 to 7 years 6,344 6,236 Leasehold improvements (1) 98,396 85,384 Construction in progress NA 421 5,711 1,425,155 1,403,268 Less accumulated depreciation and amortization (366,106 ) (303,482 ) Property and equipment, net $ 1,059,049 $ 1,099,786 (1) Leasehold improvements are amortized over the shorter of the useful life of the asset or the remaining lease term.

Other Assets (Tables)

Other Assets (Tables)	12 Months Ended
	Dec. 31, 2018
Deferred Costs Capitalized Prepaid And Other Assets Disclosure [Abstract]
Schedule of Other Assets	Other assets consist of the following (in thousands): December 31, 2018 2017 Deferred lease costs, net $ 4,715 $ 5,555 Security and other deposits 9,889 10,234 Other 1,881 3,047 $ 16,485 $ 18,836

Accrued Expenses (Tables)

Accrued Expenses (Tables)	12 Months Ended
	Dec. 31, 2018
Text Block [Abstract]
Schedule of Accrued Expenses	Accrued expenses consist of the following (in thousands): December 31, 2018 2017 Accrued salaries, bonuses and related expenses $ 11,996 $ 13,015 Accrued property taxes 14,079 14,208 Accrued interest 3,066 3,757 Accrued health claims and workers comp 4,845 4,547 Accrued professional fees 1,012 763 Other 6,882 4,461 $ 41,880 $ 40,751

Notes Payable (Tables)

Notes Payable (Tables)	12 Months Ended
	Dec. 31, 2018
Debt Disclosure [Abstract]
Schedule of Notes Payable	Notes payable consists of the following (in thousands): Average Monthly Net Book Value Interest Maturity Notes Payable December 31, Lender Payment Of Collateral (1) Rate Date 2018 2017 Fannie Mae $ — $ — 5.69 August 2021 $ — $ 12,283 Fannie Mae — — 4.97 October 2021 — 4,331 Fannie Mae — — 4.92 October 2021 — 17,097 Fannie Mae — — 5.19 October 2021 — 4,839 Fannie Mae — — 4.92 November 2021 — 19,886 Fannie Mae — — 4.38 March 2022 — 4,831 Fannie Mae — — 4.76 April 2022 — 10,403 Fannie Mae — — 4.85 April 2022 — 3,470 Fannie Mae 135 25,781 4.69 April 2022 23,127 23,637 Fannie Mae 11 4,140 4.97 April 2022 1,991 2,022 Fannie Mae 60 14,707 4.48 May 2022 10,462 10,699 Fannie Mae 20 14,707 4.85 May 2022 3,640 3,697 Fannie Mae — — 4.34 November 2022 — 26,382 Fannie Mae — — 4.50 November 2022 — 5,881 Fannie Mae — — 5.49 November 2022 — 7,403 Fannie Mae 84 16,577 4.32 January 2023 15,194 15,532 Fannie Mae 49 16,577 5.39 January 2023 8,327 8,453 Fannie Mae 39 7,943 4.58 January 2023 6,808 6,953 Fannie Mae 17 7,943 5.49 January 2023 2,990 3,029 Fannie Mae — — 4.66 April 2023 — 15,131 Fannie Mae — — 5.46 April 2023 — 3,068 Fannie Mae 45 8,166 5.93 October 2023 7,092 7,205 Fannie Mae 67 12,893 5.50 November 2023 10,992 11,180 Fannie Mae 67 12,202 5.38 November 2023 11,042 11,236 Fannie Mae 282 50,722 5.56 January 2024 45,892 46,662 Fannie Mae 632 109,519 4.24 July 2024 118,715 121,141 Fannie Mae 120 25,091 4.48 July 2024 21,963 22,394 Fannie Mae 81 19,891 4.30 July 2024 15,156 15,462 Fannie Mae 91 65,624 4.98 July 2024 16,322 16,579 Fannie Mae 11 9,290 6.30 July 2024 1,796 — Fannie Mae 134 26,589 4.59 September 2024 24,342 24,805 Fannie Mae 22 13,433 5.72 September 2024 3,634 3,682 Fannie Mae 54 10,256 4.70 September 2024 9,683 9,864 Fannie Mae 53 11,808 4.50 January 2025 9,731 9,915 Fannie Mae 95 6,351 4.46 January 2025 17,686 18,023 Fannie Mae 70 15,106 4.35 February 2025 13,179 13,434 Fannie Mae 109 8,496 3.85 March 2025 21,633 22,086 Fannie Mae 102 23,648 3.84 April 2025 20,324 20,749 Fannie Mae 31 23,648 5.53 April 2025 5,300 5,372 Fannie Mae — — 4.55 June 2025 — 8,794 Fannie Mae — — 4.79 June 2025 — 10,753 Fannie Mae 81 15,219 5.30 June 2025 13,335 13,580 Fannie Mae — — 5.71 June 2025 — 4,079 Fannie Mae 58 12,481 4.69 October 2025 10,595 10,780 Fannie Mae 44 9,256 4.70 October 2025 8,008 8,147 Fannie Mae 273 38,141 4.68 December 2025 50,295 51,163 Fannie Mae 9 7,577 5.81 December 2025 1,426 1,445 Fannie Mae — — 5.43 April 2026 — 10,443 Fannie Mae — — 5.84 April 2026 — 4,903 Fannie Mae 98 21,982 4.10 October 2026 19,498 19,854 Fannie Mae 108 24,350 4.24 December 2026 21,243 21,617 Fannie Mae 652 160,096 5.13 January 2029 150,782 — Fannie Mae 194 160,096 (3 ) January 2029 50,261 — Protective Life 96 24,088 3.55 April 2025 19,787 20,234 Protective Life 49 10,994 4.25 August 2025 9,350 9,535 Protective Life 78 17,506 4.25 September 2025 14,871 15,163 Protective Life 138 32,096 4.25 November 2025 26,478 26,993 Protective Life 57 13,460 4.50 February 2026 10,761 10,959 Protective Life 187 41,379 4.38 March 2026 32,920 33,705 Protective Life 70 15,019 4.13 October 2031 12,326 12,645 Berkadia 378 93,631 (4 ) February 2020 65,000 65,000 Berkadia 18 7,292 (5 ) July 2020 3,500 — Berkadia 97 18,785 (6 ) October 2021(5) 11,255 11,505 HUD 16 5,356 4.48 September 2045 2,933 2,989 Insurance Financing — — 2.76 May 2018 — 725 Insurance Financing — — 3.04 November 2018 — 3,505 Insurance Financing 160 — 3.64 May 2019 799 — Insurance Financing 70 — 4.40 November 2019 763 — $ 5,412 4.64% (2) $ 983,207 $ 967,332 Less deferred loan costs, net 9,457 9,398 $ 973,750 $ 957,934 Less current portion 14,342 19,728 $ 959,408 $ 938,206 (1) 80 (2) Weighted average interest rate on current fixed interest rate debt outstanding. (3) Variable interest rate of LIBOR plus 2.14%, which was 4.57% at December 31, 2018. (4) Variable interest rate of LIBOR plus 4.00%, which was 6.89% at December 31, 2018. ( 5 ) Variable interest rate of LIBOR plus 3.75%, which was 6.21% at December 31, 2018. ( 6 ) Variable interest rate of LIBOR plus 5.00%, which was 7.89% at December 31, 2018. Effective June 29, 2018, the Company extended the maturity date with Berkadia to October 10, 2021.
Summary of Aggregate Scheduled Maturities of Notes Payable	The aggregate scheduled maturities of notes payable at December 31, 2018 are as follows (in thousands): 2019 $ 16,050 2020 83,595 2021 26,254 2022 54,381 2023 74,729 Thereafter 728,198 $ 983,207

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	12 Months Ended
	Dec. 31, 2018
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Stock Option Activity and Related Information	A summary of the Company’s stock option activity and related information for the years ended December 31, 2018, 2017, and 2016 is presented below: Outstanding Beginning of Year Granted Exercised Forfeited Outstanding End of Year Options Exercisable December 31, 2018 Shares — — — — — — Weighted average price $ — — $ — — $ — $ — December 31, 2017 Shares — — — — — — Weighted average price $ — — $ — — $ — $ — December 31, 2016 Shares 3,000 — 3,000 — — — Weighted average price $ 10.97 — $ 10.97 — $ — $ —
Restricted Common Stock Awards Activity and Related Information	A summary of the Company’s restricted common stock awards activity and related information for the years ended December 31, 2018, 2017, and 2016 is presented below: Outstanding Beginning of Year Issued Vested Forfeited Outstanding End of Year December 31, 2018 Shares 964,484 830,794 (386,900 ) (63,219 ) 1,345,159 December 31, 2017 Shares 829,766 565,745 (355,400 ) (75,627 ) 964,484 December 31, 2016 Shares 783,310 666,883 (565,224 ) (55,203 ) 829,766

Income Taxes (Tables)

