AlerisLife (ALR) 10-Q 14 Nov 18 2018 Q3 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	9 Months Ended
	Sep. 30, 2018	Nov. 09, 2018
Document and Entity Information [Abstract]
Entity Registrant Name	FIVE STAR SENIOR LIVING INC.
Entity Central Index Key	1,159,281
Current Fiscal Year End Date	--12-31
Entity Filer Category	Non-accelerated Filer
Document Type	10-Q
Document Period End Date	Sep. 30, 2018
Document Fiscal Year Focus	2,018
Document Fiscal Period Focus	Q3
Entity Current Reporting Status	Yes
Amendment Flag	false
Entity Small Business	true
Entity Emerging Growth Company	false
Entity Common Stock, Shares Outstanding		50,568,224

CONDENSED CONSOLIDATED BALANCE

CONDENSED CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Sep. 30, 2018	Dec. 31, 2017
Current assets:
Cash and cash equivalents	$ 13,128	$ 26,255
Accounts receivable, net of allowance of $4,478 and $3,572 at September 30, 2018 and December 31, 2017, respectively	36,860	38,673
Due from related persons	6,062	4,774
Investments, of which $6,008 and $7,310 are restricted at September 30, 2018 and December 31, 2017, respectively	21,175	22,524
Restricted cash	20,123	20,747
Prepaid expenses and other current assets	26,870	25,132
Assets held for sale	0	59,080
Total current assets	124,218	197,185
Property and equipment, net	244,748	251,504
Equity investment of an investee	9,157	8,185
Restricted cash	1,538	1,476
Restricted investments	8,753	10,758
Other long term assets	6,211	6,800
Total assets	394,625	475,908
Current liabilities:
Revolving credit facility	0	0
Accounts payable and accrued expenses	70,419	74,734
Accrued compensation and benefits	45,057	37,893
Due to related persons	18,757	18,683
Mortgage notes payable	333	316
Accrued real estate taxes	16,430	11,801
Security deposits and current portion of continuing care contracts	3,573	4,073
Other current liabilities	39,187	36,361
Liabilities held for sale	0	34,781
Total current liabilities	193,756	218,642
Long term liabilities:
Mortgage notes payable	7,620	7,872
Accrued self insurance obligations	32,248	33,082
Deferred gain on sale and leaseback transaction	61,130	66,087
Other long term liabilities	4,903	5,231
Total long term liabilities	105,901	112,272
Commitments and contingencies
Shareholders’ equity:
Common stock, par value $.01: 75,000,000 shares authorized, 50,579,744 and 50,524,424 shares issued and outstanding at September 30, 2018 and December 31, 2017, respectively	506	505
Additional paid in capital	361,595	360,942
Accumulated deficit	(268,967)	(220,489)
Accumulated other comprehensive income	1,834	4,036
Total shareholders’ equity	94,968	144,994
TOTAL LIABILITIES AND SHAREHOLDERS' EQUITY	$ 394,625	$ 475,908

CONDENSED CONSOLIDATED BALANC_2

CONDENSED CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) $ in Thousands	Sep. 30, 2018	Dec. 31, 2017
Statement of Financial Position [Abstract]
Accounts receivable, allowance	$ 4,478	$ 3,572
Investments in available for sale securities, restricted	$ 6,008	$ 7,310
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, shares authorized (in shares)	75,000,000	75,000,000
Common stock, shares issued (in shares)	50,579,744	50,524,424
Common stock, shares outstanding (in shares)	50,579,744	50,524,424

CONDENSED CONSOLIDATED STATEMEN

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Revenues:
Total revenues	$ 348,910	$ 347,101	$ 1,037,525	$ 1,047,815
Operating expenses:
Rent expense	52,282	51,779	156,640	154,524
General and administrative expenses	18,965	17,851	57,405	56,733
Depreciation and amortization expense	9,137	9,753	26,974	29,040
Loss (gain) on sale of senior living communities	62	0	(7,131)	0
Long lived asset impairment	0	142	365	528
Total operating expenses	371,442	353,031	1,087,481	1,067,427
Operating loss	(22,532)	(5,930)	(49,956)	(19,612)
Interest, dividend and other income	192	167	577	559
Interest and other expense	(466)	(1,139)	(1,773)	(3,200)
Gain on early extinguishment of debt	0	143	0	143
Unrealized gain on equity investments	133	0	127	0
Realized gain (loss) on sale of debt and equity investments, net of tax	2	70	(8)	351
Loss before income taxes and equity in earnings of an investee	(22,671)	(6,689)	(51,033)	(21,759)
Benefit (provision) for income taxes	263	55	(274)	1,330
Equity in earnings of an investee, net of tax	826	31	882	533
Net loss	$ (21,582)	$ (6,603)	$ (50,425)	$ (19,896)
Weighted average shares outstanding—basic and diluted (in shares)	49,682	49,242	49,643	49,199
Net loss per share—basic and diluted (in dollars per share)	$ (0.43)	$ (0.13)	$ (1.02)	$ (0.40)
Senior living
Revenues:
Total revenues	$ 272,701	$ 279,654	$ 818,108	$ 842,938
Management fee revenue
Revenues:
Total revenues	4,009	3,414	11,408	10,531
Reimbursed costs incurred on behalf of managed communities
Revenues:
Total revenues	72,200	64,033	208,009	194,346
Operating expenses:
Cost of revenues	72,200	64,033	208,009	194,346
Senior living wages and benefits
Operating expenses:
Cost of revenues	142,035	138,255	418,917	413,196
Other senior living operating expenses
Operating expenses:
Cost of revenues	$ 76,761	$ 71,218	$ 226,302	$ 219,060

CONDENSED CONSOLIDATED STATEM_2

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Statement of Comprehensive Income [Abstract]
Net loss	$ (21,582)	$ (6,603)	$ (50,425)	$ (19,896)
Other comprehensive income:
Unrealized gain (loss) on investments, net of tax	3	145	(437)	504
Equity in unrealized gain of an investee, net of tax	173	116	90	296
Realized loss (gain) on investments reclassified and included in net loss, net of tax	25	(70)	92	(351)
Other comprehensive income	201	191	(255)	449
Comprehensive loss	$ (21,381)	$ (6,412)	$ (50,680)	$ (19,447)

CONDENSED CONSOLIDATED STATEM_3

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017	Dec. 31, 2017	Sep. 30, 2018	Dec. 31, 2017	Sep. 30, 2017
Cash flows from operating activities:
Net loss	$ (21,582)	$ (6,603)	$ (50,425)	$ (19,896)
Adjustments to reconcile net loss to cash provided by (used in) operating activities:
Depreciation and amortization expense			26,974	29,040
Gain on sale of senior living communities	62	0	(7,131)	0
Gain on early extinguishment of debt			0	(166)
Unrealized gain on equity investments	(133)	0	(127)	0
Realized loss (gain) on sale of debt and equity investments	(2)	(70)	8	(351)
Loss on disposal of property and equipment			263	202
Long lived asset impairment	0	142	365	528
Equity in earnings of an investee, net of tax	(826)	(31)	(882)	(533)
Stock based compensation			654	784
Provision for losses on receivables			3,694	3,632
Amortization of deferred gain on sale and leaseback transaction			(4,957)	(4,956)
Other noncash expense (income) adjustments, net			279	325
Changes in assets and liabilities:
Accounts receivable			(1,881)	(2,797)
Prepaid expenses and other assets			(1,715)	(8,853)
Accounts payable and accrued expenses			(2,491)	3,821
Accrued compensation and benefits			7,164	8,613
Due from related persons, net			(1,670)	9,131
Other current and long term liabilities			5,879	6,642
Cash (used in) provided by operating activities			(25,999)	25,166
Cash flows from investing activities:
Acquisition of property and equipment			(36,941)	(55,049)
Purchases of investments			(3,239)	(10,895)
Proceeds from sale of property and equipment			14,749	30,698
Proceeds from sale of land			0	750
Proceeds from sale of communities			31,819	0
Proceeds from sale of investments			6,349	15,681
Cash provided by (used in) investing activities			12,737	(18,815)
Cash flows from financing activities:
Proceeds from borrowings on revolving credit facility			25,000	40,000
Repayments of borrowings on revolving credit facility			(25,000)	(35,000)
Repayments of mortgage notes payable			(427)	(14,111)
Prepayment fees on early extinguishment of debt			0	(132)
Payment of deferred financing fees			0	(1,889)	$ (1,889)
Cash used in financing activities			(427)	(11,132)
Cash flows from discontinued operations:
Net cash provided by operating activities			0	1,003
Net cash flows provided by discontinued operations			0	1,003
Change in cash and cash equivalents and restricted cash			(13,689)	(3,778)
Cash and cash equivalents and restricted cash at beginning of period			48,478	33,576	33,576
Cash and cash equivalents and restricted cash at end of period	34,789	29,798	34,789	29,798	48,478
Reconciliation of cash and cash equivalents and restricted cash:
Cash and cash equivalents						$ 13,128	$ 26,255	$ 8,706
Restricted cash						21,661		21,092
Cash and cash equivalents and restricted cash at end of period	$ 34,789	$ 29,798	48,478	33,576	$ 33,576	$ 34,789	$ 48,478	$ 29,798
Supplemental cash flow information:
Cash paid for interest			1,195	2,913
Cash paid for income taxes, net			338	275
Non-cash activities:
Real estate sale			33,364	0
Mortgage notes assumed by purchaser in real estate sale			$ 33,364	$ 0

Basis of Presentation and Organ

Basis of Presentation and Organization	9 Months Ended
	Sep. 30, 2018
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Presentation and Organization	Basis of Presentation and Organization General The accompanying condensed consolidated financial statements of Five Star Senior Living Inc. and its subsidiaries, or we, us or our, are unaudited. Certain information and disclosures required by U.S. generally accepted accounting principles, or GAAP, for complete financial statements have been condensed or omitted. We believe the disclosures made are adequate to make the information presented not misleading. However, the accompanying financial statements should be read in conjunction with the financial statements and notes contained in our Annual Report on Form 10-K for the year ended December 31, 2017 , or our Annual Report. In the opinion of our management, all adjustments, which include only normal recurring adjustments, considered necessary for a fair presentation have been included. All intercompany transactions and balances with or among our consolidated subsidiaries have been eliminated. Our operating results for interim periods are not necessarily indicative of the results that may be expected for the full year. Certain reclassifications have been made to the prior years’ condensed consolidated financial statements to conform to the current year’s presentation. We operate senior living communities, including independent living communities, assisted living communities and skilled nursing facilities, or SNFs. As of September 30, 2018 , we operated 283 senior living communities located in 32 states with 31,805 living units, including 254 primarily independent and assisted living communities with 29,300 living units and 29 SNFs with 2,505 living units. As of September 30, 2018 , we owned and operated 20 of these senior living communities ( 2,108 living units), we leased and operated 188 of these senior living communities ( 20,182 living units) and we managed 75 of these senior living communities ( 9,515 living units). Our 283 senior living communities, as of September 30, 2018 , included 10,741 independent living apartments, 16,292 assisted living suites and 4,772 SNF units. The foregoing numbers exclude living units categorized as out of service. Going Concern On January 1, 2016, we adopted Financial Accounting Standards Board, or FASB, Accounting Standards Update, or ASU, No. 2014-15, Presentation of Financial Statements-Going Concern: Disclosure of Uncertainties about an Entity’s Ability to Continue as a Going Concern , which requires us to evaluate, as of each reporting period, whether there are conditions or events that raise substantial doubt about our ability to continue as a going concern within one year after the date that our financial statements are issued and to provide related disclosures in certain circumstances. The accompanying condensed consolidated financial statements have been prepared on the basis that we will continue as a going concern, which accordingly assumes, among other things, the realization of assets and the satisfaction of liabilities in the ordinary course of business. We face increased competition across the senior living industry, including in specific markets in which we operate senior living communities. Medical advances and healthcare services also allow some potential residents to defer the time when they require the special services available at our communities. In addition, low unemployment in the United States combined with a competitive labor market within our industry are increasing our employment costs. These challenges are currently negatively impacting our revenues, expenses, cash flows and results from operations, and we expect these challenges to continue at least through 2019. At September 30, 2018, we have an accumulated deficit of $268,967 and have incurred operating losses in each of the last three years. These conditions raise substantial doubt about our ability to continue as a going concern. The accompanying financial statements do not include any adjustments that might result from the outcome of this uncertainty. Based on our cash balance at September 30, 2018 and projected cash needs for the next 12 months, our management believes that we will need to increase our revenues, reduce our costs and/or pursue other transactions to be able to continue to fund our operating and capital requirements and meet our debt covenant obligations. See Note 8 for more information regarding our indebtedness and covenants. We will need to raise the additional funds by: (i) increasing occupancy and/or rates we charge at our senior living communities, (ii) reducing our costs, (iii) increasing our revenues from other services we provide, such as rehabilitation, home health or other services, (iv) engaging in additional sale and leaseback or manageback transactions, (v) selling assets, including senior living communities we own, (vi) obtaining mortgage financing for our owned senior living communities, (vii) obtaining additional debt financing, such as term debt and/or a new credit facility, and/or (viii) issuing other debt or equity securities. We cannot be sure that we will be able to obtain any such additional funds by any of the foregoing or other means, and any such funds we may obtain may not be sufficient. If we are unable to obtain sufficient funds, we may be unable to continue as a going concern. Segment Information We have two operating segments: (i) senior living community and (ii) rehabilitation and wellness. In the senior living community segment, we operate for our own account or manage for the account of others independent living communities, assisted living communities and SNFs that are subject to centralized oversight and provide housing and services to elderly residents. In the rehabilitation and wellness operating segment, we provide therapy services, including physical, occupational, speech and other specialized therapy services, in the inpatient setting and in outpatient clinics. We have determined that our two operating segments meet the aggregation criteria as prescribed under FASB Accounting Standards Codification TM , or ASC, Topic 280, Segment Reporting , and we have therefore determined that our business is comprised of one reportable segment, senior living. All of our operations and assets are located in the United States, except for the operations of our Cayman Islands organized captive insurance company subsidiary, which participates in our workers’ compensation, professional and general liability and certain automobile insurance programs.