Income Taxes (Tables)	12 Months Ended
	Dec. 31, 2018
Income Tax Disclosure [Abstract]
Schedule of (Benefit) Provision for Income Taxes	The (benefit) provision for income taxes consists of the following (in thousands): Year Ended December 31, 2018 2017 2016 Current: Federal $ (152 ) $ 6 $ — State 474 550 435 Deferred: Federal (2,093 ) 1,940 — State — — — (Benefit) Provision for income taxes $ (1,771 ) $ 2,496 $ 435
(Benefit) Provision for Income Taxes Differed from Amounts of Income Tax (Benefit) Provision Determined by Applying Federal Statutory Income Tax Rate to Income Before (Benefit) Provision for Income Taxes	The (benefit) provision for income taxes differed from the amounts of income tax (benefit) provision determined by applying the U.S. federal statutory income tax rate to income before (benefit) provision for income taxes as a result of the following (in thousands): Year Ended December 31, 2018 2017 2016 Tax benefit at federal statutory rates $ (11,627 ) $ (14,168 ) $ (9,335 ) State income tax benefit, net of federal effects (665 ) (648 ) (550 ) Change in deferred tax asset valuation allowance 9,543 7,857 8,569 Tax reform impact on deferred income taxes — 13,959 — Share based compensation ASU 2016-09 adoption — (5,326 ) — Other 978 822 1,751 (Benefit) Provision for income taxes $ (1,771 ) $ 2,496 $ 435
Summary of Deferred Tax Assets and Liabilities	A summary of the Company’s deferred tax assets and liabilities, are as follows (in thousands): December 31, 2018 2017 Deferred tax assets: Deferred gains on sale/leaseback transactions $ 2,440 $ 2,890 Net operating loss carryforward 33,252 25,441 Compensation costs 3,087 2,245 Depreciation and amortization 5,323 4,367 Other 2,330 2,099 Total deferred tax assets 46,432 37,042 Deferred tax asset valuation allowance (46,280 ) (36,737 ) Total deferred tax assets, net 152 305 Deferred tax liabilities: Depreciation and amortization — (2,246 ) Total deferred tax liabilities $ — $ (2,246 ) Deferred taxes, net $ 152 $ (1,941 )
Schedule of Unrecognized Tax Benefits Activity and Related Information	A summary of the Company’s unrecognized tax benefits activity and related information for the years ended December 31, 2018, 2017, and 2016 is presented below (in thousands): 2018 2017 2016 Beginning balance, January 1 $ 3,416 $ 3,786 $ — Gross increases – tax positions in prior period 1,228 — 2,451 Gross decreases – tax positions in prior period — (370 ) — Gross increases – tax positions in current period — — 1,335 Settlements — — — Lapse of statute of limitations — — — Ending balance, December 31 $ 4,644 $ 3,416 $ 3,786

Fair Value of Financial Instr_2

Fair Value of Financial Instruments (Tables)	12 Months Ended
	Dec. 31, 2018
Fair Value Disclosures [Abstract]
Carrying Amounts and Fair Values of Financial Instruments	The carrying amounts and fair values of financial instruments at December 31, 2018 and 2017 are as follows (in thousands): 2018 2017 Carrying Amount Fair Value Carrying Amount Fair Value Cash and cash equivalents $ 31,309 $ 31,309 $ 17,646 $ 17,646 Restricted cash 13,011 13,011 13,378 13,378 Notes payable, excluding deferred loan costs 983,207 945,318 967,332 929,000

Allowance for Doubtful Accoun_2

Allowance for Doubtful Accounts (Tables)	12 Months Ended
	Dec. 31, 2018
Text Block [Abstract]
Schedule of Allowance for Doubtful Accounts	The components of the allowance for doubtful accounts are as follows (in thousands): December 31, 2018 2017 2016 Balance at beginning of year $ 4,881 $ 4,253 $ 3,188 Provision for bad debts, net of recoveries 2,990 1,748 1,727 Write-offs and other (1,078 ) (1,120 ) (662 ) Balance at end of year $ 6,793 $ 4,881 $ 4,253

Leases (Tables)

Leases (Tables)	12 Months Ended
	Dec. 31, 2018
Leases [Abstract]
Summary of Company's Facility Lease Agreements	The following table summarizes each of the Company’s facility lease agreements as of December 31, 2018 (dollars in millions): Landlord Initial Date of Lease Number of Communities Value of Transaction Current Expiration and Renewal Term Initial Lease Rate (1) Lease Acquisition and Modification Costs (2) Deferred Gains /Lease Concessions (3) Ventas September 30, 2005 4 $ 61.4 September 30, 2025 (4) (Two five-year renewals) 8 % $ 7.7 $ 4.2 Ventas January 31, 2008 1 5.0 September 30, 2025 (4) (Two five-year renewals) 7.75 % 0.2 — Ventas June 27, 2012 2 43.3 September 30, 2025 (4) (Two five-year renewals) 6.75 % 0.8 — HCP May 1, 2006 3 54.0 October 31, 2020 (5) (Two 10-year renewals) 8 % 0.3 12.8 HCP May 31, 2006 6 43.0 April 30, 2026 (6) (One 10-year renewal) 8 % 0.2 0.6 HCP December 1, 2006 4 51.0 October 31, 2020 (5) (Two 10-year renewals) 8 % 0.7 — HCP December 14, 2006 1 18.0 October 31, 2020 (5) (Two 10-year renewals) 7.75 % 0.3 — HCP April 11, 2007 1 8.0 October 31, 2020 (5) (Two 10-year renewals) 7.25 % 0.1 — Welltower April 16, 2010 5 48.5 April 30, 2025 (15 years) (One 15-year renewal) 8.25 % 0.6 0.8 Welltower May 1, 2010 3 36.0 April 30, 2025 (15 years) (One 15-year renewal) 8.25 % 0.2 0.4 Welltower September 10, 2010 12 104.6 September 30, 2025 (15 years) (One 15-year renewal) 8.50 % 0.4 2.0 Welltower April 8, 2011 4 141.0 April 30, 2026 (15 years) (One 15-year renewal) 7.25 % 0.9 16.3 Subtotal 12.4 37.1 Accumulated amortization through December 31, 2018 (7.9 ) — Accumulated deferred gains / lease concessions recognized through December 31, 2018 — (26.2 ) Net lease acquisition costs / deferred gains / lease concessions as of December 31, 2018 $ 4.5 $ 10.9 (1) Initial lease rates are measured against agreed upon fair market values and are subject to conditional lease escalation provisions as set forth in each respective lease agreement. (2) Lease acquisition and modification costs are being amortized over the respective lease terms. (3) Deferred gains of $34.5 million and lease concessions of $2.6 million are being recognized in the Company’s Consolidated Statements of Operations and Comprehensive Loss as a reduction in facility lease expense over the respective initial lease terms. Lease concessions of $0.6 million relate to the transaction with HCP on May 31, 2006, and $2.0 million relate to the transaction with Welltower on September 10, 2010 (4) Effective June 17, 2015, the Company executed amendments to the master lease agreements with Ventas to facilitate leasehold improvements for 10 of the leased communities, of which the underlying real estate associated with four of its operating leases was acquired by the Company upon closing the Four Property Lease Transaction on January 31, 2017, and extend the lease terms through September 30, 2025, with two five-year renewal extensions available at the Company’s option (5) On November 11, 2013, the Company executed a third amendment to the master lease agreement associated with nine of its leased communities with HCP to facilitate leasehold improvements for one of the leased communities and extend the respective lease terms through October 31, 2020, with two 10-year renewal extensions available at the Company’s option (6) On April 24, 2015, the Company exercised its right to extend the lease term with HCP through April 30, 2026, with one 10-year renewal extension remaining available at the Company’s option
Summary of Future Minimum Lease Commitments	Future minimum lease commitments as of December 31, 2018, are as follows (in thousands): 2019 $ 66,455 2020 63,929 2021 52,093 2022 52,062 2023 52,026 Thereafter 97,165 $ 383,730

Quarterly Financial Informati_2

Quarterly Financial Information (Unaudited) (Tables)	12 Months Ended
	Dec. 31, 2018
Quarterly Financial Information Disclosure [Abstract]
Schedule of Quarterly Financial Information	The following table presents certain unaudited quarterly financial information for each of the four quarters ended December 31, 2018 and 2017. This information has been prepared on the same basis as the audited consolidated financial statements of the Company and include, in the opinion of the Company’s management, all adjustments (consisting of normal recurring adjustments) necessary to present fairly the quarterly results when read in conjunction with the audited consolidated financial statements of the Company. 2018 Calendar Quarters First Second Third Fourth (1) (In thousands, except per share amounts) Total revenues $ 114,643 $ 114,627 $ 115,650 $ 115,098 Income (Loss) from operations 5,386 3,643 1,696 (3,122 ) Net loss and comprehensive loss (7,156 ) (9,060 ) (11,089 ) (26,291 ) Net loss per share, basic $ (0.24 ) $ (0.30 ) $ (0.37 ) $ (0.88 ) Net loss per share, diluted $ (0.24 ) $ (0.30 ) $ (0.37 ) $ (0.88 ) Weighted average shares outstanding, basic 29,627 29,831 29,877 29,908 Weighted average shares outstanding, fully diluted 29,627 29,831 29,877 29,908 (1) The fourth quarter of calendar 2018 was impacted by $4.2 million of additional general and administrative expenses for separation and placement costs primarily associated with the retirement and replacement of the Company’s CEO and $12.6 million for write-off of deferred loan costs and prepayment premiums from the early repayment of certain mortgage debt on the Company’s owned properties due to the opportunity to establish a MCF with Berkadia and extend scheduled maturities. 2017 Calendar Quarters First Second Third Fourth (In thousands, except per share amounts) Total revenues $ 115,990 $ 116,718 $ 117,318 $ 116,971 (Loss) Income from operations (9,610 ) 4,691 4,513 8,248 Net loss and comprehensive loss (21,842 ) (7,835 ) (8,132 ) (6,359 ) Net loss per share, basic $ (0.75 ) $ (0.27 ) $ (0.28 ) $ (0.22 ) Net loss per share, diluted $ (0.75 ) $ (0.27 ) $ (0.28 ) $ (0.22 ) Weighted average shares outstanding, basic 29,288 29,478 29,512 29,531 Weighted average shares outstanding, fully diluted 29,288 29,478 29,512 29,531

Organization - Additional Infor

Organization - Additional Information (Detail)	Dec. 31, 2018CommunityStateResident	Dec. 18, 2018Community	Dec. 31, 2017Community
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Senior housing communities operated by company	129	21
Number of states in which senior housing communities operated | State	23
Aggregate capacity of residents in company operated senior housing communities | Resident	16,500
Senior housing communities owned by company	83
Senior housing communities on lease by company	46		46

Summary of Significant Accoun_4

Summary of Significant Accounting Policies - Schedule of Cash and Cash Equivalents and Restricted Cash (Detail) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Accounting Policies [Abstract]
Cash and cash equivalents	$ 31,309	$ 17,646
Restricted cash	13,011	13,378
Total Cash and cash equivalents and Restricted cash	$ 44,320	$ 31,024	$ 47,323	$ 69,246

Summary of Significant Accoun_5

Summary of Significant Accounting Policies - Additional Information (Detail) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2018USD ($)Communityshares	Sep. 30, 2018USD ($)	Jun. 30, 2018USD ($)	Mar. 31, 2018USD ($)	Dec. 31, 2017USD ($)Community	Sep. 30, 2017USD ($)	Jun. 30, 2017USD ($)	Mar. 31, 2017USD ($)	Dec. 31, 2018USD ($)CommunitySegmentshares	Dec. 31, 2017USD ($)Communityshares	Dec. 31, 2016USD ($)Communityshares	Dec. 31, 2009shares	Jan. 31, 2017Community	Dec. 31, 2015USD ($)
Accounting Policies [Line Items]
Uncertain tax position maximum percentage									50.00%
Resident revenue	$ 115,098	$ 115,650	$ 114,627	$ 114,643	$ 116,971	$ 117,318	$ 116,718	$ 115,990	$ 460,018	$ 466,997	$ 447,448
Contract liabilities for deferred fees recognized into revenue									4,500	3,900
Contract liabilities for deferred fees included as deferred income	3,900				5,800				3,900	5,800
Customer deposits	1,302				1,394				$ 1,302	$ 1,394
Percentage of revenue from Medicare and Medicaid programs									5.40%	5.60%	5.50%
Provider of services under Medicaid program, number of communities | Community									40	41	40
Provider of services under Medicare program, number of communities | Community									0	0	0
Resident receivables due period									30 days
Allowance for doubtful accounts	$ 6,793				$ 4,881				$ 6,793	$ 4,881	$ 4,253			$ 3,188
Senior housing communities on lease by company | Community	46				46				46	46
Communities on operating lease | Community	44				48				44	48
Senior housing communities on capital lease and financing obligations | Community	2				2				2	2
Outstanding unvested restricted stock | shares									1,300,000	900,000	800,000
Repurchase of common stock | shares									0	0	144,315	349,800
Number of reporting segment | Segment									1
Number of operating segment | Segment									1
2007 Omnibus Stock and Incentive Plan [Member]
Accounting Policies [Line Items]
Authorized shares of common stock | shares	4,600,000								4,600,000
Number of shares of common stock reserved for future issuance | shares	286,000								286,000
Ventas [Member]
Accounting Policies [Line Items]
Acquisition of senior housing community | Community													4
Rental and Other Services [Member]
Accounting Policies [Line Items]
Resident revenue									$ 452,500	$ 458,300
Ancillary Services [Member]
Accounting Policies [Line Items]
Resident revenue									4,700	5,100
Community Fees [Member]
Accounting Policies [Line Items]
Resident revenue									2,800	3,600
Customer deposits	$ 1,100				$ 1,300				$ 1,100	$ 1,300
Maximum [Member]
Accounting Policies [Line Items]
Residency agreements duration period									1 year

Summary of Significant Accoun_6

Summary of Significant Accounting Policies - Computation of Basic and Diluted Net Loss Per Share (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2017	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Accounting Policies [Abstract]
Net loss	$ (26,291)	$ (11,089)	$ (9,060)	$ (7,156)	$ (6,359)	$ (8,132)	$ (7,835)	$ (21,842)	$ (53,596)	$ (44,168)	$ (28,017)
Net loss allocated to unvested restricted shares									0	0	0
Undistributed net loss allocated to common shares									$ (53,596)	$ (44,168)	$ (28,017)
Weighted average shares outstanding — basic	29,908	29,877	29,831	29,627	29,531	29,512	29,478	29,288	29,812	29,453	28,909
Effects of dilutive securities:
Employee equity compensation plans									0	0	0
Weighted average shares outstanding — diluted	29,908	29,877	29,831	29,627	29,531	29,512	29,478	29,288	29,812	29,453	28,909
Basic net loss per share	$ (880)	$ (370)	$ (300)	$ (240)	$ (220)	$ (280)	$ (270)	$ (750)	$ (1.80)	$ (1.50)	$ (0.97)
Diluted net loss per share	$ (880)	$ (370)	$ (300)	$ (240)	$ (220)	$ (280)	$ (270)	$ (750)	$ (1.80)	$ (1.50)	$ (0.97)

Acquisitions - Additional Infor

Acquisitions - Additional Information (Detail) - Ventas [Member] $ in Millions	Jan. 31, 2017USD ($)Community	Mar. 31, 2017USD ($)
Business Acquisition [Line Items]
Acquisition cost	$ 85
Number of acquisition closed | Community	4
Payments for rent	$ 2.3
Number of remaining lease communities | Community	7
Lease termination obligation	$ 16
Estimated fair value of the acquired entities	88.1
Business acquisition, aggregate consideration	101
Loss on facility lease termination		$ 12.9
Transaction cost related to acquisition	$ 0.4
Additions to property and equipment		$ 88.1
Minimum [Member]
Business Acquisition [Line Items]
Long term fixed interest rate	7.25%
Maximum [Member]
Business Acquisition [Line Items]
Long term fixed interest rate	8.50%
Bridge Loan [Member]
Business Acquisition [Line Items]
Acquisition cost	$ 65
Initial variable interest rate	4.00%
Bridge loan period	36 months

Property and Equipment - Schedu

Property and Equipment - Schedule of Property and Equipment (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 1,425,155	$ 1,403,268
Less accumulated depreciation and amortization	(366,106)	(303,482)
Property and equipment, net	1,059,049	1,099,786
Land [Member]
Property, Plant and Equipment [Line Items]
Property and equipment, gross	69,842	69,842
Land Improvements [Member]
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 25,373	24,665
Land Improvements [Member] | Minimum [Member]
Property, Plant and Equipment [Line Items]
Asset Lives	5 years
Land Improvements [Member] | Maximum [Member]
Property, Plant and Equipment [Line Items]
Asset Lives	20 years
Building and Building Improvements [Member]
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 1,158,577	1,148,816
Building and Building Improvements [Member] | Minimum [Member]
Property, Plant and Equipment [Line Items]
Asset Lives	10 years
Building and Building Improvements [Member] | Maximum [Member]
Property, Plant and Equipment [Line Items]
Asset Lives	40 years
Furniture and Equipment [Member]
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 66,202	62,614
Furniture and Equipment [Member] | Minimum [Member]
Property, Plant and Equipment [Line Items]
Asset Lives	5 years
Furniture and Equipment [Member] | Maximum [Member]
Property, Plant and Equipment [Line Items]
Asset Lives	10 years
Automobiles [Member]
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 6,344	6,236
Automobiles [Member] | Minimum [Member]
Property, Plant and Equipment [Line Items]
Asset Lives	5 years
Automobiles [Member] | Maximum [Member]
Property, Plant and Equipment [Line Items]
Asset Lives	7 years
Leasehold Improvements [Member]
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 98,396	85,384
Construction in Progress [Member]
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 421	$ 5,711

Property and Equipment - Additi

Property and Equipment - Additional Information (Detail) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Property, Plant and Equipment [Line Items]
Capitalized computer software development costs	$ 3,800	$ 3,200
Capitalized computer software development costs, accumulated depreciation and amortization	3,100	3,000
Assets under capital lease included in Property and Equipment	1,425,155	1,403,268
Assets under capital lease, accumulated amortization	366,106	303,482
Assets Held under Capital Leases [Member]
Property, Plant and Equipment [Line Items]
Assets under capital lease included in Property and Equipment	31,800	31,800
Assets under capital lease, accumulated amortization	$ 16,300	$ 15,400