Summary of Significant Accounti

Summary of Significant Accounting Policies	9 Months Ended
	Sep. 30, 2018
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	Summary of Significant Accounting Policies Revenue Recognition On January 1, 2018, we adopted FASB ASC Topic 606, Revenue from Contracts with Customers, or ASC Topic 606, under the modified retrospective approach applied to certain contracts which were not completed as of December 31, 2017 using the practical expedient in paragraph 606-10-10-4 that allows for the use of a portfolio approach, because we have determined that the effect of applying the guidance to our portfolios of contracts within the scope of ASC Topic 606 on our consolidated financial statements would not differ materially from applying the guidance to each individual contract within the respective portfolio or our performance obligations within that portfolio. This approach will also be used for future contract modifications, if any. The five step model defined by ASC Topic 606 requires us to: (1) identify our contracts with customers, (2) identify our performance obligations under those contracts, (3) determine the transaction prices of those contracts, (4) allocate the transaction prices to our performance obligations in those contracts and (5) recognize revenue when each performance obligation under those contracts is satisfied. Revenue is recognized when promised goods or services are transferred to the customer in an amount that reflects the consideration expected in exchange for those goods or services. Our adoption of ASC Topic 606 did not result in an adjustment to our retained earnings and did not have a material impact on the amount and timing of our revenue recognition for the three and nine months ended September 30, 2018 . A substantial portion of our revenue relates to contracts with residents for housing services that are generally short term in nature and fall under FASB ASC Topic 840, Leases , or ASC Topic 840, which are specifically excluded from the scope of ASC Topic 606. Our contracts with residents and other customers that are within the scope of ASC Topic 606 are also generally short term in nature. We have determined that services performed under those contracts are considered one performance obligation in accordance with ASC Topic 606 as such services are regarded a series of distinct events with the same timing and pattern of transfer to the resident or customer. Revenue is recognized for those contracts when our performance obligation is satisfied by transferring control of the service provided to the resident or customer, which is generally when the services are provided over time. Senior Living Revenue. Resident fees at our independent living and assisted living communities consist of regular monthly charges for basic housing and support services and fees for additional requested services, such as assisted living services, personalized health services and ancillary services. Fees are specified in our agreements with residents, which are generally short term ( 30 days to one year ), with regular monthly charges billed in advance. Funds received from residents in advance of services being provided are not material to our consolidated financial statements. Some of our senior living communities require payment of an entrance fee in advance of a resident moving into the community; substantially all of these community fees are non-refundable and are initially recorded as deferred revenue and included in other current liabilities in our consolidated balance sheets. These deferred amounts then are amortized on a straight line basis into revenue over the term of the resident agreement. Revenue recorded and deferred in connection with community fees is not material to our consolidated financial statements. A substantial portion of our senior living revenue related to housing services falls under ASC Topic 840, and is recorded on a straight line basis over the term of the resident agreement. Revenue for additional requested services is recognized in accordance with ASC Topic 606 and measured based on the consideration specified in the resident agreement and is recorded when the services are provided. In our SNFs and certain of our independent and assisted living communities where we provide SNF services, we are paid fixed daily rates from governmental and contracted third party payers, and we charge a predetermined fixed daily rate for private pay residents. These fixed daily rates and certain other fees are billed monthly in arrears. Although there are complex regulatory compliance rules governing fixed daily rates, we have no episodic payments or capitation arrangements. We currently use the “most likely amount” technique to estimate revenue in accordance with ASC Topic 606, although rates are generally known and considered fixed prior to services being performed, whether included in the resident agreement or contracted with governmental or third party payers. Rate adjustments from Medicare or Medicaid are recorded when known (without regard to when the assessment is paid or withheld), and subsequent adjustments to these amounts are recorded in revenues when known. Billings under certain of these programs are subject to audit and possible retroactive adjustment, and related revenue is recorded at the amount we ultimately expect to receive, which is inclusive of the estimated retroactive adjustments or refunds, if any, under reimbursement programs. Retroactive adjustments are recorded on an estimated basis in the period the related services are rendered and adjusted in future periods or as final settlements are determined. Revenue is recognized when performance obligations are satisfied by transferring control of the service provided to the resident, which is generally when services are provided over the duration of care. We derived approximately 23.1% and 22.6% of our senior living revenues for the three months ended September 30, 2018 and 2017 , respectively, and 23.2% and 22.9% for the nine months ended September 30, 2018 and 2017 , respectively, from payments under Medicare and Medicaid programs. Management Fee Revenue and Reimbursed Costs Incurred on Behalf of Managed Communities. We manage senior living communities for the account of Senior Housing Properties Trust, or, together with its subsidiaries, SNH, pursuant to long term management agreements which provide for periodic management fee payments to us and reimbursement for our direct costs and expenses related to such communities. Management fees are determined by an agreed upon percentage of gross revenues (as defined) and recognized in accordance with ASC Topic 606 in the same period that we provide the management services to SNH, generally monthly. FASB ASU No. 2016-08, Revenue from Contracts with Customers (Topic 606): Principal versus Agent Considerations (Reporting Revenue Gross versus Net) , which we adopted effective January 1, 2018, clarifies how an entity should identify the unit of accounting for the principal versus agent evaluation and how it should apply the control principle to certain types of arrangements, such as service transactions. Where we are the primary obligor and therefore control the transfer of the goods and services with respect to any such operating expenses incurred in connection with the management of these communities, we recognize revenue when the goods have been delivered or the service has been rendered and we are due to be reimbursed from SNH. Such revenue is included in reimbursed costs incurred on behalf of managed communities in our consolidated statements of operations. The related costs are included in costs incurred on behalf of managed communities in our consolidated statements of operations. Amounts due from SNH related to management fees and reimbursed costs incurred on behalf of managed communities are included in due from related persons in our consolidated balance sheets. The following table presents revenue disaggregated by type of contract and payer: Three Months Ended September 30, 2018 Nine Months Ended September 30, 2018 Leasing revenue (1) 162,397 486,279 Revenue from contracts with customers: Medicare and Medicaid programs (1) 62,982 190,138 Additional requested services, and private pay and other third party payer SNF services (1) 47,322 141,691 Management fee revenue 4,009 11,408 Reimbursed costs incurred on behalf of managed communities 72,200 208,009 186,513 551,246 Total revenues 348,910 1,037,525 (1) Included in senior living revenue in our consolidated statements of operations. Recent Accounting Pronouncements On January 1, 2018, we adopted FASB ASU No. 2016-01, Recognition and Measurement of Financial Assets and Financial Liabilities, which changes how entities measure certain equity investments and present changes in the fair value of financial liabilities measured under the fair value option that are attributable to their own credit. Prior to our adoption of this ASU, we recorded changes in the fair value of our equity investments through other comprehensive income. Pursuant to this ASU, these changes will now be recorded through earnings. We adopted this ASU using the cumulative effect adjustment method and recorded an adjustment of $1,107 on January 1, 2018 to accumulated other comprehensive income and accumulated deficit in our consolidated balance sheets. Affiliates Insurance Company, or AIC, a private company in which we have an equity investment, chose to early adopt this ASU during the second quarter of 2018, and therefore we recorded a cumulative effect adjustment of $840 to accumulated other comprehensive income and accumulated deficit in our consolidated balance sheets to reflect our share of AIC's adjustment to its equity investments. See Note 11 for more information regarding our arrangements with AIC. In May 2014, the FASB issued ASU No. 2014-09, Revenue from Contracts with Customers (Topic 606) , which outlines a comprehensive model for entities to use in accounting for revenue arising from contracts with customers. In March 2016, the FASB issued ASU No. 2016-08, Revenue from Contracts with Customers (Topic 606): Principal versus Agent Considerations (Reporting Revenue Gross versus Net) , which clarifies how an entity should identify the unit of accounting for the principal versus agent evaluation and how it should apply the control principle to certain types of arrangements, such as service transactions. Additionally, real estate sales are within the scope of ASU No. 2014-09, as amended by ASU No. 2017-05, Other Income - Gains and Losses from the Derecognition of Nonfinancial Assets . Under these ASUs, income recognition for real estate sales is primarily based on the transfer of control of the real estate rather than the continuing involvement in the real estate under the current guidance. As a result, more of our transactions may qualify as real estate sales and we may be required to recognize gains or losses sooner. We adopted these ASUs on January 1, 2018 using the modified retrospective approach. The adoption of these ASUs did not result in any adjustment to our initial retained earnings and did not result in any significant change to the amount and timing of our revenue recognition. The adoption of these ASUs did result in expanded disclosures related to the nature, amount, timing and uncertainty of our revenue and cash flows arising from our contracts with customers that are included within the scope of these ASUs. See also the discussion above under “Revenue Recognition” for more information regarding the impact of these ASUs on our consolidated financial statements. On January 1, 2018, we adopted FASB ASU No. 2016-15, Statement of Cash Flows (Topic 230): Classification of Certain Cash Receipts and Cash Payments , which clarifies how entities present and classify certain cash receipts and cash payments in the statement of cash flows. The adoption of this ASU did not have a material impact on our consolidated financial statements. On January 1, 2018, we adopted FASB ASU No. 2016-18, Statement of Cash Flows (Topic 230): Restricted Cash , which requires that the reconciliation of the beginning-of-period and end-of-period amounts presented in the statement of cash flows include restricted cash and restricted cash equivalents. We adopted this ASU retrospectively to all periods presented in our consolidated statement of cash flows. Pursuant to this ASU, in the event restricted cash is presented separately from cash and cash equivalents in the balance sheets, entities are required to reconcile the amounts presented in the statement of cash flows to the amounts presented in the balance sheet and to disclose information about the nature of the restrictions. We have presented our consolidated statement of cash flows to reconcile both cash and cash equivalents and restricted cash and restricted cash equivalents and have provided a reconciliation to the amounts presented in our consolidated statements of cash flows to the amounts presented in our consolidated balance sheets. In February 2016, the FASB issued ASU No. 2016-02, Leases (Topic 842) , which sets out the principles for the recognition, measurement, presentation and disclosure of leases for both parties to a contract (i.e., lessees and lessors). This ASU requires lessees to apply a dual approach, classifying leases as either finance or operating leases based on the principle of whether or not the lease is effectively a financed purchase of the leased asset by the lessee. This classification will determine whether the lease expense is recognized based on an effective interest method or on a straight line basis over the term of the lease. A lessee is also required to record a right of use asset and a lease liability for all leases with a term of greater than 12 months regardless of their classification. Leases with a term of 12 months or less will be accounted for similar to existing guidance for operating leases. This ASU also changes the accounting for sale and leaseback transactions, such as our sale and leaseback transaction with SNH in June 2016, and any associated deferred gain. Additionally, this ASU requires lessors to account for leases using an approach that is substantially equivalent to existing guidance for sales type leases, direct financing leases and operating leases. This ASU is effective for reporting periods beginning after December 15, 2018, with early adoption permitted. In July 2018, the FASB issued ASU No. 2018-11, Leases (Topic 842): Targeted Improvements , which works to improve on certain aspects of ASU No. 2016-02 identified by stakeholders as problematic or difficult to implement, including the adoption method. ASU No. 2018-11 provides for a transition method option, allowing entities to recognize a cumulative effect adjustment to the opening balance of retained earnings in the period of adoption, rather than restating comparative periods being presented. ASU No. 2018-11 also provides lessors with a practical expedient, by class of underlying asset, not to separate non-lease components from the associated lease component if certain conditions are met. In addition, ASU No. 2018-11 clarifies which ASC Topic (Topic 842 or Topic 606) applies for the combined component. Specifically, if the non-lease components associated with the lease component are the predominant component of the combined component, an entity should account for the combined component in accordance with ASC Topic 606. Otherwise, the entity should account for the combined component as an operating lease in accordance with ASC Topic 842. We expect to elect this practical expedient provided to lessors and will recognize revenue under our resident agreements based upon the predominant component. We will adopt these ASUs as required effective January 1, 2019 utilizing the modified retrospective transition method with no adjustments to comparative periods presented in accordance with ASU No. 2018-11. While we are continuing to assess the potential impact that the adoption of these ASUs may have on our consolidated financial statements, we believe the adoption of these ASUs will have a material impact on our consolidated balance sheets due to the recognition of lease rights and obligations as assets and liabilities, and any previously unrecognized right of use assets will need to be reviewed for impairment effective January 1, 2019. While the adoption of these ASUs will not affect the rent we pay, we expect the rent expense amounts presented in our consolidated statements of operations and comprehensive loss to change materially due to changes in how we will account for our deferred gain on our sale and leaseback transaction described above. In June 2016, the FASB issued ASU No. 2016-13, Financial Instruments—Credit Losses (Topic 326), which requires a financial asset or a group of financial assets measured at amortized cost basis to be presented at the net amount expected to be collected. This ASU eliminates the probable initial recognition threshold and instead requires reflection of an entity’s current estimate of all expected credit losses. In addition, this ASU amends the current available for sale security other-than-temporary impairment model for debt securities. The length of time that the fair value of an available for sale debt security has been below the amortized cost will no longer impact the determination of whether a credit loss exists and credit losses will now be limited to the difference between a security’s amortized cost basis and its fair value. This ASU is effective for reporting periods beginning after December 15, 2019. We are currently assessing the potential impact that the adoption of this ASU will have on our consolidated financial statements. In March 2017, the FASB issued ASU No. 2017-08, Receivables—Nonrefundable Fees and Other Costs (Subtopic 310-20) , which shortens the amortization period for certain callable debt securities held at a premium. Specifically, this ASU requires the premium to be amortized to the earliest call date. This ASU does not require an accounting change for securities held at a discount; the discount continues to be amortized to maturity. This ASU is effective for reporting periods beginning after December 15, 2018, with early adoption permitted. We are currently assessing the potential impact that the adoption of this ASU will have on our consolidated financial statements. In February 2018, the FASB issued ASU No. 2018-02, Income Statement—Reporting Comprehensive Income (Topic 220) , which permits an entity to reclassify the tax effects that remain recorded within other comprehensive income to retained earnings as a result of tax reform legislation that became effective in December 2017. This ASU is effective for reporting periods beginning after December 15, 2018. We are currently assessing the potential impact that the adoption of this ASU will have on our consolidated financial statements. In June 2018, the FASB issued ASU No. 2018-07, Compensation—Stock Compensation (Topic 718) , which expands the scope of Topic 718 to include share based payment transactions for acquiring goods and services from non-employees. This ASU is effective for reporting periods beginning after December 15, 2018. We are currently assessing the potential impact that the adoption of this ASU will have on our consolidated financial statements. In August 2018, the FASB issued ASU No. 2018-13, Fair Value Measurement (Topic 820) , which modifies certain disclosure requirements in Topic 820, such as the removal of the need to disclose the amount of and reason for transfers between Level 1 and Level 2 of the fair value hierarchy, and several changes related to Level 3 fair value measurements. This ASU is effective for reporting periods beginning after December 15, 2019. We are currently assessing the potential impact that the adoption of this ASU will have on our consolidated financial statements. In August 2018, the FASB also issued ASU No. 2018-15, Intangibles—Goodwill and Other—Internal Use Software (Subtopic 350-40) , which aligns the requirements for capitalizing implementation costs incurred in a cloud computing hosting arrangement that is a service contract with the requirements for capitalizing implementation costs incurred to develop or obtain internal use software. This ASU is effective for reporting periods beginning after December 15, 2019. We are currently assessing the potential impact that the adoption of this ASU will have on our consolidated financial statements.