Other Assets - Schedule of Othe

Other Assets - Schedule of Other Assets (Detail) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Deferred Costs Capitalized Prepaid And Other Assets Disclosure [Abstract]
Deferred lease costs, net	$ 4,715	$ 5,555
Security and other deposits	9,889	10,234
Other	1,881	3,047
Other assets, net	$ 16,485	$ 18,836

Accrued Expenses - Schedule of

Accrued Expenses - Schedule of Accrued Expenses (Detail) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Other Income And Expenses [Abstract]
Accrued salaries, bonuses and related expenses	$ 11,996	$ 13,015
Accrued property taxes	14,079	14,208
Accrued interest	3,066	3,757
Accrued health claims and workers comp	4,845	4,547
Accrued professional fees	1,012	763
Other	6,882	4,461
Accrued Expenses, Current, Total	$ 41,880	$ 40,751

Notes Payable - Schedule of Not

Notes Payable - Schedule of Notes Payable (Detail) - Notes Payable [Member] - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Debt Instrument [Line Items]
Average Monthly Payment	$ 5,412
Interest rate	4.64%
Notes Payable	$ 983,207	$ 967,332
Less deferred loan costs, net	9,457	9,398
Deferred loan costs, Total	973,750	957,934
Less current portion	14,342	19,728
Notes payable, Noncurrent, Total	$ 959,408	938,206
Fannie Mae Maturing on August 2021 [Member]
Debt Instrument [Line Items]
Interest rate	5.69%
Maturity Date	2021-08
Notes Payable		12,283
Fannie Mae Maturing on October 2021 [Member]
Debt Instrument [Line Items]
Interest rate	4.97%
Maturity Date	2021-10
Notes Payable		4,331
Fannie Mae Two Maturing on October 2021 [Member]
Debt Instrument [Line Items]
Interest rate	4.92%
Maturity Date	2021-10
Notes Payable		17,097
Fannie Mae Three Maturing on October 2021 [Member]
Debt Instrument [Line Items]
Interest rate	5.19%
Maturity Date	2021-10
Notes Payable		4,839
Fannie Mae Maturing on November 2021 [Member]
Debt Instrument [Line Items]
Interest rate	4.92%
Maturity Date	2021-11
Notes Payable		19,886
Fannie Mae Maturing on March 2022 [Member]
Debt Instrument [Line Items]
Interest rate	4.38%
Maturity Date	2022-03
Notes Payable		4,831
Fannie Mae Maturing on April 2022 [Member]
Debt Instrument [Line Items]
Interest rate	4.76%
Maturity Date	2022-04
Notes Payable		10,403
Fannie Mae Two Maturing on April 2022 [Member]
Debt Instrument [Line Items]
Interest rate	4.85%
Maturity Date	2022-04
Notes Payable		3,470
Fannie Mae Three Maturing on April 2022 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	$ 135
Net Book Value Of Collateral	$ 25,781
Interest rate	4.69%
Maturity Date	2022-04
Notes Payable	$ 23,127	23,637
Fannie Mae Four Maturing on April 2022 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	11
Net Book Value Of Collateral	$ 4,140
Interest rate	4.97%
Maturity Date	2022-04
Notes Payable	$ 1,991	2,022
Fannie Mae Maturing on May 2022 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	60
Net Book Value Of Collateral	$ 14,707
Interest rate	4.48%
Maturity Date	2022-05
Notes Payable	$ 10,462	10,699
Fannie Mae Two Maturing on May 2022 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	20
Net Book Value Of Collateral	$ 14,707
Interest rate	4.85%
Maturity Date	2022-05
Notes Payable	$ 3,640	3,697
Fannie Mae Maturing on November 2022 [Member]
Debt Instrument [Line Items]
Interest rate	4.34%
Maturity Date	2022-11
Notes Payable		26,382
Fannie Mae Two Maturing on November 2022 [Member]
Debt Instrument [Line Items]
Interest rate	4.50%
Maturity Date	2022-11
Notes Payable		5,881
Fannie Mae Three Maturing on November 2022 [Member]
Debt Instrument [Line Items]
Interest rate	5.49%
Maturity Date	2022-11
Notes Payable		7,403
Fannie Mae Maturing on January 2023 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	$ 84
Net Book Value Of Collateral	$ 16,577
Interest rate	4.32%
Maturity Date	2023-01
Notes Payable	$ 15,194	15,532
Fannie Mae Two Maturing on January 2023 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	49
Net Book Value Of Collateral	$ 16,577
Interest rate	5.39%
Maturity Date	2023-01
Notes Payable	$ 8,327	8,453
Fannie Mae Three Maturing on January 2023 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	39
Net Book Value Of Collateral	$ 7,943
Interest rate	4.58%
Maturity Date	2023-01
Notes Payable	$ 6,808	6,953
Fannie Mae Four Maturing on January 2023 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	17
Net Book Value Of Collateral	$ 7,943
Interest rate	5.49%
Maturity Date	2023-01
Notes Payable	$ 2,990	3,029
Fannie Mae Maturing on April 2023 [Member]
Debt Instrument [Line Items]
Interest rate	4.66%
Maturity Date	2023-04
Notes Payable		15,131
Fannie Mae Two Maturing on April 2023 [Member]
Debt Instrument [Line Items]
Interest rate	5.46%
Maturity Date	2023-04
Notes Payable		3,068
Fannie Mae Maturing on October 2023 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	$ 45
Net Book Value Of Collateral	$ 8,166
Interest rate	5.93%
Maturity Date	2023-10
Notes Payable	$ 7,092	7,205
Fannie Mae Maturing on November 2023 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	67
Net Book Value Of Collateral	$ 12,893
Interest rate	5.50%
Maturity Date	2023-11
Notes Payable	$ 10,992	11,180
Fannie Mae Two Maturing on November 2023 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	67
Net Book Value Of Collateral	$ 12,202
Interest rate	5.38%
Maturity Date	2023-11
Notes Payable	$ 11,042	11,236
Fannie Mae Maturing on January 2024 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	282
Net Book Value Of Collateral	$ 50,722
Interest rate	5.56%
Maturity Date	2024-01
Notes Payable	$ 45,892	46,662
Fannie Mae Maturing on July 2024[Member]
Debt Instrument [Line Items]
Average Monthly Payment	632
Net Book Value Of Collateral	$ 109,519
Interest rate	4.24%
Maturity Date	2024-07
Notes Payable	$ 118,715	121,141
Fannie Mae Two Maturing on July 2024 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	120
Net Book Value Of Collateral	$ 25,091
Interest rate	4.48%
Maturity Date	2024-07
Notes Payable	$ 21,963	22,394
Fannie Mae Three Maturing on July 2024 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	81
Net Book Value Of Collateral	$ 19,891
Interest rate	4.30%
Maturity Date	2024-07
Notes Payable	$ 15,156	15,462
Fannie Mae Four Maturing on July 2024 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	91
Net Book Value Of Collateral	$ 65,624
Interest rate	4.98%
Maturity Date	2024-07
Notes Payable	$ 16,322	16,579
Fannie Mae Five Maturing On July 2024 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	11
Net Book Value Of Collateral	$ 9,290
Interest rate	6.30%
Maturity Date	2024-07
Notes Payable	$ 1,796
Fannie Mae Maturing on September 2024 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	134
Net Book Value Of Collateral	$ 26,589
Interest rate	4.59%
Maturity Date	2024-09
Notes Payable	$ 24,342	24,805
Fannie Mae Two Maturing on September 2024 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	22
Net Book Value Of Collateral	$ 13,433
Interest rate	5.72%
Maturity Date	2024-09
Notes Payable	$ 3,634	3,682
Fannie Mae Three Maturing on September 2024 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	54
Net Book Value Of Collateral	$ 10,256
Interest rate	4.70%
Maturity Date	2024-09
Notes Payable	$ 9,683	9,864
Fannie Mae Maturing on January 2025 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	53
Net Book Value Of Collateral	$ 11,808
Interest rate	4.50%
Maturity Date	2025-01
Notes Payable	$ 9,731	9,915
Fannie Mae Two Maturing on January 2025 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	95
Net Book Value Of Collateral	$ 6,351
Interest rate	4.46%
Maturity Date	2025-01
Notes Payable	$ 17,686	18,023
Fannie Mae Maturing on February 2025 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	70
Net Book Value Of Collateral	$ 15,106
Interest rate	4.35%
Maturity Date	2025-02
Notes Payable	$ 13,179	13,434
Fannie Mae Maturing on March 2025 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	109
Net Book Value Of Collateral	$ 8,496
Interest rate	3.85%
Maturity Date	2025-03
Notes Payable	$ 21,633	22,086
Fannie Mae Maturing on April 2025 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	102
Net Book Value Of Collateral	$ 23,648
Interest rate	3.84%
Maturity Date	2025-04
Notes Payable	$ 20,324	20,749
Fannie Mae Two Maturing on April 2025 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	31
Net Book Value Of Collateral	$ 23,648
Interest rate	5.53%
Maturity Date	2025-04
Notes Payable	$ 5,300	5,372
Fannie Mae Maturing on June 2025 [Member]
Debt Instrument [Line Items]
Interest rate	4.55%
Maturity Date	2025-06
Notes Payable		8,794
Fannie Mae Two Maturing on June 2025 [Member]
Debt Instrument [Line Items]
Interest rate	4.79%
Maturity Date	2025-06
Notes Payable		10,753
Fannie Mae Three Maturing on June 2025 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	$ 81
Net Book Value Of Collateral	$ 15,219
Interest rate	5.30%
Maturity Date	2025-06
Notes Payable	$ 13,335	13,580
Fannie Mae Four Maturing on June 2025 [Member]
Debt Instrument [Line Items]
Interest rate	5.71%
Maturity Date	2025-06
Notes Payable		4,079
Fannie Mae Maturing on October 2025 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	$ 58
Net Book Value Of Collateral	$ 12,481
Interest rate	4.69%
Maturity Date	2025-10
Notes Payable	$ 10,595	10,780
Fannie Mae Two Maturing on October 2025 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	44
Net Book Value Of Collateral	$ 9,256
Interest rate	4.70%
Maturity Date	2025-10
Notes Payable	$ 8,008	8,147
Fannie Mae Maturing on December 2025 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	273
Net Book Value Of Collateral	$ 38,141
Interest rate	4.68%
Maturity Date	2025-12
Notes Payable	$ 50,295	51,163
Fannie Mae Two Maturing on December 2025 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	9
Net Book Value Of Collateral	$ 7,577
Interest rate	5.81%
Maturity Date	2025-12
Notes Payable	$ 1,426	1,445
Fannie Mae Maturing on April 2026 [Member]
Debt Instrument [Line Items]
Interest rate	5.43%
Maturity Date	2026-04
Notes Payable		10,443
Fannie Mae Two Maturing on April 2026 [Member]
Debt Instrument [Line Items]
Interest rate	5.84%
Maturity Date	2026-04
Notes Payable		4,903
Fannie Mae Maturing on October 2026 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	$ 98
Net Book Value Of Collateral	$ 21,982
Interest rate	4.10%
Maturity Date	2026-10
Notes Payable	$ 19,498	19,854
Fannie Mae Maturing on December 2026 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	108
Net Book Value Of Collateral	$ 24,350
Interest rate	4.24%
Maturity Date	2026-12
Notes Payable	$ 21,243	21,617
Protective Life Maturing on April 2025 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	96
Net Book Value Of Collateral	$ 24,088
Interest rate	3.55%
Maturity Date	2025-04
Notes Payable	$ 19,787	20,234
Fannie Mae Maturing on January 2029 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	652
Net Book Value Of Collateral	$ 160,096
Interest rate	5.13%
Maturity Date	2029-01
Notes Payable	$ 150,782
Protective Life Maturing on August 2025 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	49
Net Book Value Of Collateral	$ 10,994
Interest rate	4.25%
Maturity Date	2025-08
Notes Payable	$ 9,350	9,535
Fannie Mae Two Maturing on January 2029 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	194
Net Book Value Of Collateral	$ 160,096
Maturity Date	2029-01
Notes Payable	$ 50,261
Protective Life Maturing on September 2025 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	78
Net Book Value Of Collateral	$ 17,506
Interest rate	4.25%
Maturity Date	2025-09
Notes Payable	$ 14,871	15,163
Protective Life Maturing on November 2025 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	138
Net Book Value Of Collateral	$ 32,096
Interest rate	4.25%
Maturity Date	2025-11
Notes Payable	$ 26,478	26,993
Protective Life Maturing on February 2026 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	57
Net Book Value Of Collateral	$ 13,460
Interest rate	4.50%
Maturity Date	2026-02
Notes Payable	$ 10,761	10,959
Protective Life Maturing on March 2026 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	187
Net Book Value Of Collateral	$ 41,379
Interest rate	4.38%
Maturity Date	2026-03
Notes Payable	$ 32,920	33,705
Protective Life Maturing on October 2031 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	70
Net Book Value Of Collateral	$ 15,019
Interest rate	4.13%
Maturity Date	2031-10
Notes Payable	$ 12,326	12,645
Berkadia Maturing on February 2020 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	378
Net Book Value Of Collateral	$ 93,631
Maturity Date	2020-02
Notes Payable	$ 65,000	65,000
Berkadia Maturing on July 2020 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	18
Net Book Value Of Collateral	$ 7,292
Maturity Date	2020-07
Notes Payable	$ 3,500
HUD Maturing on September 2045 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	16
Net Book Value Of Collateral	$ 5,356
Interest rate	4.48%
Maturity Date	2045-09
Notes Payable	$ 2,933	2,989
Insurance Financing Maturing on May 2018 [Member]
Debt Instrument [Line Items]
Interest rate	2.76%
Maturity Date	2018-05
Notes Payable		725
Insurance Financing Maturing on November 2018 [Member]
Debt Instrument [Line Items]
Interest rate	3.04%
Maturity Date	2018-11
Notes Payable		3,505
Berkadia Maturing on October 2021 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	$ 97
Net Book Value Of Collateral	$ 18,785
Maturity Date	2021-10
Notes Payable	$ 11,255	$ 11,505
Insurance Financing Maturing on May 2019 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	$ 160
Interest rate	3.64%
Maturity Date	2019-05
Notes Payable	$ 799
Insurance Financing Maturing on November 2019 [Member]
Debt Instrument [Line Items]
Average Monthly Payment	$ 70
Interest rate	4.40%
Maturity Date	2019-11
Notes Payable	$ 763

Notes Payable - Schedule of N_2

Notes Payable - Schedule of Notes Payable (Parenthetical) (Detail)	12 Months Ended
	Dec. 31, 2018Facility
Debt Instrument [Line Items]
Number of facilities owned	80
Notes Payable [Member] | Fannie Mae Two Maturing on January 2029 [Member]
Debt Instrument [Line Items]
Basis on variable rate	2.14%
Interest Rate	4.57%
Notes Payable [Member] | Berkadia Maturing on February 2020 [Member]
Debt Instrument [Line Items]
Basis on variable rate	4.00%
Interest Rate	6.89%
Notes Payable [Member] | Berkadia Maturing on July 2020 [Member]
Debt Instrument [Line Items]
Basis on variable rate	3.75%
Interest Rate	6.21%
Notes Payable [Member] | Berkadia Maturing on October 2021 [Member]
Debt Instrument [Line Items]
Basis on variable rate	5.00%
Interest Rate	7.89%

Notes Payable - Summary of Aggr

Notes Payable - Summary of Aggregate Scheduled Maturities of Notes (Detail) - Notes Payable [Member] $ in Thousands	Dec. 31, 2018USD ($)
Debt Instrument [Line Items]
2,019	$ 16,050
2,020	83,595
2,021	26,254
2,022	54,381
2,023	74,729
Thereafter	728,198
Total	$ 983,207

Notes Payable - Additional Info

Notes Payable - Additional Information (Detail)

Dec. 18, 2018USD ($)CommunityLoan

Dec. 01, 2018USD ($)

Nov. 30, 2018USD ($)Community

Jun. 29, 2018Community

Dec. 15, 2017USD ($)Community

Dec. 01, 2017USD ($)

Nov. 30, 2017USD ($)Community

May 31, 2017USD ($)

Jan. 31, 2017USD ($)

May 31, 2018USD ($)

Dec. 31, 2018USD ($)Community

Dec. 31, 2017USD ($)

Debt Instrument [Line Items]

Senior housing communities operated by company | Community

21

129

Deferred financing cost

$ 14,100,000

$ 14,000,000

Accumulated amortization

4,700,000

$ 4,600,000

Amortization expense

1,700,000

Hartford Financial Services [Member]

Debt Instrument [Line Items]

Letters of credit remain outstanding

3,400,000

Welltower, Inc. [Member]

Debt Instrument [Line Items]

Letters of credit remain outstanding

6,700,000

HCP, Inc. [Member]

Debt Instrument [Line Items]

Letters of credit remain outstanding

$ 2,900,000

Mortgage Loan [Member] | Ventas [Member]

Debt Instrument [Line Items]

Mortgage debt

$ 65,000,000

Debt instrument, repayment term

3 years

Deferred financing costs amortization period

3 years

Acquisition price at a variable rate

LIBOR

Deferred financing cost

$ 900,000

Berkadia Commercial Mortgage LLC [Member] | Variable Interest Rate LIBOR Plus 3.75% Loan [Member]

Debt Instrument [Line Items]

Senior housing communities operated by company | Community

1

Mortgage debt

$ 3,500,000

Debt instrument, repayment term

18 months

Deferred financing costs amortization period

18 months

Acquisition price at a variable rate

LIBOR plus 3.75%

Debt instrument variable interest rate

3.75%

Deferred financing costs

$ 91,000

Berkadia Commercial Mortgage LLC [Member] | Variable Interest Rate LIBOR Plus 5.0% Loan [Member]

Debt Instrument [Line Items]