Property and Equipment

Property and Equipment	9 Months Ended
	Sep. 30, 2018
Property, Plant and Equipment [Abstract]
Property and Equipment	Property and Equipment Property and equipment consists of the following: September 30, 2018 December 31, 2017 Land $ 16,383 $ 16,383 Buildings and improvements 207,379 211,812 Furniture, fixtures and equipment 232,252 208,262 Property and equipment, at cost 456,014 436,457 Accumulated depreciation (211,266 ) (184,953 ) Property and equipment, net $ 244,748 $ 251,504 We recorded depreciation expense relating to our property and equipment of $ 9,117 and $ 9,732 for the three months ended September 30, 2018 and 2017 , respectively, and $ 26,915 and $ 28,863 for the nine months ended September 30, 2018 and 2017 , respectively. We review the carrying value of long lived assets for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. If there is an indication that the carrying value of an asset is not recoverable, we determine the amount of impairment loss, if any, by comparing the historical carrying value of the asset to its estimated fair value. We determine estimated fair value based on input from market participants, our experience selling similar assets, market conditions and internally developed cash flow models that our assets or asset groups are expected to generate, and we consider these estimates to be a Level 3 fair value measurement. As a result of our long lived assets impairment review, we recorded impairment charges to certain of our long lived assets of $0 and $365 for the three and nine months ended September 30, 2018 , respectively, and $142 and $528 for the three and nine months ended September 30, 2017 , respectively. As of September 30, 2018 and December 31, 2017 , we had $0 and $59,080 , respectively, of net property and equipment classified as held for sale and presented separately in our consolidated balance sheets. See Note 9 for more information regarding our communities that we had classified as held for sale. As of September 30, 2018 , we had $987 of assets related to our leased senior living communities included in our property and equipment that we expect to request SNH to purchase from us for an increase in future rent; however, SNH is not obligated to purchase such amounts. See Note 9 for more information regarding our leases and other arrangements with SNH.

Accumulated Other Comprehensive

Accumulated Other Comprehensive Income	9 Months Ended
	Sep. 30, 2018
Equity [Abstract]
Accumulated Other Comprehensive Income	Accumulated Other Comprehensive Income The following table details the changes in accumulated other comprehensive income, net of tax, for the nine months ended September 30, 2018 : Equity Investment of an Investee Investments Accumulated Other Comprehensive Income Balance at January 1, 2018 $ 642 $ 3,394 $ 4,036 Cumulative effect of reclassification of unrealized gain on equity investments in connection with the adoption of FASB ASU No. 2016-01 (840 ) (1,107 ) (1,947 ) Unrealized loss on investments, net of tax — (437 ) (437 ) Equity in unrealized gain of an investee, net of tax 90 — 90 Realized loss on investments reclassified and included in net loss, net of tax — 92 92 Balance at September 30, 2018 $ (108 ) $ 1,942 $ 1,834 Accumulated other comprehensive income represents the unrealized gains and losses of our debt investments, net of tax, and our share of other comprehensive income of AIC. See Note 11 for more information regarding our arrangements with AIC.

Income Taxes

Income Taxes	9 Months Ended
	Sep. 30, 2018
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes We recognized a benefit for income taxes of $263 and $55 for the three months ended September 30, 2018 and 2017 , respectively. We recognized a provision for income taxes of $274 for the nine months ended September 30, 2018 and a benefit for income taxes of $1,330 for the nine months ended September 30, 2017 . The benefit for income taxes for the three months ended September 30, 2018 and the provision for income taxes for the nine months ended September 30, 2018 relate to our state income taxes. The benefit for income taxes for the three months ended September 30, 2017 is due primarily to intra-period tax allocation benefits related to the unrealized gains on our debt and equity investments and the benefit for income taxes for the nine months ended September 30, 2017 is due primarily to our monetization of alternative minimum tax credits during the second quarter of 2017 . We previously determined it was more likely than not that a majority of our net deferred tax assets would not be realized and concluded that a valuation allowance was required, which eliminated the majority of our net deferred tax assets recorded in our consolidated balance sheets. In the future, if we believe that we will more likely than not realize the benefit of these deferred tax assets, we will adjust our valuation allowance and recognize an income tax benefit, which may affect our results of operations.

Earnings Per Share

Earnings Per Share	9 Months Ended
	Sep. 30, 2018
Earnings Per Share [Abstract]
Earnings Per Share	Earnings Per Share We calculated basic earnings per common share, or EPS, for the three and nine months ended September 30, 2018 and 2017 using the weighted average number of shares of our common stock, $.01 par value per share, or our common shares, outstanding during the periods. When applicable, diluted EPS reflects the more dilutive earnings per common share amount calculated using the two class method or the treasury stock method. The three months ended September 30, 2018 and 2017 had 1,207,928 and 1,053,305 , respectively, and the nine months ended September 30, 2018 and 2017 had 1,239,628 and 1,031,793 , respectively, of potentially dilutive restricted unvested common shares that were not included in the calculation of diluted EPS because to do so would have been antidilutive.

Fair Values of Assets and Liabi

Fair Values of Assets and Liabilities	9 Months Ended
	Sep. 30, 2018
Fair Value Disclosures [Abstract]
Fair Values of Assets and Liabilities	Fair Values of Assets and Liabilities Our assets recorded at fair value have been categorized based on a fair value hierarchy in accordance with FASB ASC Topic 820, Fair Value Measurements and Disclosures . We apply the following fair value hierarchy, which prioritizes the inputs used to measure fair value into three levels. Level 1 inputs are quoted prices (unadjusted) in active markets for identical assets or liabilities that we have the ability to access at the measurement date. Level 2 inputs are inputs other than quoted prices included within Level 1 that are observable for the asset or liability, either directly or indirectly. Level 2 inputs include quoted prices for similar assets and liabilities in active markets and quoted prices in inactive markets. Level 3 inputs are unobservable inputs for the asset or liability in which there is little, if any, market activity for the asset or liability at the measurement date. Recurring Fair Value Measures The tables below present the assets measured at fair value at September 30, 2018 and December 31, 2017 categorized by the level of inputs used in the valuation of each asset. As of September 30, 2018 Quoted Prices in Active Markets for Identical Assets Significant Other Observable Inputs Significant Unobservable Inputs Description Total (Level 1) (Level 2) (Level 3) Cash equivalents (1) $ 24,191 $ 24,191 $ — $ — Investments: Equity investments (2) Financial services industry 2,000 2,000 — — REIT industry 115 115 — — Other 4,112 4,112 — — Total equity investments 6,227 6,227 — — Debt investments: (3) International bond fund (4) 2,503 — 2,503 — High yield fund (5) 2,812 — 2,812 — Industrial bonds 2,042 — 2,042 — Technology bonds 2,371 — 2,371 — Government bonds 10,159 10,159 — — Energy bonds 590 — 590 — Financial bonds 1,459 — 1,459 — Other 1,765 — 1,765 — Total debt investments 23,701 10,159 13,542 — Total investments 29,928 16,386 13,542 — Total $ 54,119 $ 40,577 $ 13,542 $ — As of December 31, 2017 Quoted Prices in Active Markets for Identical Assets Significant Other Observable Inputs Significant Unobservable Inputs Description Total (Level 1) (Level 2) (Level 3) Cash equivalents (1) $ 23,578 $ 23,578 Investments: Equity investments (2) Financial services industry 2,199 2,199 — — REIT industry 145 145 — — Other 4,094 4,094 — — Total equity investments 6,438 6,438 — — Debt investments (3) International bond fund (4) 2,511 — 2,511 — High yield fund (5) 2,744 — 2,744 — Industrial bonds 2,017 — 2,017 — Technology bonds 2,972 — 2,972 — Government bonds 10,707 10,610 97 — Energy bonds 1,216 — 1,216 — Financial bonds 1,423 — 1,423 — Other 3,254 — 3,254 — Total debt investments 26,844 10,610 16,234 — Total investments 33,282 17,048 16,234 — Total $ 56,860 $ 40,626 $ 16,234 $ — (1) Cash equivalents consist of short term, highly liquid investments and money market funds held principally for obligations arising from our self insurance programs. Cash equivalents are reported in our condensed consolidated balance sheets as cash and cash equivalents and current and long term restricted cash. Cash equivalents include $ 20,480 and $ 20,316 of balances that are restricted at September 30, 2018 and December 31, 2017 , respectively. (2) The fair value of our equity investments is readily determinable. During the nine months ended September 30, 2018 and 2017 , we received gross proceeds of $697 and $ 3,083 , respectively, in connection with the sales of equity investments and recorded gross realized gains totaling $92 and $360 , respectively, and gross realized losses totaling $5 and $145 , respectively. (3) As of September 30, 2018 , our debt investments, which are classified as available for sale, had a fair value of $ 23,701 with an amortized cost of $ 22,788 ; the difference between the fair value and amortized cost amounts resulted from unrealized gains of $ 1,352 , net of unrealized losses of $ 439 . As of December 31, 2017 , our debt investments had a fair value of $ 26,844 with an amortized cost of $ 25,589 ; the difference between the fair value and amortized cost amounts resulted from unrealized gains of $ 1,401 , net of unrealized losses of $ 146 . Debt investments include $14,768 and $18,068 of balances that are restricted as of September 30, 2018 and December 31, 2017 , respectively. At September 30, 2018 , 37 of the securities we hold, with a fair value of $ 8,932 , have been in a loss position for less than 12 months and 28 of the investments we hold, with a fair value of $ 8,748 , have been in a loss position for greater than 12 months . We do not believe these investments are impaired primarily because they have not been in a loss position for an extended period of time, the financial conditions of the issuers of these investments remain strong with solid fundamentals, or we intend to hold these investments until recovery, and other factors that support our conclusion that the loss is temporary. During the nine months ended September 30, 2018 and 2017 , we received gross proceeds of $ 5,652 and $ 12,598 , respectively, in connection with the sales of debt investments and recorded gross realized gains totaling $ 9 and $ 167 , respectively, and gross realized losses totaling $ 104 and $ 31 , respectively. We record gains and losses on the sales of these investments using the specific identification method. (4) The investment strategy of this fund is to invest principally in fixed income securities issued by non-U.S. issuers. The fund invests in such securities or investment vehicles as it considers appropriate to achieve the fund’s investment objective, which is to provide an above average rate of total return while attempting to limit investment risk by investing in a diversified portfolio of U.S. dollar investment grade fixed income securities. There are no unfunded commitments and the investment can be redeemed weekly. (5) The investment strategy of this fund is to invest principally in fixed income securities. The fund invests in such securities or investment vehicles as it considers appropriate to achieve the fund’s investment objective, which is to provide an above average rate of total return while attempting to limit investment risk by investing in a diversified portfolio of primarily fixed income securities issued by companies with below investment grade ratings. There are no unfunded commitments and the investment can be redeemed weekly. During the nine months ended September 30, 2018 , we did not change the type of inputs used to determine the fair value of any of our assets and liabilities that we measure at fair value. Accordingly, there were no transfers of assets or liabilities between levels of the fair value hierarchy during the nine months ended September 30, 2018 . The carrying value of accounts receivable and accounts payable approximates fair value as of September 30, 2018 and December 31, 2017 . The carrying value and fair value of our mortgage notes payable were $ 7,953 and $ 8,937 , respectively, as of September 30, 2018 and $ 8,188 and $ 9,617 , respectively, as of December 31, 2017 , and are categorized in Level 3 of the fair value hierarchy in their entirety. We estimate the fair values of our mortgage notes payable by using discounted cash flow analyses and currently prevailing market terms as of the measurement date. The carrying value and fair value of our mortgage notes payable as of December 31, 2017 excludes $34,781 of mortgage notes payable categorized as held for sale and presented separately in our condensed consolidated balance sheets. See Note 9 for more information regarding our communities classified as held for sale. Non-Recurring Fair Value Measures We review the carrying value of our long lived assets, including our property and equipment and other intangible assets, for impairment whenever events or changes in circumstances indicate that the carrying value of an asset or asset group may not be recoverable. See Note 3 for more information regarding fair value measurements related to impairments of our long lived assets we recorded.