Senior housing communities operated by company | Community

1

Deferred financing costs amortization period

25 years

Acquisition price at a variable rate

LIBOR plus 5.0%

Debt instrument variable interest rate

5.00%

Debt instrument maturity date

Oct. 10, 2021

LIBOR [Member] | Mortgage Loan [Member] | Ventas [Member]

Debt Instrument [Line Items]

Debt instrument variable interest rate

4.00%

Fannie Mae [Member]

Debt Instrument [Line Items]

Repayment of mortgage loans

170,600,000

Fannie Mae [Member] | 6.30% [Member] | Texas [Member]

Debt Instrument [Line Items]

Senior housing communities operated by company | Community

1

Mortgage debt

$ 1,800,000

Fixed interest rate

6.30%

Mortgage debt maturity

2024-07

Deferred financing cost

$ 100,000

Fannie Mae [Member] | 5.71% [Member] | New York [Member]

Debt Instrument [Line Items]

Senior housing communities operated by company | Community

1

Mortgage debt

$ 4,100,000

Fixed interest rate

5.71%

Mortgage debt maturity

2025-06

Deferred financing cost

$ 200,000

Fannie Mae [Member] | 5.49% [Member] | Ohio [Member]

Debt Instrument [Line Items]

Senior housing communities operated by company | Community

1

Mortgage debt

$ 3,000,000

Fixed interest rate

5.49%

Mortgage debt maturity

2023-01

Deferred financing cost

$ 100,000

Mortgage Loans [Member]

Debt Instrument [Line Items]

Mortgage debt

$ 201,000,000

Number of mortgage loans | Loan

2

Deferred financing costs amortization period

10 years

Deferred financing costs

$ 3,000,000

Unamortized deferred financing cost

1,500,000

Prepayment premiums

11,100,000

Mortgage Loans [Member] | Long-term Fixed Interest Rate Debt [Member]

Debt Instrument [Line Items]

Mortgage debt

$ 150,800,000

Debt instrument, fixed interest rate

5.13%

Debt instrument, repayment term

10 years

Deferred financing costs amortization period

30 years

Mortgage Loans [Member] | Long-term Fixed Interest Rate Debt [Member] | Interest Only Period [Member]

Debt Instrument [Line Items]

Debt instrument, repayment term

36 months

Mortgage Loans [Member] | Long-term Variable Interest Rate [Member]

Debt Instrument [Line Items]

Mortgage debt

$ 50,300,000

Debt instrument, repayment term

10 years

Acquisition price at a variable rate

LIBOR plus 2.14%

Debt instrument variable interest rate

2.14%

Fixed monthly principal component

$ 67,000,000

Mortgage Loans [Member] | Long-term Variable Interest Rate [Member] | Interest Only Period [Member]

Debt Instrument [Line Items]

Debt instrument, repayment term

36 months

4.40%,11-Month Term Financing Agreement [Member]

Debt Instrument [Line Items]

Debt instrument, fixed interest rate

4.40%

Debt instrument, repayment term

11 months

Insurance finance agreement, outstanding amount

$ 800,000

3.64%,11-Month Term Financing Agreement [Member]

Debt Instrument [Line Items]

Debt instrument, fixed interest rate

3.64%

Debt instrument, repayment term

11 months

Insurance finance agreement, outstanding amount

$ 1,700,000

3.04% Insurance Financing Agreement [Member]

Debt Instrument [Line Items]

Debt instrument, fixed interest rate

3.04%

Debt instrument, repayment term

11 months

Insurance finance agreement, outstanding amount

$ 3,500,000

2.76% Insurance Financing Agreement [Member]

Debt Instrument [Line Items]

Debt instrument, fixed interest rate

2.76%

Debt instrument, repayment term

11 months

Insurance finance agreement, outstanding amount

$ 1,600,000

Equity - Additional Information

Equity - Additional Information (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2009	Jan. 22, 2009
Equity [Abstract]
Preferred stock, shares outstanding	0	0
Authorization for purchase of company's common stock					$ 10,000,000
Purchase common stock shares	0	0	144,315	349,800
Average cost of per share			$ 17.29	$ 2.67
Purchase common stock value			$ 2,496,000	$ 900,000

Stock-Based Compensation - Addi

Stock-Based Compensation - Additional Information (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock options vesting period, Minimum	1 year
Stock options vesting period, Maximum	5 years
Number of stock options outstanding	0	0
Period of recognition for compensation expense, Minimum	1 year
Period of recognition for compensation expense, Maximum	4 years
Unrecognized stock based compensation expense, net of estimated forfeitures	$ 9,500,000
General and Administrative Expenses [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Compensation expense recognized	8,400,000	$ 7,700,000	$ 11,600,000
Restricted Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Compensation expense recognized	0
Restricted stock outstanding, intrinsic value	$ 9,100,000	$ 13,000,000	$ 13,300,000
Restricted common stock, Granted	830,794	565,745	666,883
Performance and market based restricted stock, Granted	237,840
Average market value of common stock awarded to certain employees and directors of company	$ 11.08
Restricted stock award vesting period, Minimum	1 year
Restricted stock award vesting period, Maximum	4 years
Restricted stock outstanding	$ 9,200,000
Restricted Stock [Member] | Directors [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Restricted common stock, Granted	67,356
Average market value of common stock awarded to certain employees and directors of company	$ 10.69
Restricted stock outstanding	$ 700,000
Restricted stock award vesting period	1 year
Performance and Market Based Stock Awards [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Restricted stock award vesting period	3 years
Performance and Market Based Stock Awards [Member] | Minimum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected period of expenses	1 year
Performance and Market Based Stock Awards [Member] | Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected period of expenses	3 years
Nonperformance Based Stock Awards [Member] | Minimum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected period of expenses	1 year
Nonperformance Based Stock Awards [Member] | Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected period of expenses	4 years

Stock-Based Compensation - Stoc

Stock-Based Compensation - Stock Option Activity and Related Information (Detail) - $ / shares	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Shares, Outstanding Beginning of Year			3,000
Shares, Granted	0	0	0
Shares, Exercised			3,000
Shares, Forfeited	0	0	0
Weighted average exercise price per share, Outstanding Beginning of Year			$ 10.97
Weighted average exercise price per share, Granted	$ 0	$ 0	0
Weighted average exercise price per share, Exercised			10.97
Weighted average exercise price per share, Forfeited	$ 0	$ 0	$ 0

Stock-Based Compensation - Rest

Stock-Based Compensation - Restricted Stock Awards Activity and Related Information (Detail) - Restricted Stock [Member] - shares	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares, Outstanding Beginning of Year	964,484	829,766	783,310
Shares, Issued	830,794	565,745	666,883
Shares, Vested	(386,900)	(355,400)	(565,224)
Shares, Forfeited	(63,219)	(75,627)	(55,203)
Shares, Outstanding End of Year	1,345,159	964,484	829,766

Income Taxes - Schedule of (Ben

Income Taxes - Schedule of (Benefit) Provision for Income Taxes (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Current:
Federal	$ (152)	$ 6	$ 0
State	474	550	435
Deferred:
Federal	(2,093)	1,940	0
State	0	0	0
(Benefit) Provision for income taxes	$ (1,771)	$ 2,496	$ 435

Income Taxes - (Benefit) Provis

Income Taxes - (Benefit) Provision for Income Taxes Differed from Amounts of Income Tax (Benefit) Provision Determined by Applying Federal Statutory Income Tax Rate to Income Before (Benefit) Provision for Income Taxes (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Income Tax Disclosure [Abstract]
Tax benefit at federal statutory rates	$ (11,627)	$ (14,168)	$ (9,335)
State income tax benefit, net of federal effects	(665)	(648)	(550)
Change in deferred tax asset valuation allowance	9,543	7,857	8,569
Tax reform impact on deferred income taxes		13,959
Share based compensation ASU 2016-09 adoption		(5,326)
Other	978	822	1,751
(Benefit) Provision for income taxes	$ (1,771)	$ 2,496	$ 435

Income Taxes - Additional Infor

Income Taxes - Additional Information (Detail)	12 Months Ended
	Dec. 31, 2018USD ($)Community	Dec. 31, 2017USD ($)Community	Dec. 31, 2016USD ($)Community	Dec. 31, 2015USD ($)
Income Taxes [Line Items]
Corporate statutory tax rate	21.00%	34.00%
TCJA, provisional remeasurement, net reduction in value of deferred tax assets and liabilities		$ 14,000,000
TCJA, remeasurement, net reduction in value of deferred tax assets		15,900,000
TCJA, Alternative Minimum Tax, provisional income tax benefit		$ 300,000
TCJA, reduction of maximum deduction for net operating loss carryforwards, percentage of taxable income for losses arising in future tax years		80.00%
Adjustments to valuation allowance	$ (2,200,000)	$ 2,200,000
Deferred tax assets related to federal Net operating loss carry forwards	30,900,000
Deferred tax assets related to state Net operating loss carry forwards	$ 6,700,000
Uncertain tax position maximum percentage	50.00%
Unrecognized tax benefits	$ 4,644,000	$ 3,416,000	$ 3,786,000	$ 0
Domestic Tax Authority [Member]
Income Taxes [Line Items]
Net operating loss carry forwards	147,200,000
AMT credit carryforward	$ 200,000
Domestic Tax Authority [Member] | Earliest Tax Year [Member] | Prior Fiscal Year
Income Taxes [Line Items]
NOL expiration year	2,033
Domestic Tax Authority [Member] | Latest Tax Year [Member] | Prior Fiscal Year
Income Taxes [Line Items]
NOL expiration year	2,037
State and Local Jurisdiction [Member]
Income Taxes [Line Items]
Net operating loss carry forwards	$ 121,200,000
State and Local Jurisdiction [Member] | Earliest Tax Year [Member] | Prior Fiscal Year
Income Taxes [Line Items]
NOL expiration year	2,019
State and Local Jurisdiction [Member] | Latest Tax Year [Member] | Prior Fiscal Year
Income Taxes [Line Items]
NOL expiration year	2,038
Texas [Member]
Income Taxes [Line Items]
Number of communities consolidated | Community	38	38	38

Income Taxes - Summary of Defer

Income Taxes - Summary of Deferred Tax Assets and Liabilities (Detail) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Deferred tax assets:
Deferred gains on sale/leaseback transactions	$ 2,440	$ 2,890
Net operating loss carryforward	33,252	25,441
Compensation costs	3,087	2,245
Depreciation and amortization	5,323	4,367
Other	2,330	2,099
Total deferred tax assets	46,432	37,042
Deferred tax asset valuation allowance	(46,280)	(36,737)
Total deferred tax assets, net	152	305
Deferred tax liabilities:
Depreciation and amortization		(2,246)
Total deferred tax liabilities		(2,246)
Deferred taxes, net	$ 152
Deferred taxes, net		$ (1,941)

Income Taxes - Schedule of Unre

Income Taxes - Schedule of Unrecognized Tax Benefits Activity and Related Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Income Tax Disclosure [Abstract]
Beginning balance, January 1	$ 3,416	$ 3,786	$ 0
Gross increases – tax positions in prior period	1,228		2,451
Gross decreases – tax positions in prior period		(370)	0
Gross increases – tax positions in current period			1,335
Settlements		0	0
Lapse of statute of limitations		0	0
Ending balance, December 31	$ 4,644	$ 3,416	$ 3,786

Employee Benefit Plans - Additi

Employee Benefit Plans - Additional Information (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Compensation Related Costs [Abstract]
Employer matching contributions from annual salary	4.00%
Percentage of employer match	50.00%
Contributed to the Plan annually	$ 500,000	$ 500,000	$ 500,000
Administrative expenses	$ 25,000	$ 21,300	$ 24,600

Contingencies - Additional Info

Contingencies - Additional Information (Detail)	3 Months Ended	6 Months Ended	12 Months Ended
	Sep. 30, 2017USD ($)Community	Dec. 31, 2018USD ($)Community	Dec. 31, 2018USD ($)Community	Dec. 31, 2017USD ($)	Dec. 31, 2015USD ($)
Loss Contingencies [Line Items]
Senior housing communities owned by company | Community		83	83
Hurricane related expenses deductible for insurance claim	$ 100,000
Clean-up and physical repair costs		$ 6,900,000
Payments received from insurance underwriters			$ 9,200,000	$ 2,700,000
Business interruption insurance recoveries			$ 5,100,000	2,200,000
Condition for employer shared responsibility payment			The ESRP is applicable to employers that had 50 or more full-time equivalent employees, did not offer minimum essential coverage (“MEC”) to at least 70% of full-time employees and their dependents, or did offer MEC to at least 70% of full-time employees and their dependents which did not meet the affordable or minimum value criteria and had one or more full-time employees certified as being allowed the premium tax credit (“PTC”).
Employer Shared Responsibility Payment accrued in employee benefit reserves		11,996,000	$ 11,996,000	$ 13,015,000
Internal Revenue Service [Member]
Loss Contingencies [Line Items]
Employer shared responsibility payment contingent liability		83,200,000	83,200,000		$ 2,100,000
Internal Revenue Service [Member] | ESRP Penalties [Member]
Loss Contingencies [Line Items]
Employer Shared Responsibility Payment accrued in employee benefit reserves		$ 200,000	$ 200,000
Texas [Member]
Loss Contingencies [Line Items]
Senior housing communities owned by company | Community	2

Fair Value of Financial Instr_3

Fair Value of Financial Instruments - Carrying Amounts and Fair Values of Financial Instruments (Detail) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Restricted cash	$ 13,011	$ 13,378
Carrying Amount [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Cash and cash equivalents	31,309	17,646
Restricted cash	13,011	13,378
Notes payable, excluding deferred loan costs	983,207	967,332
Fair Value [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Cash and cash equivalents	31,309	17,646
Restricted cash	13,011	13,378
Notes payable, excluding deferred loan costs	$ 945,318	$ 929,000

Allowance for Doubtful Accoun_3

Allowance for Doubtful Accounts - Schedule of Allowance for Doubtful Accounts (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Receivables [Abstract]
Balance at beginning of year	$ 4,881	$ 4,253	$ 3,188
Provision for bad debts, net of recoveries	2,990	1,748	1,727
Write-offs and other	(1,078)	(1,120)	(662)
Balance at end of year	$ 6,793	$ 4,881	$ 4,253

Leases - Additional Information

Leases - Additional Information (Detail) $ in Millions	Jan. 31, 2017USD ($)Community	Jun. 30, 2018USD ($)	Jun. 30, 2017USD ($)	Jun. 30, 2016USD ($)	Jun. 30, 2015USD ($)Property	Dec. 31, 2018USD ($)CommunityLeaseProperty	Dec. 31, 2017USD ($)	Dec. 31, 2016USD ($)Community
Loans And Leases [Line Items]
Number of new facility leases | Lease						0
Number of leased senior housing communities | Community						46
Period of Initial lease terms in which deferred lease acquisition costs are being amortized						5 years
Lease contracts period						5 years
Incurred lease expense						$ 60.6	$ 59.7	$ 64.5
Deferred lease costs, Gross						12.4
Accumulated amortization cost						8	$ 7.2
Expected amortization expense next 12 months						0.8
Expected amortization expense year two						0.8
Expected amortization expense year three						0.8
Expected amortization expense year four						0.8
Expected amortization expense year five						$ 0.8
HCP [Member]
Loans And Leases [Line Items]
Number of leased senior housing communities | Community						15
Capital improvement project						$ 3.3
Number of Lease Extension Available | Property					1	2
Lease agreements initial terms						10 years
Available renewal extension period						10 years
Lease acquisition costs incurred						$ 1.6
Period of Initial lease terms in which deferred lease acquisition costs are being amortized						10 years
Welltower [Member]
Loans And Leases [Line Items]
Number of leased senior housing communities | Community						24
Number of Lease Extension Available | Property						1
Lease agreements initial terms						15 years
Available renewal extension period						15 years
Lease acquisition costs incurred						$ 2.1
Period of Initial lease terms in which deferred lease acquisition costs are being amortized						15 years
Minimum [Member] | HCP [Member]
Loans And Leases [Line Items]
Lease agreements range						7.25%
Minimum [Member] | Welltower [Member]
Loans And Leases [Line Items]
Interim financing variable rate						7.25%
Lease expiration year and month						2025-04
Maximum [Member] | HCP [Member]
Loans And Leases [Line Items]
Lease agreements range						8.00%
Maximum [Member] | Welltower [Member]
Loans And Leases [Line Items]
Interim financing variable rate						8.50%
Lease expiration year and month						2026-04
Ventas [Member]
Loans And Leases [Line Items]
Number of leased senior housing communities | Community						7		11
Acquisition of senior housing community | Community	4
Number of senior housing communities closed | Community	4
Acquisition cost	$ 85
Capital improvement project		$ 17	$ 28.5	$ 24.5	$ 24.5
Lease expiration date						Sep. 30, 2025
Number of Lease Extension Available | Property						1
Lease agreements initial terms						5 years
Available renewal extension period						5 years
Capital improvement project, amended amount		$ 20		$ 28.5
Capital improvement project, decrease in amount			$ 17
Lease expiration extended date		Jun. 30, 2019	Jun. 30, 2018
Lease acquisition costs incurred						$ 11.4
Lease acquisition costs incurred with remaining property						$ 8.7
Number of properties accounts as operating lease | Property						5
Number of properties accounts as financing obligation | Property						2
Mortgage debt assumed						$ 18.3
Additional Cash collateral Deposits						$ 3.4
Lease period						5 years
Property and equipment amortized						$ 11.8
Additions to property and equipment						13.2
Unamortized portion of the deferred gain						$ 4.9
Lease portfolio period						5 years
Ventas [Member] | Minimum [Member]
Loans And Leases [Line Items]
Lease agreements range						6.75%
Ventas [Member] | Maximum [Member]
Loans And Leases [Line Items]
Lease agreements range						8.00%
Ventas [Member] | Bridge Loan [Member]
Loans And Leases [Line Items]
Acquisition cost	$ 65
Bridge loan period	36 months
Bridge loan extend period	6 months
Initial variable interest rate	4.00%
Ventas [Member] | Bridge Loan [Member] | LIBOR [Member]
Loans And Leases [Line Items]
Initial variable interest rate	4.00%
Interim financing variable rate description						LIBOR plus 4.0%