Indebtedness

Indebtedness	9 Months Ended
	Sep. 30, 2018
Debt Disclosure [Abstract]
Indebtedness	Indebtedness We previously had a $100,000 secured revolving credit facility, or our prior credit facility, which was scheduled to mature in April 2017. In February 2017, we replaced our prior credit facility with a new $100,000 secured revolving credit facility, or our credit facility, with terms substantially similar to those of our prior credit facility. We paid fees of $1,889 in 2017 in connection with the closing of our credit facility, which fees were deferred and are being amortized over the initial term of our credit facility. Our credit facility is available for general business purposes, including acquisitions, provides for issuance of letters of credit and matures in February 2020. Subject to our payment of extension fees and meeting other conditions, we have options to extend the stated maturity date of our credit facility for two , one year periods. We are required to pay interest at a rate based on, at our option, LIBOR or a base rate, plus a premium, or 4.61% and 6.75% , respectively, per annum as of September 30, 2018 , on outstanding borrowings under our credit facility. We are also required to pay a quarterly commitment fee of 0.35% per annum on the unused part of the available borrowings under our credit facility. We can borrow, repay and re-borrow funds available until maturity, and no principal repayment is due until maturity. The weighted average annual interest rate for borrowings under our credit facility was 6.51% and 5.61% for the nine months ended September 30, 2018 and 2017 , respectively. We incurred aggregate interest expense and other associated costs related to our credit facilities of $329 and $358 for the three months ended September 30, 2018 and 2017 , respectively, and $864 and $848 for the nine months ended September 30, 2018 and 2017 , respectively. Our credit facility is secured by real estate mortgages on 10 senior living communities with a combined 1,219 living units owned by certain of our subsidiaries that guarantee our obligations under our credit facility. Our credit facility is also secured by these subsidiaries’ accounts receivable and related collateral. The amount of available borrowings under our credit facility is subject to our having qualified collateral, which is primarily based on the value of the communities securing our obligations under our credit facility. Accordingly, the maximum availability of borrowings under our credit facility at any time may be less than $100,000 . Our credit facility provides for acceleration of payment of all amounts outstanding under our credit facility upon the occurrence and continuation of certain events of default, including a change of control of us, as defined. The agreement governing our credit facility, or our credit agreement, contains a number of financial and other covenants, including covenants that restrict our ability to incur indebtedness or to pay dividends or make other distributions to our stockholders in certain circumstances, and requires us to maintain financial ratios and a minimum net worth. The lenders under our credit facility have waived for the period of six fiscal quarters commencing with the quarter ended March 31, 2018 and ending with the quarter ending June 30, 2019, or the waiver period, any default resulting from our non-compliance with the leverage and fixed charge coverage ratio covenants contained in our credit agreement. In connection with this waiver, we agreed that, if at any time during the waiver period we are in non-compliance with either the leverage covenant or the fixed charge coverage ratio covenant (before giving effect to the waiver), the maximum amount available to be drawn under our credit facility (giving effect to applicable borrowing base conditions) less the aggregate outstanding extensions of credit under the credit facility will not be less than approximately $33,333 . We have also agreed not to declare or pay any dividends, purchase, redeem, retire, defease or otherwise acquire for value any shares of our capital stock, return any capital to our stockholders or distribute any obligations, securities or other assets to our stockholders if we are not in compliance with the leverage covenant or the fixed charge coverage ratio covenant (before giving effect to the waiver) at the time of such action. At September 30, 2018 , we had seven irrevocable standby letters of credit outstanding, totaling $25,216 . In June 2018, we increased, from $17,800 to $22,700 , one of these letters of credit which secures our workers' compensation insurance program, and this letter of credit is currently collateralized by approximately $17,885 of cash equivalents and $6,247 of debt and equity investments. This letter of credit currently matures in June 2019, at which time we expect to renew it for an amount then required for our workers' compensation insurance program. At September 30, 2018 , the cash equivalents collateralizing this letter of credit, including accumulated interest, were classified as short term restricted cash in our condensed consolidated balance sheets, and the debt and equity investments collateralizing this letter of credit are classified as short term investments in our condensed consolidated balance sheets. The remaining six irrevocable standby letters of credit outstanding at September 30, 2018 , totaling $2,516 , secure certain of our other obligations. These letters of credit were scheduled to mature between October 2018 and September 2019 at September 30, 2018 and are required to be renewed annually. The letter of credit scheduled to mature in October 2018 was renewed for an additional year prior to its maturity. Our obligations under these six letters of credit are issued under our credit facility. As of September 30, 2018 , we had these six letters of credit, totaling $2,516 , issued and outstanding under our credit facility, and, after giving effect to the waiver described above, $52,811 available for borrowing under our credit facility. At September 30, 2018 , one of our senior living communities was encumbered by a mortgage. This mortgage contains standard mortgage covenants. We recorded a mortgage discount in connection with the assumption of this mortgage as part of our acquisition of the community secured by this mortgage in order to record this mortgage at its estimated fair value. We amortize this mortgage discount as an increase in interest expense until the maturity of this mortgage. This mortgage requires payments of principal and interest monthly until maturity. The following table is a summary of this mortgage as of September 30, 2018 : Balance as of Contractual Stated Effective Monthly September 30, 2018 Interest Rate Interest Rate Maturity Date Payment Lender Type $ 8,239 (1) 6.20 % 6.70 % September 2032 $ 72 Federal Home Loan Mortgage Corporation (1) Contractual principal payment excluding unamortized discount and debt issuance costs of $286 . We incurred mortgage interest expense, net of discount amortization, of $137 and $781 for the three months ended September 30, 2018 and 2017 , respectively, and $909 and $2,352 for the nine months ended September 30, 2018 and 2017 , respectively. This mortgage requires monthly payments into escrows for taxes, insurance and property replacement funds; certain withdrawals from these escrows require Federal Home Loan Mortgage Corporation approval. In February 2018, in connection with the sale of one of our senior living communities to SNH, SNH assumed a Federal National Mortgage Association mortgage that had a principal balance of $16,776 and required interest at the contracted rate of 6.64% per annum. In connection with SNH's assumption of this debt, we recorded a gain of $543 , which amount is included in gain on sale of senior living communities in our condensed consolidated statements of operations. In June 2018, in connection with the sale of two of our senior living communities to SNH, SNH assumed a commercial lender mortgage that had a principal balance of $16,588 and required interest at the contracted rate of 5.75% per annum. In connection with SNH's assumption of this debt, we recorded a gain of $638 , which amount is included in gain on sale of senior living communities in our condensed consolidated statements of operations. As of September 30, 2018 , we believe we were in compliance with all applicable covenants under our mortgage debt and, giving effect to the waiver discussed above, our credit facility.

Leases and Management Agreement

Leases and Management Agreements with SNH	9 Months Ended
	Sep. 30, 2018
Leases [Abstract]
Leases and Management Agreements with SNH	Leases and Management Agreements with SNH Senior Living Communities Leased from SNH . We are SNH’s largest tenant and SNH is our largest landlord. As of September 30, 2018 and 2017 , we leased 184 and 185 senior living communities from SNH, respectively. We lease senior living communities from SNH pursuant to five leases with SNH. Our total annual rent payable to SNH as of September 30, 2018 and 2017 was $207,504 and $ 206,297 , respectively, excluding percentage rent based on increases in gross revenues at certain communities. Our total rent expense under all of our leases with SNH, net of lease inducement amortization and the amortization of the deferred gain associated with the sale and leaseback transaction with SNH in June 2016 described below, was $51,541 and $51,056 for the three months ended September 30, 2018 and 2017 , respectively, and $154,425 and $152,358 for the nine months ended September 30, 2018 and 2017 , respectively, which amounts included estimated percentage rent of $1,387 and $1,353 for the three months ended September 30, 2018 and 2017 , respectively, and $4,068 and $4,190 for the nine months ended September 30, 2018 and 2017 , respectively. As of September 30, 2018 and December 31, 2017 , we had outstanding rent due and payable to SNH of $18,642 and $18,555 , respectively, which amounts are included in due to related persons in our condensed consolidated balance sheets. Pursuant to the terms of our leases with SNH, for the nine months ended September 30, 2018 and 2017 , we sold to SNH $14,749 and $30,698 , respectively, of improvements to communities leased from SNH. As a result, the annual rent payable by us to SNH increased by approximately $1,177 and $2,464 as of September 30, 2018 and 2017 , respectively. As of September 30, 2018 , our property and equipment included $987 for similar improvements to communities leased from SNH that we expect to request SNH to purchase from us for an increase in future rent; however, SNH is not obligated to purchase these improvements. In June 2016, we entered an agreement with SNH pursuant to which, on June 29, 2016, we sold seven senior living communities to SNH for an aggregate purchase price of $112,350 , and SNH simultaneously leased these communities back to us under a new long term lease agreement. Under the new lease, we are required to pay SNH initial annual rent of $8,426 , plus percentage rent beginning in 2018. In accordance with FASB ASC Topic 840, Leases , the June 2016 sale and leaseback transaction qualifies for sale-leaseback accounting. Accordingly, the gain generated from the sale of $82,644 was deferred and is being amortized as a reduction of rent expense over the initial term of the lease. As of September 30, 2018 and December 31, 2017 , the short term portion of the deferred gain in the amount of $6,609 is presented in other current liabilities in our condensed consolidated balance sheets, and the long term portion is presented separately in our condensed consolidated balance sheets. In June 2018, we and SNH sold to a third party one SNF, which was previously leased to us, located in California with 97 living units for a sales price of approximately $6,500 , excluding closing costs. We recorded a loss of $62 and $102 for the three and nine months ended September 30, 2018 , respectively, as a result of this sale, which loss is included in loss (gain) on sale of senior living communities in our condensed consolidated statements of operations. This community, while leased by us, generated a loss from operations before income taxes of $24 and $358 for the three months ended September 30, 2018 and 2017, respectively, and $283 and $461 for the nine months ended September 30, 2018 and 2017 , respectively, excluding the loss on sale of the community. Pursuant to the terms of our lease with SNH, as a result of this sale, our annual rent payable to SNH decreased by 10% of the net proceeds that SNH received from this sale, in accordance with the terms of the applicable lease. Also in June 2018, SNH acquired an additional living unit at a senior living community we lease from SNH located in Florida which was added to the lease for that senior living community, and, as a result of this acquisition, our annual rent payable to SNH increased by $14 in accordance with the terms of such lease. Senior Living Communities Managed for the Account of SNH and its Related Entities . As of September 30, 2018 and 2017 , we managed 75 and 68 senior living communities, respectively, for the account of SNH. We earned base management fees of $3,597 and $3,199 from the senior living communities we managed for the account of SNH for the three months ended September 30, 2018 and 2017 , respectively, and $10,486 and $9,708 for the nine months ended September 30, 2018 and 2017 , respectively. In addition, we earned fees for our management of capital expenditure projects at the communities we managed for the account of SNH of $344 and $128 for the three months ended September 30, 2018 and 2017 , respectively, and $714 and $628 for the nine months ended September 30, 2018 and 2017 , respectively. These amounts are included in management fee revenue in our condensed consolidated statements of operations. In November 2017, we entered a transaction agreement with SNH, or the transaction agreement, pursuant to which in December 2017, January 2018, February 2018 and June 2018 we sold to, and began managing for the account of, SNH a total of six senior living communities and, concurrently with those sales, we and SNH entered management agreements for each of these senior living communities and two new pooling agreements with terms substantially similar to our other management and pooling agreements with SNH. In accordance with FASB ASC Topic 360, Property, Plant and Equipment, or ASC 360, these six senior living communities met the conditions to be classified as held for sale in November 2017. These six senior living communities, while owned by us, generated income (loss) from operations before income taxes of $(14) and $806 for the three months ended September 30, 2018 and 2017 , respectively, and $137 and $ 2,075 for the nine months ended September 30, 2018 and 2017 , respectively, excluding the gain on sale of the communities. These amounts are included in our condensed consolidated statements of operations. In December 2017, we sold two of the six senior living communities described above for an aggregate sales price of $39,150 . These two senior living communities had an aggregate carrying value of $ 29,444 , net of mortgage debt and discount of $2,303 . In accordance with ASC 360, these two transactions qualify as real estate sales and the gains on these transactions were recognized immediately in accordance with the full accrual method as a result of our lack of continuing involvement in the ownership of the senior living communities after completing these sales. The carrying value of these senior living communities was not included in our condensed consolidated balance sheet as of December 31, 2017. In January and February 2018, we sold two additional senior living communities described above for an aggregate sales price of $41,917 . These two senior living communities had an aggregate carrying value of $19,425 , net of mortgage debt and premiums of $17,356 , of which the principal amount of $16,776 was assumed by SNH. These transactions are accounted for in accordance with ASU No. 2014-09, in particular ASC Topic 610 and related ASUs, effective with the adoption of these new ASUs on January 1, 2018. Under these new ASUs, the income recognition for real estate sales is largely based on the transfer of control rather than continuing involvement in the ownership of the real estate. We recorded a gain of $5,684 for the three months ended March 31, 2018 as a result of the sale of these two senior living communities, which gain is included in loss (gain) on sale of senior living communities in our condensed consolidated statements of operations. In June 2018, we sold the remaining two senior living communities described above for an aggregate sales price of $23,300 . These two senior living communities had an aggregate carrying value of $5,163 , net of mortgage debt and premiums of $17,226 , of which the principal amount of $16,588 was assumed by SNH. These transactions are accounted for in accordance with ASU No. 2014-09, in particular ASC Topic 610 and related ASUs, effective with our adoption of these new ASUs on January 1, 2018. We recorded a gain of $1,549 for the three months ended June 30, 2018 as a result of the sale of these two senior living communities, which gain is included in loss (gain) on sale of senior living communities in our condensed consolidated statements of operations. In June 2018, we began managing for the account of SNH, pursuant to a management agreement and our existing Pooling Agreement No. 12 with SNH, as amended and restated, a senior living community SNH owns located in California with 98 living units. Pursuant to the terms of the management and pooling agreements with respect to this senior living community, we will earn a management fee equal to 5% of the gross revenues realized at this community plus reimbursement for our direct costs and expenses related to our operation of this community, as well as an annual incentive fee equal to 20% of the annual net operating income of this community remaining after SNH realizes an annual minimum return of $1,000 plus 7% of its invested capital for this community in excess of $500 made after the date we began managing this community, and SNH’s annual minimum return for this community will not be used in determining whether or not there is a priority return shortfall, as defined, under the pooling agreement until 2019. In November 2018, we began managing for the account of SNH, pursuant to a management agreement with SNH, a senior living community SNH owns located in Colorado with 238 living units. Pursuant to the terms of the management agreement with respect to this senior living community, we will earn a management fee equal to 5% of the gross revenues realized at this community plus reimbursement for our direct costs and expenses related to our operation of this community, as well as an annual incentive fee equal to 20% of the annual net operating income of this community remaining after SNH realizes an annual minimum return of $1,500 plus 7% of its invested capital for this community made after the date we began managing this community. We and SNH both have the option to terminate the management agreement with respect to this community as of December 31, 2019. We also provide certain other services to residents at some of the senior living communities we manage for SNH, such as rehabilitation services. At senior living communities we manage for the account of SNH where we provide rehabilitation services on an outpatient basis, the residents, third party payers or government programs pay us for those rehabilitation services. At senior living communities we manage for the account of SNH where we provide both inpatient and outpatient rehabilitation services, SNH generally pays us for these services and charges for such services are included in amounts charged to residents, third party payers or government programs. We earned revenues of $1,584 and $1,841 for the three months ended September 30, 2018 and 2017 , respectively, and $4,944 and $5,709 for the nine months ended September 30, 2018 and 2017 , respectively, for rehabilitation services we provided at senior living communities we manage for the account of SNH and that are payable by SNH. These amounts are included in senior living revenue in our condensed consolidated statements of operations. In order to accommodate certain requirements of New York healthcare licensing laws, a part of the senior living community SNH owns, and we manage, located in Yonkers, New York is subleased by a subsidiary of SNH to D&R Yonkers LLC. As of September 30, 2018 , D&R Yonkers LLC was owned by our Executive Vice President, Chief Financial Officer and Treasurer and by SNH’s former president and chief operating officer. We count the part of this senior living community that we manage for D&R Yonkers LLC and the part of this senior living community that we manage for the account of SNH as one senior living community. We earned management fees of $68 and $87 for the three months ended September 30, 2018 and 2017 , respectively, and $208 and $195 for the nine months ended September 30, 2018 and 2017 , respectively, under this management arrangement with D&R Yonkers LLC, which amounts are included in management fee revenue in our condensed consolidated statements of operations.

Business Management Agreement w

Business Management Agreement with RMR LLC	9 Months Ended
	Sep. 30, 2018
Management Agreement [Abstract]
Business Management Agreement with RMR LLC	Business Management Agreement with RMR LLC The RMR Group LLC, or RMR LLC, provides us certain services that we require to operate our business and which relate to various aspects of our business. RMR LLC provides these services pursuant to a business management agreement. Pursuant to our business management agreement with RMR LLC, we recognized business management fees of $2,258 and $2,264 for the three months ended September 30, 2018 and 2017 , respectively, and $6,771 and $6,817 for the nine months ended September 30, 2018 and 2017 , respectively. In addition, we are responsible for our share of RMR LLC’s costs for providing our internal audit function. The amounts recognized as expense for internal audit costs were $61 and $72 for the three months ended September 30, 2018 and 2017 , respectively, and $184 and $207 for the nine months ended September 30, 2018 and 2017 , respectively, which amounts are included in general and administrative expenses in our condensed consolidated statements of operations.

Related Person Transactions

Related Person Transactions	9 Months Ended
	Sep. 30, 2018
Related Party Transactions [Abstract]
Related Person Transactions	Related Person Transactions We have relationships and historical and continuing transactions with SNH, RMR LLC, ABP Trust, AIC and others related to them, including other companies to which RMR LLC or its subsidiaries provide management services and which have trustees, directors and officers who are also our Directors or officers. SNH . SNH is currently one of our largest stockholders, owning, as of September 30, 2018 , 4,235,000 of our common shares, or approximately 8.4% of our outstanding common shares. We lease from, and manage for the account of, SNH a majority of the senior living communities we operate. RMR LLC provides management services to both us and SNH and Adam D. Portnoy, one of our Managing Directors, also serves as a managing trustee of SNH. See Notes 9 and 10 for more information regarding our relationships, agreements and transactions with SNH and certain parties related to it and us. RMR LLC. We have an agreement with RMR LLC to provide management services to us. See Note 10 for more information regarding our management agreement with RMR LLC. ABP Trust. A subsidiary of ABP Trust is our largest stockholder, owning, as of September 30, 2018 , 17,999,999 of our common shares, or approximately 35.6% of our outstanding common shares. Adam D. Portnoy, one of our Managing Directors, is the sole trustee, an officer and the controlling shareholder of ABP Trust, which is the controlling shareholder of The RMR Group Inc., or RMR Inc.; RMR Inc. is the managing member of RMR LLC. We lease our headquarters from another subsidiary of ABP Trust. Our rent expense for our headquarters, including utilities and real estate taxes that we pay as additional rent, was $420 and $416 for the three months ended September 30, 2018 and 2017 , respectively, and $1,299 and $1,212 for the nine months ended September 30, 2018 and 2017 , respectively. AIC . We, ABP Trust, SNH and four other companies to which RMR LLC provides management services currently own AIC, an Indiana insurance company, in equal amounts. We and the other AIC shareholders participate in a combined property insurance program arranged and reinsured in part by AIC. We paid aggregate annual premiums, including taxes and fees, of approximately $3,144 in connection with the renewal of this insurance program for the policy year ending June 30, 2019, which amount may be adjusted from time to time as we acquire and dispose of properties that are included in this insurance program. As of September 30, 2018 and December 31, 2017 , our investment in AIC had a carrying value of $9,157 and $8,185 , respectively. These amounts are presented as equity investment of an investee in our condensed consolidated balance sheets. We recognized income related to our investment in AIC, which amounts are presented as equity in earnings of an investee in our condensed consolidated statements of operations. Our other comprehensive income includes our proportionate part of unrealized gains (losses) on securities that are owned by AIC related to our investment in AIC. For further information about these and other such relationships and certain other related person transactions, refer to our Annual Report.

Legal Proceedings and Claims

Legal Proceedings and Claims	9 Months Ended
	Sep. 30, 2018
Commitments and Contingencies Disclosure [Abstract]
Legal Proceedings and Claims	Legal Proceedings and Claims We have been, are currently, and expect in the future to be involved in claims, lawsuits, and regulatory and other government audits, investigations and proceedings arising in the ordinary course of our business, some of which may involve material amounts. Also, the defense and resolution of these claims, lawsuits, and regulatory and other government audits, investigations and proceedings may require us to incur significant expense. We account for claims and litigation losses in accordance with FASB ASC Topic 450, Contingencies , or ASC Topic 450. Under ASC Topic 450, loss contingency provisions are recorded for probable and estimable losses at our best estimate of a loss or, when a best estimate cannot be made, at our estimate of the minimum loss. These estimates are often developed prior to knowing the amount of the ultimate loss, require the application of considerable judgment and are refined as additional information becomes known. Accordingly, we are often initially unable to develop a best estimate of loss and therefore the estimated minimum loss amount, which could be zero , is recorded; then, as information becomes known, the minimum loss amount is updated, as appropriate. A minimum or best estimate amount may be increased or decreased when events result in a changed expectation. As previously disclosed, in July 2017, as a result of our compliance program to review records related to our Medicare billing practices, we became aware of certain potential inadequate documentation and other issues at one of our leased SNFs. This compliance review was not initiated in response to any specific complaint or allegation, but was a review of the type that we periodically undertake to test our compliance with applicable Medicare billing rules. As a result of these discoveries, we have made a voluntary disclosure of deficiencies to the U.S. Department of Health and Human Services Office of the Inspector General, or the OIG, pursuant to the OIG's Provider Self-Disclosure Protocol. We submitted supplemental disclosures to the OIG in December 2017 and March 2018. At December 31, 2017, we accrued an estimated revenue reserve of $888 for historical Medicare payments we received and expect to repay as a result of these deficiencies, which amount we reduced to $759 in March 2018. The entire $759 reserve remained accrued and unpaid at September 30, 2018 . In addition, at December 31, 2017 , we recorded an aggregate $ 658 expense for additional costs we incurred as a result of this matter, including estimated OIG imposed penalties, which amount we reduced to $594 in March 2018, and thereafter recorded an additional expense of $55 , $20 and $12 for further costs related to this matter for the three months ended March 31, 2018, June 30, 2018 and September 30, 2018 , respectively. Our total costs incurred related to this matter at September 30, 2018 , excluding revenue reserves, was $681 , $559 of which remained accrued and unpaid at September 30, 2018 . We were defendants in a lawsuit filed in the Superior Court of Maricopa County, Arizona by the estate of a former resident of a senior living community operated by us, or the Arizona litigation matter. The complaint asserted claims against us for pain and suffering as a result of improper treatment constituting violations of the Arizona Adult Protective Services Act and wrongful death. In May 2015, the jury rendered a decision in our favor on the wrongful death claim, and against us on the remaining claims, returning verdicts awarding damages of approximately $19,200 , which consisted of $2,500 for pain and suffering and the remainder in punitive damages. In March 2016, pursuant to a settlement agreement we entered with the plaintiff, $7,250 was paid to the plaintiff, of which $3,021 was paid by our then liability insurer and the balance by us. We recorded a $4,229 charge for the year ended December 31, 2015 for the net settlement amount we paid. In September 2017, pursuant to an agreement we entered with our former liability insurer to settle litigation we had commenced against it, our former liability insurer paid us an additional $800 related to our settlement of the Arizona litigation matter and we recorded a decrease to other senior living operating expenses in our condensed consolidated statements of operations consistent with the classification of the original charge.

Employee Benefit Plans

Employee Benefit Plans	9 Months Ended
	Sep. 30, 2018
Retirement Benefits [Abstract]
Employee Benefit Plans	Employee Benefit Plans Employee 401(k) Plan. We have an employee savings plan, or our 401(k) Plan, under the provisions of Section 401(k) of the Internal Revenue Code, or the IRC. All of our employees are eligible to participate in our 401(k) Plan and are entitled upon termination or retirement to receive their vested portion of our 401(k) Plan assets. We match up to a certain amount of employee contributions. We also pay certain expenses related to our 401(k) Plan. Our contributions and related expenses for our 401(k) Plan were $332 and $322 for the three months ended September 30, 2018 and 2017 , respectively, of which $292 and $288 , respectively, was recorded in senior living wages and benefits and of which $40 and $34 , respectively, was recorded in general and administrative expenses in our condensed consolidated statements of operations. Our contributions and related expenses for our 401(k) Plan were $1,003 and $1,085 for the nine months ended September 30, 2018 and 2017 , respectively, of which $879 and $943 , respectively, was recorded in senior living wages and benefits and of which $124 and $142 , respectively, was recorded in general and administrative expenses in our condensed consolidated statements of operations. Non-Qualified Deferred Compensation Plan. In May 2018, our board of directors adopted a non-qualified deferred compensation plan, or our Deferred Compensation Plan, which we began offering to certain of our employees, including our executive officers, in August 2018. Participation in our Deferred Compensation Plan is limited to a group of highly compensated employees holding the position of administrator or director or a position above such levels, which group includes our named executive officers. Our Deferred Compensation Plan is an unfunded and unsecured deferred compensation arrangement. A participant may, on a pre-tax basis, elect to defer base salary and bonus up to the maximum percentages for such deferrals as described in our Deferred Compensation Plan. We may also, at our discretion, match deferrals made under our Deferred Compensation Plan, subject to a vesting schedule. Compensation deferred under our Deferred Compensation Plan was recorded in accounts payable and accrued expenses in our condensed consolidated balance sheets as of September 30, 2018. Expenses related to such deferred compensation were recorded in senior living wages and benefits and general and administrative expenses in our condensed consolidated statements of operations. Compensation deferred under our Deferred Compensation Plan was not material to our condensed consolidated balance sheets as of September 30, 2018 or our condensed consolidated statements of operations for three and nine months ended September 30, 2018 .