Leases - Summary of Company's F

Leases - Summary of Company's Facility Lease Agreements (Detail) $ in Millions	12 Months Ended
	Dec. 31, 2018USD ($)Community
Schedule Of Operating Leases [Line Items]
Lease Acquisition and Modification Costs	$ 12.4
Deferred Gains / Lease Concessions	37.1
Accumulated deferred gains / lease concessions recognized through December 31, 2018	(26.2)
Net lease acquisition costs as of December 31, 2018	4.5
Net deferred gains / lease concessions as of December 31, 2018	10.9
Property Subject to Operating Lease [Member]
Schedule Of Operating Leases [Line Items]
Accumulated amortization through December 31, 2018	$ (7.9)
Ventas September 30, 2005 [Member]
Schedule Of Operating Leases [Line Items]
Initial Date of Lease	Sep. 30, 2005
Number of Communities | Community	4
Value of Transaction	$ 61.4
Current Expiration	Sep. 30, 2025
Renewal Term	10 years
Initial Lease Rate	8.00%
Lease Acquisition and Modification Costs	$ 7.7
Deferred Gains / Lease Concessions	$ 4.2
Ventas January 31, 2008 [Member]
Schedule Of Operating Leases [Line Items]
Initial Date of Lease	Jan. 31, 2008
Number of Communities | Community	1
Value of Transaction	$ 5
Current Expiration	Sep. 30, 2025
Renewal Term	10 years
Initial Lease Rate	7.75%
Lease Acquisition and Modification Costs	$ 0.2
Ventas June 27, 2012 [Member]
Schedule Of Operating Leases [Line Items]
Initial Date of Lease	Jun. 27, 2012
Number of Communities | Community	2
Value of Transaction	$ 43.3
Current Expiration	Sep. 30, 2025
Renewal Term	10 years
Initial Lease Rate	6.75%
Lease Acquisition and Modification Costs	$ 0.8
HCP May 1, 2006 [Member]
Schedule Of Operating Leases [Line Items]
Initial Date of Lease	May 1, 2006
Number of Communities | Community	3
Value of Transaction	$ 54
Current Expiration	Oct. 31, 2020
Renewal Term	20 years
Initial Lease Rate	8.00%
Lease Acquisition and Modification Costs	$ 0.3
Deferred Gains / Lease Concessions	$ 12.8
HCP May 31, 2006 [Member]
Schedule Of Operating Leases [Line Items]
Initial Date of Lease	May 31, 2006
Number of Communities | Community	6
Value of Transaction	$ 43
Current Expiration	Apr. 30, 2026
Renewal Term	10 years
Initial Lease Rate	8.00%
Lease Acquisition and Modification Costs	$ 0.2
Deferred Gains / Lease Concessions	$ 0.6
HCP December 1, 2006 [Member]
Schedule Of Operating Leases [Line Items]
Initial Date of Lease	Dec. 1, 2006
Number of Communities | Community	4
Value of Transaction	$ 51
Current Expiration	Oct. 31, 2020
Renewal Term	20 years
Initial Lease Rate	8.00%
Lease Acquisition and Modification Costs	$ 0.7
HCP December 14, 2006 [Member]
Schedule Of Operating Leases [Line Items]
Initial Date of Lease	Dec. 14, 2006
Number of Communities | Community	1
Value of Transaction	$ 18
Current Expiration	Oct. 31, 2020
Renewal Term	20 years
Initial Lease Rate	7.75%
Lease Acquisition and Modification Costs	$ 0.3
HCP April 11, 2007 [Member]
Schedule Of Operating Leases [Line Items]
Initial Date of Lease	Apr. 11, 2007
Number of Communities | Community	1
Value of Transaction	$ 8
Current Expiration	Oct. 31, 2020
Renewal Term	20 years
Initial Lease Rate	7.25%
Lease Acquisition and Modification Costs	$ 0.1
Welltower April 16, 2010 [Member]
Schedule Of Operating Leases [Line Items]
Initial Date of Lease	Apr. 16, 2010
Number of Communities | Community	5
Value of Transaction	$ 48.5
Current Expiration	Apr. 30, 2025
Renewal Term	15 years
Initial Lease Rate	8.25%
Lease Acquisition and Modification Costs	$ 0.6
Deferred Gains / Lease Concessions	$ 0.8
Welltower May 1, 2010 [Member]
Schedule Of Operating Leases [Line Items]
Initial Date of Lease	May 1, 2010
Number of Communities | Community	3
Value of Transaction	$ 36
Current Expiration	Apr. 30, 2025
Renewal Term	15 years
Initial Lease Rate	8.25%
Lease Acquisition and Modification Costs	$ 0.2
Deferred Gains / Lease Concessions	$ 0.4
Welltower September 10, 2010 [Member]
Schedule Of Operating Leases [Line Items]
Initial Date of Lease	Sep. 10, 2010
Number of Communities | Community	12
Value of Transaction	$ 104.6
Current Expiration	Sep. 30, 2025
Renewal Term	15 years
Initial Lease Rate	8.50%
Lease Acquisition and Modification Costs	$ 0.4
Deferred Gains / Lease Concessions	$ 2
Welltower April 8, 2011 [Member]
Schedule Of Operating Leases [Line Items]
Initial Date of Lease	Apr. 8, 2011
Number of Communities | Community	4
Value of Transaction	$ 141
Current Expiration	Apr. 30, 2026
Renewal Term	15 years
Initial Lease Rate	7.25%
Lease Acquisition and Modification Costs	$ 0.9
Deferred Gains / Lease Concessions	$ 16.3

Leases - Summary of Company's_2

Leases - Summary of Company's Facility Lease Agreements (Parenthetical) (Detail) $ in Millions	Jan. 31, 2017Community	Apr. 24, 2015Property	Nov. 11, 2013LeaseProperty	Dec. 31, 2018USD ($)Property
Schedule Of Operating Leases [Line Items]
Deferred gains				$ 34.5
Lease concessions				$ 2.6
HCP [Member]
Schedule Of Operating Leases [Line Items]
Available renewal extension period			10 years
Lease expiration date		Apr. 30, 2026	Oct. 31, 2020
Number of Lease Extension Available | Property		1	2
Number of operating lease remaining | Lease			9
Ventas [Member]
Schedule Of Operating Leases [Line Items]
Available renewal extension period				5 years
Lease agreements initial terms				5 years
Lease expiration date				Sep. 30, 2025
Number of senior housing communities acquired | Community	4
Number of senior housing communities closed | Community	4
Number of Lease Extension Available | Property				1
HCP May 31, 2006 [Member]
Schedule Of Operating Leases [Line Items]
Lease concessions				$ 0.6
Lease expiration date				Apr. 30, 2026
Welltower September 10, 2010 [Member]
Schedule Of Operating Leases [Line Items]
Lease concessions				$ 2
Lease expiration date				Sep. 30, 2025

Leases - Summary of Future Mini

Leases - Summary of Future Minimum Lease Commitments (Detail) $ in Thousands	Dec. 31, 2018USD ($)
Leases [Abstract]
2,019	$ 66,455
2,020	63,929
2,021	52,093
2,022	52,062
2,023	52,026
Thereafter	97,165
Total	$ 383,730

Quarterly Financial Informati_3

Quarterly Financial Information (Unaudited) - Schedule of Quarterly Financial Information (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2017	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Quarterly Financial Information Disclosure [Abstract]
Total revenues	$ 115,098	$ 115,650	$ 114,627	$ 114,643	$ 116,971	$ 117,318	$ 116,718	$ 115,990	$ 460,018	$ 466,997	$ 447,448
Income (Loss) from operations	(3,122)	1,696	3,643	5,386	8,248	4,513	4,691	(9,610)
Net loss and comprehensive loss	$ (26,291)	$ (11,089)	$ (9,060)	$ (7,156)	$ (6,359)	$ (8,132)	$ (7,835)	$ (21,842)	$ (53,596)	$ (44,168)	$ (28,017)
Net loss per share, basic	$ (880)	$ (370)	$ (300)	$ (240)	$ (220)	$ (280)	$ (270)	$ (750)	$ (1.80)	$ (1.50)	$ (0.97)
Net loss per share, diluted	$ (880)	$ (370)	$ (300)	$ (240)	$ (220)	$ (280)	$ (270)	$ (750)	$ (1.80)	$ (1.50)	$ (0.97)
Weighted average shares outstanding, basic	29,908	29,877	29,831	29,627	29,531	29,512	29,478	29,288	29,812	29,453	28,909
Weighted average shares outstanding, fully diluted	29,908	29,877	29,831	29,627	29,531	29,512	29,478	29,288	29,812	29,453	28,909

Quarterly Financial Informati_4

Quarterly Financial Information (Unaudited) - Schedule of Quarterly Financial Information (Parenthetical) (Detail) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Quarterly Financial Information [Line Item]
General and administrative expenses related to retirement and replacement		$ 26,961	$ 23,574	$ 23,671
Write-off of deferred loan costs and prepayment premiums	$ 12,600	$ 12,623
CEO
Quarterly Financial Information [Line Item]
General and administrative expenses related to retirement and replacement	$ 4,200