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	9 Months Ended
	Sep. 30, 2018
Accounting Policies [Abstract]
Revenue Recognition	Revenue Recognition On January 1, 2018, we adopted FASB ASC Topic 606, Revenue from Contracts with Customers, or ASC Topic 606, under the modified retrospective approach applied to certain contracts which were not completed as of December 31, 2017 using the practical expedient in paragraph 606-10-10-4 that allows for the use of a portfolio approach, because we have determined that the effect of applying the guidance to our portfolios of contracts within the scope of ASC Topic 606 on our consolidated financial statements would not differ materially from applying the guidance to each individual contract within the respective portfolio or our performance obligations within that portfolio. This approach will also be used for future contract modifications, if any. The five step model defined by ASC Topic 606 requires us to: (1) identify our contracts with customers, (2) identify our performance obligations under those contracts, (3) determine the transaction prices of those contracts, (4) allocate the transaction prices to our performance obligations in those contracts and (5) recognize revenue when each performance obligation under those contracts is satisfied. Revenue is recognized when promised goods or services are transferred to the customer in an amount that reflects the consideration expected in exchange for those goods or services. Our adoption of ASC Topic 606 did not result in an adjustment to our retained earnings and did not have a material impact on the amount and timing of our revenue recognition for the three and nine months ended September 30, 2018 . A substantial portion of our revenue relates to contracts with residents for housing services that are generally short term in nature and fall under FASB ASC Topic 840, Leases , or ASC Topic 840, which are specifically excluded from the scope of ASC Topic 606. Our contracts with residents and other customers that are within the scope of ASC Topic 606 are also generally short term in nature. We have determined that services performed under those contracts are considered one performance obligation in accordance with ASC Topic 606 as such services are regarded a series of distinct events with the same timing and pattern of transfer to the resident or customer. Revenue is recognized for those contracts when our performance obligation is satisfied by transferring control of the service provided to the resident or customer, which is generally when the services are provided over time. Senior Living Revenue. Resident fees at our independent living and assisted living communities consist of regular monthly charges for basic housing and support services and fees for additional requested services, such as assisted living services, personalized health services and ancillary services. Fees are specified in our agreements with residents, which are generally short term ( 30 days to one year ), with regular monthly charges billed in advance. Funds received from residents in advance of services being provided are not material to our consolidated financial statements. Some of our senior living communities require payment of an entrance fee in advance of a resident moving into the community; substantially all of these community fees are non-refundable and are initially recorded as deferred revenue and included in other current liabilities in our consolidated balance sheets. These deferred amounts then are amortized on a straight line basis into revenue over the term of the resident agreement. Revenue recorded and deferred in connection with community fees is not material to our consolidated financial statements. A substantial portion of our senior living revenue related to housing services falls under ASC Topic 840, and is recorded on a straight line basis over the term of the resident agreement. Revenue for additional requested services is recognized in accordance with ASC Topic 606 and measured based on the consideration specified in the resident agreement and is recorded when the services are provided. In our SNFs and certain of our independent and assisted living communities where we provide SNF services, we are paid fixed daily rates from governmental and contracted third party payers, and we charge a predetermined fixed daily rate for private pay residents. These fixed daily rates and certain other fees are billed monthly in arrears. Although there are complex regulatory compliance rules governing fixed daily rates, we have no episodic payments or capitation arrangements. We currently use the “most likely amount” technique to estimate revenue in accordance with ASC Topic 606, although rates are generally known and considered fixed prior to services being performed, whether included in the resident agreement or contracted with governmental or third party payers. Rate adjustments from Medicare or Medicaid are recorded when known (without regard to when the assessment is paid or withheld), and subsequent adjustments to these amounts are recorded in revenues when known. Billings under certain of these programs are subject to audit and possible retroactive adjustment, and related revenue is recorded at the amount we ultimately expect to receive, which is inclusive of the estimated retroactive adjustments or refunds, if any, under reimbursement programs. Retroactive adjustments are recorded on an estimated basis in the period the related services are rendered and adjusted in future periods or as final settlements are determined. Revenue is recognized when performance obligations are satisfied by transferring control of the service provided to the resident, which is generally when services are provided over the duration of care. We derived approximately 23.1% and 22.6% of our senior living revenues for the three months ended September 30, 2018 and 2017 , respectively, and 23.2% and 22.9% for the nine months ended September 30, 2018 and 2017 , respectively, from payments under Medicare and Medicaid programs. Management Fee Revenue and Reimbursed Costs Incurred on Behalf of Managed Communities. We manage senior living communities for the account of Senior Housing Properties Trust, or, together with its subsidiaries, SNH, pursuant to long term management agreements which provide for periodic management fee payments to us and reimbursement for our direct costs and expenses related to such communities. Management fees are determined by an agreed upon percentage of gross revenues (as defined) and recognized in accordance with ASC Topic 606 in the same period that we provide the management services to SNH, generally monthly. FASB ASU No. 2016-08, Revenue from Contracts with Customers (Topic 606): Principal versus Agent Considerations (Reporting Revenue Gross versus Net) , which we adopted effective January 1, 2018, clarifies how an entity should identify the unit of accounting for the principal versus agent evaluation and how it should apply the control principle to certain types of arrangements, such as service transactions. Where we are the primary obligor and therefore control the transfer of the goods and services with respect to any such operating expenses incurred in connection with the management of these communities, we recognize revenue when the goods have been delivered or the service has been rendered and we are due to be reimbursed from SNH. Such revenue is included in reimbursed costs incurred on behalf of managed communities in our consolidated statements of operations. The related costs are included in costs incurred on behalf of managed communities in our consolidated statements of operations. Amounts due from SNH related to management fees and reimbursed costs incurred on behalf of managed communities are included in due from related persons in our consolidated balance sheets.
Recent Accounting Pronouncements	Recent Accounting Pronouncements On January 1, 2018, we adopted FASB ASU No. 2016-01, Recognition and Measurement of Financial Assets and Financial Liabilities, which changes how entities measure certain equity investments and present changes in the fair value of financial liabilities measured under the fair value option that are attributable to their own credit. Prior to our adoption of this ASU, we recorded changes in the fair value of our equity investments through other comprehensive income. Pursuant to this ASU, these changes will now be recorded through earnings. We adopted this ASU using the cumulative effect adjustment method and recorded an adjustment of $1,107 on January 1, 2018 to accumulated other comprehensive income and accumulated deficit in our consolidated balance sheets. Affiliates Insurance Company, or AIC, a private company in which we have an equity investment, chose to early adopt this ASU during the second quarter of 2018, and therefore we recorded a cumulative effect adjustment of $840 to accumulated other comprehensive income and accumulated deficit in our consolidated balance sheets to reflect our share of AIC's adjustment to its equity investments. See Note 11 for more information regarding our arrangements with AIC. In May 2014, the FASB issued ASU No. 2014-09, Revenue from Contracts with Customers (Topic 606) , which outlines a comprehensive model for entities to use in accounting for revenue arising from contracts with customers. In March 2016, the FASB issued ASU No. 2016-08, Revenue from Contracts with Customers (Topic 606): Principal versus Agent Considerations (Reporting Revenue Gross versus Net) , which clarifies how an entity should identify the unit of accounting for the principal versus agent evaluation and how it should apply the control principle to certain types of arrangements, such as service transactions. Additionally, real estate sales are within the scope of ASU No. 2014-09, as amended by ASU No. 2017-05, Other Income - Gains and Losses from the Derecognition of Nonfinancial Assets . Under these ASUs, income recognition for real estate sales is primarily based on the transfer of control of the real estate rather than the continuing involvement in the real estate under the current guidance. As a result, more of our transactions may qualify as real estate sales and we may be required to recognize gains or losses sooner. We adopted these ASUs on January 1, 2018 using the modified retrospective approach. The adoption of these ASUs did not result in any adjustment to our initial retained earnings and did not result in any significant change to the amount and timing of our revenue recognition. The adoption of these ASUs did result in expanded disclosures related to the nature, amount, timing and uncertainty of our revenue and cash flows arising from our contracts with customers that are included within the scope of these ASUs. See also the discussion above under “Revenue Recognition” for more information regarding the impact of these ASUs on our consolidated financial statements. On January 1, 2018, we adopted FASB ASU No. 2016-15, Statement of Cash Flows (Topic 230): Classification of Certain Cash Receipts and Cash Payments , which clarifies how entities present and classify certain cash receipts and cash payments in the statement of cash flows. The adoption of this ASU did not have a material impact on our consolidated financial statements. On January 1, 2018, we adopted FASB ASU No. 2016-18, Statement of Cash Flows (Topic 230): Restricted Cash , which requires that the reconciliation of the beginning-of-period and end-of-period amounts presented in the statement of cash flows include restricted cash and restricted cash equivalents. We adopted this ASU retrospectively to all periods presented in our consolidated statement of cash flows. Pursuant to this ASU, in the event restricted cash is presented separately from cash and cash equivalents in the balance sheets, entities are required to reconcile the amounts presented in the statement of cash flows to the amounts presented in the balance sheet and to disclose information about the nature of the restrictions. We have presented our consolidated statement of cash flows to reconcile both cash and cash equivalents and restricted cash and restricted cash equivalents and have provided a reconciliation to the amounts presented in our consolidated statements of cash flows to the amounts presented in our consolidated balance sheets. In February 2016, the FASB issued ASU No. 2016-02, Leases (Topic 842) , which sets out the principles for the recognition, measurement, presentation and disclosure of leases for both parties to a contract (i.e., lessees and lessors). This ASU requires lessees to apply a dual approach, classifying leases as either finance or operating leases based on the principle of whether or not the lease is effectively a financed purchase of the leased asset by the lessee. This classification will determine whether the lease expense is recognized based on an effective interest method or on a straight line basis over the term of the lease. A lessee is also required to record a right of use asset and a lease liability for all leases with a term of greater than 12 months regardless of their classification. Leases with a term of 12 months or less will be accounted for similar to existing guidance for operating leases. This ASU also changes the accounting for sale and leaseback transactions, such as our sale and leaseback transaction with SNH in June 2016, and any associated deferred gain. Additionally, this ASU requires lessors to account for leases using an approach that is substantially equivalent to existing guidance for sales type leases, direct financing leases and operating leases. This ASU is effective for reporting periods beginning after December 15, 2018, with early adoption permitted. In July 2018, the FASB issued ASU No. 2018-11, Leases (Topic 842): Targeted Improvements , which works to improve on certain aspects of ASU No. 2016-02 identified by stakeholders as problematic or difficult to implement, including the adoption method. ASU No. 2018-11 provides for a transition method option, allowing entities to recognize a cumulative effect adjustment to the opening balance of retained earnings in the period of adoption, rather than restating comparative periods being presented. ASU No. 2018-11 also provides lessors with a practical expedient, by class of underlying asset, not to separate non-lease components from the associated lease component if certain conditions are met. In addition, ASU No. 2018-11 clarifies which ASC Topic (Topic 842 or Topic 606) applies for the combined component. Specifically, if the non-lease components associated with the lease component are the predominant component of the combined component, an entity should account for the combined component in accordance with ASC Topic 606. Otherwise, the entity should account for the combined component as an operating lease in accordance with ASC Topic 842. We expect to elect this practical expedient provided to lessors and will recognize revenue under our resident agreements based upon the predominant component. We will adopt these ASUs as required effective January 1, 2019 utilizing the modified retrospective transition method with no adjustments to comparative periods presented in accordance with ASU No. 2018-11. While we are continuing to assess the potential impact that the adoption of these ASUs may have on our consolidated financial statements, we believe the adoption of these ASUs will have a material impact on our consolidated balance sheets due to the recognition of lease rights and obligations as assets and liabilities, and any previously unrecognized right of use assets will need to be reviewed for impairment effective January 1, 2019. While the adoption of these ASUs will not affect the rent we pay, we expect the rent expense amounts presented in our consolidated statements of operations and comprehensive loss to change materially due to changes in how we will account for our deferred gain on our sale and leaseback transaction described above. In June 2016, the FASB issued ASU No. 2016-13, Financial Instruments—Credit Losses (Topic 326), which requires a financial asset or a group of financial assets measured at amortized cost basis to be presented at the net amount expected to be collected. This ASU eliminates the probable initial recognition threshold and instead requires reflection of an entity’s current estimate of all expected credit losses. In addition, this ASU amends the current available for sale security other-than-temporary impairment model for debt securities. The length of time that the fair value of an available for sale debt security has been below the amortized cost will no longer impact the determination of whether a credit loss exists and credit losses will now be limited to the difference between a security’s amortized cost basis and its fair value. This ASU is effective for reporting periods beginning after December 15, 2019. We are currently assessing the potential impact that the adoption of this ASU will have on our consolidated financial statements. In March 2017, the FASB issued ASU No. 2017-08, Receivables—Nonrefundable Fees and Other Costs (Subtopic 310-20) , which shortens the amortization period for certain callable debt securities held at a premium. Specifically, this ASU requires the premium to be amortized to the earliest call date. This ASU does not require an accounting change for securities held at a discount; the discount continues to be amortized to maturity. This ASU is effective for reporting periods beginning after December 15, 2018, with early adoption permitted. We are currently assessing the potential impact that the adoption of this ASU will have on our consolidated financial statements. In February 2018, the FASB issued ASU No. 2018-02, Income Statement—Reporting Comprehensive Income (Topic 220) , which permits an entity to reclassify the tax effects that remain recorded within other comprehensive income to retained earnings as a result of tax reform legislation that became effective in December 2017. This ASU is effective for reporting periods beginning after December 15, 2018. We are currently assessing the potential impact that the adoption of this ASU will have on our consolidated financial statements. In June 2018, the FASB issued ASU No. 2018-07, Compensation—Stock Compensation (Topic 718) , which expands the scope of Topic 718 to include share based payment transactions for acquiring goods and services from non-employees. This ASU is effective for reporting periods beginning after December 15, 2018. We are currently assessing the potential impact that the adoption of this ASU will have on our consolidated financial statements. In August 2018, the FASB issued ASU No. 2018-13, Fair Value Measurement (Topic 820) , which modifies certain disclosure requirements in Topic 820, such as the removal of the need to disclose the amount of and reason for transfers between Level 1 and Level 2 of the fair value hierarchy, and several changes related to Level 3 fair value measurements. This ASU is effective for reporting periods beginning after December 15, 2019. We are currently assessing the potential impact that the adoption of this ASU will have on our consolidated financial statements. In August 2018, the FASB also issued ASU No. 2018-15, Intangibles—Goodwill and Other—Internal Use Software (Subtopic 350-40) , which aligns the requirements for capitalizing implementation costs incurred in a cloud computing hosting arrangement that is a service contract with the requirements for capitalizing implementation costs incurred to develop or obtain internal use software. This ASU is effective for reporting periods beginning after December 15, 2019. We are currently assessing the potential impact that the adoption of this ASU will have on our consolidated financial statements.

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Tables)	9 Months Ended
	Sep. 30, 2018
Accounting Policies [Abstract]
Revenue disaggregated by type of contract and payer	The following table presents revenue disaggregated by type of contract and payer: Three Months Ended September 30, 2018 Nine Months Ended September 30, 2018 Leasing revenue (1) 162,397 486,279 Revenue from contracts with customers: Medicare and Medicaid programs (1) 62,982 190,138 Additional requested services, and private pay and other third party payer SNF services (1) 47,322 141,691 Management fee revenue 4,009 11,408 Reimbursed costs incurred on behalf of managed communities 72,200 208,009 186,513 551,246 Total revenues 348,910 1,037,525 (1) Included in senior living revenue in our consolidated statements of operations.

Property and Equipment (Tables)

Property and Equipment (Tables)	9 Months Ended
	Sep. 30, 2018
Property, Plant and Equipment [Abstract]
Schedule of property and equipment	Property and equipment consists of the following: September 30, 2018 December 31, 2017 Land $ 16,383 $ 16,383 Buildings and improvements 207,379 211,812 Furniture, fixtures and equipment 232,252 208,262 Property and equipment, at cost 456,014 436,457 Accumulated depreciation (211,266 ) (184,953 ) Property and equipment, net $ 244,748 $ 251,504

Accumulated Other Comprehensi_2

Accumulated Other Comprehensive Income (Tables)	9 Months Ended
	Sep. 30, 2018
Equity [Abstract]
Schedule of changes in accumulated other comprehensive income, net of tax	The following table details the changes in accumulated other comprehensive income, net of tax, for the nine months ended September 30, 2018 : Equity Investment of an Investee Investments Accumulated Other Comprehensive Income Balance at January 1, 2018 $ 642 $ 3,394 $ 4,036 Cumulative effect of reclassification of unrealized gain on equity investments in connection with the adoption of FASB ASU No. 2016-01 (840 ) (1,107 ) (1,947 ) Unrealized loss on investments, net of tax — (437 ) (437 ) Equity in unrealized gain of an investee, net of tax 90 — 90 Realized loss on investments reclassified and included in net loss, net of tax — 92 92 Balance at September 30, 2018 $ (108 ) $ 1,942 $ 1,834

Fair Values of Assets and Lia_2

Fair Values of Assets and Liabilities (Tables)	9 Months Ended
	Sep. 30, 2018
Fair Value Disclosures [Abstract]
Schedule of assets and liabilities measured at fair value on a recurring and non recurring basis, categorized by the level of inputs used in the valuation of each asset	The tables below present the assets measured at fair value at September 30, 2018 and December 31, 2017 categorized by the level of inputs used in the valuation of each asset. As of September 30, 2018 Quoted Prices in Active Markets for Identical Assets Significant Other Observable Inputs Significant Unobservable Inputs Description Total (Level 1) (Level 2) (Level 3) Cash equivalents (1) $ 24,191 $ 24,191 $ — $ — Investments: Equity investments (2) Financial services industry 2,000 2,000 — — REIT industry 115 115 — — Other 4,112 4,112 — — Total equity investments 6,227 6,227 — — Debt investments: (3) International bond fund (4) 2,503 — 2,503 — High yield fund (5) 2,812 — 2,812 — Industrial bonds 2,042 — 2,042 — Technology bonds 2,371 — 2,371 — Government bonds 10,159 10,159 — — Energy bonds 590 — 590 — Financial bonds 1,459 — 1,459 — Other 1,765 — 1,765 — Total debt investments 23,701 10,159 13,542 — Total investments 29,928 16,386 13,542 — Total $ 54,119 $ 40,577 $ 13,542 $ — As of December 31, 2017 Quoted Prices in Active Markets for Identical Assets Significant Other Observable Inputs Significant Unobservable Inputs Description Total (Level 1) (Level 2) (Level 3) Cash equivalents (1) $ 23,578 $ 23,578 Investments: Equity investments (2) Financial services industry 2,199 2,199 — — REIT industry 145 145 — — Other 4,094 4,094 — — Total equity investments 6,438 6,438 — — Debt investments (3) International bond fund (4) 2,511 — 2,511 — High yield fund (5) 2,744 — 2,744 — Industrial bonds 2,017 — 2,017 — Technology bonds 2,972 — 2,972 — Government bonds 10,707 10,610 97 — Energy bonds 1,216 — 1,216 — Financial bonds 1,423 — 1,423 — Other 3,254 — 3,254 — Total debt investments 26,844 10,610 16,234 — Total investments 33,282 17,048 16,234 — Total $ 56,860 $ 40,626 $ 16,234 $ — (1) Cash equivalents consist of short term, highly liquid investments and money market funds held principally for obligations arising from our self insurance programs. Cash equivalents are reported in our condensed consolidated balance sheets as cash and cash equivalents and current and long term restricted cash. Cash equivalents include $ 20,480 and $ 20,316 of balances that are restricted at September 30, 2018 and December 31, 2017 , respectively. (2) The fair value of our equity investments is readily determinable. During the nine months ended September 30, 2018 and 2017 , we received gross proceeds of $697 and $ 3,083 , respectively, in connection with the sales of equity investments and recorded gross realized gains totaling $92 and $360 , respectively, and gross realized losses totaling $5 and $145 , respectively. (3) As of September 30, 2018 , our debt investments, which are classified as available for sale, had a fair value of $ 23,701 with an amortized cost of $ 22,788 ; the difference between the fair value and amortized cost amounts resulted from unrealized gains of $ 1,352 , net of unrealized losses of $ 439 . As of December 31, 2017 , our debt investments had a fair value of $ 26,844 with an amortized cost of $ 25,589 ; the difference between the fair value and amortized cost amounts resulted from unrealized gains of $ 1,401 , net of unrealized losses of $ 146 . Debt investments include $14,768 and $18,068 of balances that are restricted as of September 30, 2018 and December 31, 2017 , respectively. At September 30, 2018 , 37 of the securities we hold, with a fair value of $ 8,932 , have been in a loss position for less than 12 months and 28 of the investments we hold, with a fair value of $ 8,748 , have been in a loss position for greater than 12 months . We do not believe these investments are impaired primarily because they have not been in a loss position for an extended period of time, the financial conditions of the issuers of these investments remain strong with solid fundamentals, or we intend to hold these investments until recovery, and other factors that support our conclusion that the loss is temporary. During the nine months ended September 30, 2018 and 2017 , we received gross proceeds of $ 5,652 and $ 12,598 , respectively, in connection with the sales of debt investments and recorded gross realized gains totaling $ 9 and $ 167 , respectively, and gross realized losses totaling $ 104 and $ 31 , respectively. We record gains and losses on the sales of these investments using the specific identification method. (4) The investment strategy of this fund is to invest principally in fixed income securities issued by non-U.S. issuers. The fund invests in such securities or investment vehicles as it considers appropriate to achieve the fund’s investment objective, which is to provide an above average rate of total return while attempting to limit investment risk by investing in a diversified portfolio of U.S. dollar investment grade fixed income securities. There are no unfunded commitments and the investment can be redeemed weekly. (5) The investment strategy of this fund is to invest principally in fixed income securities. The fund invests in such securities or investment vehicles as it considers appropriate to achieve the fund’s investment objective, which is to provide an above average rate of total return while attempting to limit investment risk by investing in a diversified portfolio of primarily fixed income securities issued by companies with below investment grade ratings. There are no unfunded commitments and the investment can be redeemed weekly.

Indebtedness (Tables)

Indebtedness (Tables)	9 Months Ended
	Sep. 30, 2018
Debt Disclosure [Abstract]
Summary of mortgages	The following table is a summary of this mortgage as of September 30, 2018 : Balance as of Contractual Stated Effective Monthly September 30, 2018 Interest Rate Interest Rate Maturity Date Payment Lender Type $ 8,239 (1) 6.20 % 6.70 % September 2032 $ 72 Federal Home Loan Mortgage Corporation (1) Contractual principal payment excluding unamortized discount and debt issuance costs of $286 .

Basis of Presentation and Org_2

Basis of Presentation and Organization (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2018USD ($)living_unitsegmentstatebedpropertysuiteapartment	Dec. 31, 2017USD ($)
Going Concern
Accumulated deficit | $	$ 268,967	$ 220,489
Segment Information
Number of operating segments | segment	2
Number of reportable segments | segment	1
Senior living communities
Real estate properties
Number of properties operated | property	283
Number of states in which real estate properties are located | state	32
Number of properties owned and operated | property	20
Number of living units in properties owned and operated | living_unit	2,108
Number of properties leased and operated | property	188
Number of units in properties leased and operated | living_unit	20,182
Number of properties managed | property	75
Number of units in properties managed | living_unit	9,515
Number of living units in properties operated | living_unit	31,805
Independent and assisted living communities
Real estate properties
Number of properties operated | property	254
Number of living units in properties operated | living_unit	29,300
SNF
Real estate properties
Number of properties operated | property	29
Number of living units in properties operated | living_unit	2,505
Independent living apartment
Real estate properties
Number of living units in properties operated | apartment	10,741
Assisted living suites
Real estate properties
Number of living units in properties operated | suite	16,292
Skilled nursing units
Real estate properties
Number of living units in properties operated | bed	4,772

Summary of Significant Accoun_4

Summary of Significant Accounting Policies (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017	Jun. 30, 2018	Jan. 01, 2018	Dec. 31, 2017
Disaggregation of Revenue [Line Items]
Percentage senior living revenues	23.10%	22.60%	23.20%	22.90%
Leasing revenue	$ 162,397		$ 486,279
Revenue from contracts with customers	186,513		551,246
Total revenues	348,910	$ 347,101	1,037,525	$ 1,047,815
Accumulated deficit	(268,967)		(268,967)				$ (220,489)
Accumulated other comprehensive income	1,834		1,834				$ 4,036
ASU 2016-01 | Cumulative effect adjustment
Disaggregation of Revenue [Line Items]
Accumulated deficit						$ 1,107
Accumulated other comprehensive income						$ (1,107)
Medicare and Medicaid programs
Disaggregation of Revenue [Line Items]
Revenue from contracts with customers	62,982		190,138
Additional requested services, and private pay and other third party payer SNF services
Disaggregation of Revenue [Line Items]
Revenue from contracts with customers	47,322		141,691
Management fee revenue
Disaggregation of Revenue [Line Items]
Revenue from contracts with customers	4,009		11,408
Total revenues	4,009	3,414	11,408	10,531
Reimbursed costs incurred on behalf of managed communities
Disaggregation of Revenue [Line Items]
Revenue from contracts with customers	72,200		208,009
Total revenues	$ 72,200	$ 64,033	$ 208,009	$ 194,346
Minimum
Disaggregation of Revenue [Line Items]
Payment terms			30 days
Maximum
Disaggregation of Revenue [Line Items]
Payment terms			1 year
Affiliates Insurance Company | ASU 2016-01 | Cumulative effect adjustment
Disaggregation of Revenue [Line Items]
Accumulated deficit					$ 840
Accumulated other comprehensive income					$ (840)

Property and Equipment (Details

Property and Equipment (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017	Dec. 31, 2017
Property and Equipment
Property and equipment, gross	$ 456,014		$ 456,014		$ 436,457
Accumulated depreciation	(211,266)		(211,266)		(184,953)
Property and equipment, net	244,748		244,748		251,504
Depreciation expense	9,117	$ 9,732	26,915	$ 28,863
Long lived asset impairment	0	$ 142	365	$ 528
Assets held for sale	0		0		59,080
SNH
Property and Equipment
Assets held for sale for increased rent pursuant to the terms of leases with SNH	987		987
Land
Property and Equipment
Property and equipment, gross	16,383		16,383		16,383
Buildings and improvements
Property and Equipment
Property and equipment, gross	207,379		207,379		211,812
Furniture, fixtures and equipment
Property and Equipment
Property and equipment, gross	$ 232,252		$ 232,252		$ 208,262

Accumulated Other Comprehensi_3

Accumulated Other Comprehensive Income (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Changes in accumulated other comprehensive income
Beginning balance			$ 144,994
Unrealized loss on investments, net of tax	$ 3	$ 145	(437)	$ 504
Equity in unrealized gain of an investee, net of tax			90
Realized loss on investments reclassified and included in net loss, net of tax			92
Ending balance	94,968		94,968
Equity Investment of an Investee
Changes in accumulated other comprehensive income
Beginning balance			642
Cumulative effect of reclassification of unrealized gain on equity investments in connection with the adoption of FASB ASU No. 2016-01			(840)
Unrealized loss on investments, net of tax			0
Equity in unrealized gain of an investee, net of tax			90
Realized loss on investments reclassified and included in net loss, net of tax			0
Ending balance	(108)		(108)
Investments
Changes in accumulated other comprehensive income
Beginning balance			3,394
Cumulative effect of reclassification of unrealized gain on equity investments in connection with the adoption of FASB ASU No. 2016-01			(1,107)
Unrealized loss on investments, net of tax			(437)
Equity in unrealized gain of an investee, net of tax			0
Realized loss on investments reclassified and included in net loss, net of tax			92
Ending balance	1,942		1,942
Accumulated Other Comprehensive Income
Changes in accumulated other comprehensive income
Beginning balance			4,036
Cumulative effect of reclassification of unrealized gain on equity investments in connection with the adoption of FASB ASU No. 2016-01			(1,947)
Ending balance	$ 1,834		$ 1,834

Income Taxes (Details)

Income Taxes (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Income Tax Disclosure [Abstract]
Benefit (provision) for income taxes	$ 263	$ 55	$ (274)	$ 1,330

Earnings Per Share (Details)

Earnings Per Share (Details) - $ / shares	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017	Dec. 31, 2017
Earnings Per Share [Abstract]
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01	$ 0.01	$ 0.01	$ 0.01
Antidilutive securities excluded from computation of earnings per share (in shares)	1,207,928	1,053,305	1,239,628	1,031,793

Fair Values of Assets and Lia_3

Fair Values of Assets and Liabilities - Recurring Measurements (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2018USD ($)security	Sep. 30, 2017USD ($)	Dec. 31, 2017USD ($)
Fair Values of Assets and Liabilities
Cash equivalents	$ 24,191		$ 23,578
Total investments	29,928
Total investments			33,282
Total	54,119		56,860
Restricted cash	$ 20,480		20,316
Number of available for sale securities in a loss position less than 12 months | security	37
Fair value of securities which are in loss position for less than 12 months	$ 8,932
Number of available for sale securities in a loss position 12 months or longer | security	28
Fair value of securities which are in loss position for greater than 12 months	$ 8,748
Equity securities
Fair Values of Assets and Liabilities
Equity investments	6,227
Total investments			6,438
Gross proceeds from sale of equity securities	697
Gross proceeds from sale of equity securities		$ 3,083
Gross realized gains recorded on sale of equity securities	92
Gross realized gains recorded on sale of available for sale securities		360
Gross realized losses recorded on sale of equity securities	5
Gross realized losses recorded on sale of available for sale securities		145
Financial services industry
Fair Values of Assets and Liabilities
Equity investments	2,000
Total investments			2,199
REIT industry
Fair Values of Assets and Liabilities
Equity investments	115
Total investments			145
Other
Fair Values of Assets and Liabilities
Equity investments	4,112
Total investments			4,094
Debt investments
Fair Values of Assets and Liabilities
Debt investments	23,701
Total investments			26,844
Gross realized gains recorded on sale of available for sale securities		167
Gross realized losses recorded on sale of available for sale securities		31
Amortized cost of available for sale debt securities	22,788
Unrealized gains on available for sale debt securities	1,352
Unrealized losses on available for sale debt securities	439
Amortized cost of available for sale securities			25,589
Unrealized gains on available for sale securities			1,401
Unrealized losses on available for sale securities			146
Gross proceeds from sale of available for sale securities	5,652	$ 12,598
Gross realized gains recorded on sale of debt securities	9
Gross realized losses recorded on sale of debt securities	104
International bond fund
Fair Values of Assets and Liabilities
Debt investments	2,503
Total investments			2,511
High yield fund
Fair Values of Assets and Liabilities
Debt investments	2,812
Total investments			2,744
Industrial bonds
Fair Values of Assets and Liabilities
Debt investments	2,042
Total investments			2,017
Technology bonds
Fair Values of Assets and Liabilities
Debt investments	2,371
Total investments			2,972
Government bonds
Fair Values of Assets and Liabilities
Debt investments	10,159
Total investments			10,707
Energy bonds
Fair Values of Assets and Liabilities
Debt investments	590
Total investments			1,216
Financial bonds
Fair Values of Assets and Liabilities
Debt investments	1,459
Total investments			1,423
Other
Fair Values of Assets and Liabilities
Debt investments	1,765
Total investments			3,254
Restricted debt securities
Fair Values of Assets and Liabilities
Debt investments	14,768
Total investments			18,068
Quoted Prices in Active Markets for Identical Assets
Fair Values of Assets and Liabilities
Cash equivalents	24,191		23,578
Total investments	16,386
Total investments			17,048
Total	40,577		40,626
Quoted Prices in Active Markets for Identical Assets | Equity securities
Fair Values of Assets and Liabilities
Equity investments	6,227
Total investments			6,438
Quoted Prices in Active Markets for Identical Assets | Financial services industry
Fair Values of Assets and Liabilities
Equity investments	2,000
Total investments			2,199
Quoted Prices in Active Markets for Identical Assets | REIT industry
Fair Values of Assets and Liabilities
Equity investments	115
Total investments			145
Quoted Prices in Active Markets for Identical Assets | Other
Fair Values of Assets and Liabilities
Equity investments	4,112
Total investments			4,094
Quoted Prices in Active Markets for Identical Assets | Debt investments
Fair Values of Assets and Liabilities
Debt investments	10,159
Total investments			10,610
Quoted Prices in Active Markets for Identical Assets | International bond fund
Fair Values of Assets and Liabilities
Debt investments	0
Total investments			0
Quoted Prices in Active Markets for Identical Assets | High yield fund
Fair Values of Assets and Liabilities
Debt investments	0
Total investments			0
Quoted Prices in Active Markets for Identical Assets | Industrial bonds
Fair Values of Assets and Liabilities
Debt investments	0
Total investments			0
Quoted Prices in Active Markets for Identical Assets | Technology bonds
Fair Values of Assets and Liabilities
Debt investments	0
Total investments			0
Quoted Prices in Active Markets for Identical Assets | Government bonds
Fair Values of Assets and Liabilities
Debt investments	10,159
Total investments			10,610
Quoted Prices in Active Markets for Identical Assets | Energy bonds
Fair Values of Assets and Liabilities
Debt investments	0
Total investments			0
Quoted Prices in Active Markets for Identical Assets | Financial bonds
Fair Values of Assets and Liabilities
Debt investments	0
Total investments			0
Quoted Prices in Active Markets for Identical Assets | Other
Fair Values of Assets and Liabilities
Debt investments	0
Total investments			0
Significant Other Observable Inputs
Fair Values of Assets and Liabilities
Cash equivalents	0
Total investments	13,542
Total investments			16,234
Total	13,542		16,234
Significant Other Observable Inputs | Equity securities
Fair Values of Assets and Liabilities
Equity investments	0
Total investments			0
Significant Other Observable Inputs | Financial services industry
Fair Values of Assets and Liabilities
Equity investments	0
Total investments			0
Significant Other Observable Inputs | REIT industry
Fair Values of Assets and Liabilities
Equity investments	0
Total investments			0
Significant Other Observable Inputs | Other
Fair Values of Assets and Liabilities
Equity investments	0
Total investments			0
Significant Other Observable Inputs | Debt investments
Fair Values of Assets and Liabilities
Debt investments	13,542
Total investments			16,234
Significant Other Observable Inputs | International bond fund
Fair Values of Assets and Liabilities
Debt investments	2,503
Total investments			2,511
Significant Other Observable Inputs | High yield fund
Fair Values of Assets and Liabilities
Debt investments	2,812
Total investments			2,744
Significant Other Observable Inputs | Industrial bonds
Fair Values of Assets and Liabilities
Debt investments	2,042
Total investments			2,017
Significant Other Observable Inputs | Technology bonds
Fair Values of Assets and Liabilities
Debt investments	2,371
Total investments			2,972
Significant Other Observable Inputs | Government bonds
Fair Values of Assets and Liabilities
Debt investments	0
Total investments			97
Significant Other Observable Inputs | Energy bonds
Fair Values of Assets and Liabilities
Debt investments	590
Total investments			1,216
Significant Other Observable Inputs | Financial bonds
Fair Values of Assets and Liabilities
Debt investments	1,459
Total investments			1,423
Significant Other Observable Inputs | Other
Fair Values of Assets and Liabilities
Debt investments	1,765
Total investments			3,254
Significant Unobservable Inputs
Fair Values of Assets and Liabilities
Cash equivalents	0
Total investments	0
Total investments			0
Total	0		0
Significant Unobservable Inputs | Equity securities
Fair Values of Assets and Liabilities
Equity investments	0
Total investments			0
Significant Unobservable Inputs | Financial services industry
Fair Values of Assets and Liabilities
Equity investments	0
Total investments			0
Significant Unobservable Inputs | REIT industry
Fair Values of Assets and Liabilities
Equity investments	0
Total investments			0
Significant Unobservable Inputs | Other
Fair Values of Assets and Liabilities
Equity investments	0
Total investments			0
Significant Unobservable Inputs | Debt investments
Fair Values of Assets and Liabilities
Debt investments	0
Total investments			0
Significant Unobservable Inputs | International bond fund
Fair Values of Assets and Liabilities
Debt investments	0
Total investments			0
Significant Unobservable Inputs | High yield fund
Fair Values of Assets and Liabilities
Debt investments	0
Total investments			0
Significant Unobservable Inputs | Industrial bonds
Fair Values of Assets and Liabilities
Debt investments	0
Total investments			0
Significant Unobservable Inputs | Technology bonds
Fair Values of Assets and Liabilities
Debt investments	0
Total investments			0
Significant Unobservable Inputs | Government bonds
Fair Values of Assets and Liabilities
Debt investments	0
Total investments			0
Significant Unobservable Inputs | Energy bonds
Fair Values of Assets and Liabilities
Debt investments	0
Total investments			0
Significant Unobservable Inputs | Financial bonds
Fair Values of Assets and Liabilities
Debt investments	0
Total investments			0
Significant Unobservable Inputs | Other
Fair Values of Assets and Liabilities
Debt investments	$ 0
Total investments			$ 0

Fair Values of Assets and Lia_4

Fair Values of Assets and Liabilities - Non-recurring Measurements (Details) - USD ($) $ in Thousands	Sep. 30, 2018	Dec. 31, 2017
Carrying value and fair value
Mortgage notes payable	$ 7,620	$ 7,872
Liabilities held for sale	0	34,781
Carrying value
Carrying value and fair value
Mortgage notes payable	7,953	8,188
Estimated fair value | Significant Unobservable Inputs
Carrying value and fair value
Mortgage notes payable	$ 8,937	$ 9,617

Indebtedness - Debt Instruments

Indebtedness - Debt Instruments Summary (Details)	1 Months Ended			3 Months Ended		9 Months Ended		12 Months Ended
	Jun. 30, 2018USD ($)community	Feb. 28, 2018USD ($)community	Feb. 28, 2017period	Sep. 30, 2018USD ($)communityagreement	Sep. 30, 2017USD ($)	Sep. 30, 2018USD ($)living_unitcommunityagreementquarter	Sep. 30, 2017USD ($)	Dec. 31, 2017USD ($)	May 31, 2018USD ($)	Jan. 31, 2017USD ($)
Indebtedness
Payment of deferred financing fees						$ 0	$ 1,889,000	$ 1,889,000
Interest expense and other associated costs incurred						$ 864,000	848,000
Waiver period (quarters) | quarter						6
Borrowing capacity, not less than				$ 33,333,000		$ 33,333,000
Letters of credit outstanding				25,216,000		25,216,000
Gain on early extinguishment of debt				0	$ 143,000	0	143,000
Mortgage notes
Indebtedness
Interest expense and other associated costs incurred				$ 137,000	781,000	$ 909,000	$ 2,352,000
Senior living communities | Mortgage notes
Indebtedness
Number of real estate properties mortgaged | community				1		1
Standby letters of credit | Certain of our other obligations
Indebtedness
Number of irrevocable standby letters of credit agreements | agreement				6		6
Letters of credit outstanding				$ 2,516,000		$ 2,516,000
Letters of credit
Indebtedness
Number of irrevocable standby letters of credit agreements | agreement				7		7
Letters of credit | Workers' compensation insurance program
Indebtedness
Letter of credit amount securing workers' compensation insurance program	$ 22,700,000								$ 17,800,000
Revolving credit facility
Indebtedness
Maximum borrowing capacity		$ 100,000,000								$ 100,000,000
New revolving credit facility
Indebtedness
Number of extension options | period			2
Extension period			1 year
Quarterly commitment fee on the unused part of borrowing availability						0.35%
Weighted average annual interest rate						6.51%	5.61%
Interest expense and other associated costs incurred				$ 329,000	$ 358,000
Letters of credit outstanding				2,516,000		$ 2,516,000
Remaining borrowing capacity under line of credit				$ 52,811,000		$ 52,811,000
New revolving credit facility | Senior living communities
Indebtedness
Number of real estate properties securing borrowings on the new credit facility | community						10
Number of units in real estate properties securing borrowings on the new credit facility | living_unit						1,219
New revolving credit facility | LIBOR
Indebtedness
Interest rate at period end				4.61%		4.61%
New revolving credit facility | Base Rate
Indebtedness
Interest rate at period end				6.75%		6.75%
Federal National Mortgage Association mortgage | Senior living communities
Indebtedness
Number of properties sold | community	2	1
Early repayment of debt	$ 16,588,000	$ 16,776,000
Contractual stated interest rate	5.75%	6.64%
Gain on early extinguishment of debt	$ 638,000	$ 543,000
Cash Equivalents | Letters of credit | Workers' compensation insurance program
Indebtedness
Collateral securing workers' compensation insurance program	17,885,000
Debt and Equity Investments | Letters of credit | Workers' compensation insurance program
Indebtedness
Collateral securing workers' compensation insurance program	$ 6,247,000

Indebtedness - Payments of Prin

Indebtedness - Payments of Principal and Interest (Details) - September 2032 $ in Thousands	9 Months Ended
	Sep. 30, 2018USD ($)
Indebtedness
Unamortized discount and debt issuance costs	$ 286
Mortgage notes
Indebtedness
Balances	$ 8,239
Contractual Stated Interest Rate	6.20%
Effective Interest Rate	6.70%
Monthly Payment	$ 72

Leases and Management Agreeme_2

Leases and Management Agreements with SNH - Lease Summary (Details)	Jun. 30, 2018USD ($)	Nov. 30, 2018USD ($)living_unit	Jun. 30, 2018USD ($)living_unit	Jun. 30, 2018USD ($)community	Jun. 30, 2018USD ($)	Jun. 30, 2018USD ($)	Dec. 31, 2017USD ($)community	Jun. 30, 2016USD ($)community	Feb. 28, 2018USD ($)community	Sep. 30, 2018USD ($)communityproperty	Sep. 30, 2017USD ($)community	Jun. 30, 2018USD ($)communityagreement	Sep. 30, 2018USD ($)communityleaseproperty	Sep. 30, 2017USD ($)community
Leases
Gain recognized on sale leaseback transaction													$ 4,957,000	$ 4,956,000
Deferred gain on sale and leaseback transaction							$ 66,087,000			$ 61,130,000			61,130,000
Revenues										$ 348,910,000	$ 347,101,000		$ 1,037,525,000	1,047,815,000
Senior living communities
Leases
Number of properties leased and operated | property										188			188
SNH
Leases
Total minimum annual rent payable										$ 207,504,000	206,297,000		$ 207,504,000	206,297,000
Rent expense under leases, net of lease inducement amortization										51,541,000	51,056,000		154,425,000	152,358,000
Outstanding rent due and payable							18,555,000			18,642,000			18,642,000
Assets held for sale for increased rent pursuant to the terms of leases with SNH										987,000			987,000
SNH | Other Services Provided to Residents at Managed Communities
Leases
Rehabilitation service revenue										1,584,000	1,841,000		4,944,000	5,709,000
SNH | Senior living communities | 2017 Transaction Agreement
Leases
Income (loss) from continuing operations before income taxes										$ (14,000)	$ 806,000		137,000	2,075,000
SNH | Improvements to communities
Leases
Leasehold improvements sold to lessor													14,749,000	30,698,000
Increase (decrease) in annual lease rent payable													$ 1,177,000	$ 2,464,000
SNH | Senior living communities
Leases
Number of properties leased and operated | community										184	185		184	185
Number of leases | lease													5
Percentage rent										$ 1,387,000	$ 1,353,000		$ 4,068,000	$ 4,190,000
Number of communities purchased by related party | community								7
Aggregate purchase price								$ 112,350,000
Gain recognized on sale leaseback transaction								82,644,000
Number of communities managed | community													75	68
Minimum return as percentage of invested capital						7.00%
Number of living units begun managing | living_unit			98
Management fee as percentage of gross revenue						5.00%
Incentive fee as a percentage of net operating income						20.00%
Annual minimum return for incentive fee					$ 1,000,000
Minimum return as percentage of invested capital, amount in excess of					500,000
SNH | Senior living communities | D&R Yonkers LLC
Leases
Number of communities managed | community													1
SNH | Senior living communities | June 2018 Sale of Skilled Nursing Facility in California
Leases
Number of communities to be sold			97	1
Sales price					6,500,000
Loss on sale										62,000			$ 102,000
Income (loss) from continuing operations before income taxes										(24,000)	(358,000)		$ (283,000)	$ (461,000)
Rent payables a percentage of net proceeds, decrease													10.00%
SNH | Senior living communities | June 2018 Florida Living Unit Leased Acquired by Related Party
Leases
Increase (decrease) in annual lease rent payable	$ 14,000
SNH | Senior living communities | December 2017 sales group | 2017 Transaction Agreement
Leases
Sales price							$ 39,150,000
Related party transaction, number of properties sold to, and subsequently managed for related party | community							2
Aggregate carrying value of communities sold							$ 29,444,000
Mortgage debt and discounts							2,303,000
SNH | Senior living communities | January and February 2018 sales group | 2017 Transaction Agreement
Leases
Sales price									$ 41,917,000
Related party transaction, number of properties sold to, and subsequently managed for related party | community									2
Aggregate carrying value of communities sold									$ 19,425,000
Mortgage debt and discounts									17,356,000
Principle transferred									16,776,000
Gain generated from sale of communities									$ 5,684,000
SNH | Senior living communities | June 2018 Sales Group | 2017 Transaction Agreement
Leases
Sales price					23,300,000
Related party transaction, number of properties sold to, and subsequently managed for related party | community				2
Aggregate carrying value of communities sold					5,163,000
Mortgage debt and discounts	$ 17,226,000		$ 17,226,000	$ 17,226,000	17,226,000	$ 17,226,000						$ 17,226,000
Principle transferred					16,588,000
Gain generated from sale of communities					$ 1,549,000
SNH | Senior living communities | Other current liabilities
Leases
Deferred gain on sale and leaseback transaction							$ 6,609,000			6,609,000			$ 6,609,000
SNH | Senior living communities | New long term lease agreement
Leases
Initial annual rent								$ 8,426,000
SNH | Senior living communities | 2017 Transaction Agreement
Leases
Number of new pooling agreements | agreement												2
Related party transaction, number of properties sold to, and subsequently managed for related party | community												6
Management fee revenue
Leases
Revenues										4,009,000	3,414,000		11,408,000	10,531,000
Management fee revenue | SNH
Leases
Revenues										3,597,000	3,199,000		10,486,000	9,708,000
Management fee revenue | SNH | Senior living communities
Leases
Capital expenditure management revenue										344,000	128,000		714,000	628,000
Management fee revenue | SNH | Senior living communities | D&R Yonkers LLC
Leases
Revenues										$ 68,000	$ 87,000		$ 208,000	$ 195,000
Scenario, Forecast | SNH | Senior living communities
Leases
Minimum return as percentage of invested capital		7.00%
Number of living units begun managing | living_unit		238
Management fee as percentage of gross revenue		5.00%
Incentive fee as a percentage of net operating income		20.00%
Annual minimum return for incentive fee		$ 1,500,000

Business Management Agreement_2

Business Management Agreement with RMR LLC - Narrative (Details) - RMR LLC - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Business Management Agreement [Line Items]
Business management fees	$ 2,258	$ 2,264	$ 6,771	$ 6,817
Reimbursable expenses, internal audit costs	$ 61	$ 72	$ 184	$ 207

Related Person Transactions (De

Related Person Transactions (Details) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018USD ($)companyshares	Sep. 30, 2017USD ($)	Sep. 30, 2018USD ($)companyshares	Sep. 30, 2017USD ($)	Dec. 31, 2017USD ($)
Related Party Transaction [Line Items]
Rent expense	$ 52,282	$ 51,779	$ 156,640	$ 154,524
Equity investment of an investee	$ 9,157		$ 9,157		$ 8,185
SNH
Related Party Transaction [Line Items]
Number of shares owned (in shares) | shares	4,235,000		4,235,000
Percentage of outstanding common shares owned	8.40%		8.40%
ABP Trust
Related Party Transaction [Line Items]
Number of shares owned (in shares) | shares	17,999,999		17,999,999
Percentage of outstanding common shares owned	35.60%		35.60%
Rent expense	$ 420	$ 416	$ 1,299	$ 1,212
AIC
Related Party Transaction [Line Items]
Number of companies in related party entity | company	4		4
Aggregate annual premiums to be paid in next policy year	$ 3,144		$ 3,144
Equity investment of an investee	$ 9,157		$ 9,157		$ 8,185

Legal Proceedings and Claims (D

Legal Proceedings and Claims (Details) $ in Thousands	Dec. 31, 2017USD ($)	Mar. 31, 2018USD ($)	Sep. 30, 2017USD ($)	Mar. 31, 2016USD ($)	May 31, 2015USD ($)	Sep. 30, 2018USD ($)	Mar. 31, 2018USD ($)	Sep. 30, 2018USD ($)community	Dec. 31, 2015USD ($)
Loss Contingencies [Line Items]
Estimated minimum loss								$ 0
Arizona Litigation Matter
Loss Contingencies [Line Items]
Damages awarded against company					$ 19,200
Damages awarded against company, pain and suffering					$ 2,500
Damages paid to defendant				$ 7,250
Damages paid to defendant by liability insurer			$ 800	$ 3,021
Charge for litigation matter									$ 4,229
Unfavorable regulatory action | Office of the Inspector General
Loss Contingencies [Line Items]
Accrual for loss contingency						$ 559		559
Litigation expense								681
Unfavorable regulatory action | Health Care Organization, resident service revenue | Office of the Inspector General
Loss Contingencies [Line Items]
Accrual for loss contingency	$ 888	$ 759				759	$ 759	$ 759
Unfavorable regulatory action | Imposed penalties | Office of the Inspector General
Loss Contingencies [Line Items]
Litigation expense	$ 658	$ 594
Unfavorable regulatory action | Other costs of services | Office of the Inspector General
Loss Contingencies [Line Items]
Litigation expense						$ 20	$ 55
Senior living communities | SNF, California | SNH
Loss Contingencies [Line Items]
Number of communities | community								1

Employee Benefit Plans (Details

Employee Benefit Plans (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Defined Contribution Plan Disclosure [Line Items]
Contributions and related expenses	$ 332	$ 322	$ 1,003	$ 1,085
Senior Living Wages and Benefits
Defined Contribution Plan Disclosure [Line Items]
Contributions and related expenses	292	288	879	943
General and Administrative Expenses
Defined Contribution Plan Disclosure [Line Items]
Contributions and related expenses	$ 40	$ 34	$ 124	$ 142