AlerisLife (ALR) 10-Q 8 May 19 2019 Q1 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	3 Months Ended
	Mar. 31, 2019	May 03, 2019
Document and Entity Information [Abstract]
Entity Registrant Name	FIVE STAR SENIOR LIVING INC.
Entity Central Index Key	0001159281
Current Fiscal Year End Date	--12-31
Entity Filer Category	Non-accelerated Filer
Document Type	10-Q
Document Period End Date	Mar. 31, 2019
Document Fiscal Year Focus	2019
Document Fiscal Period Focus	Q1
Entity Current Reporting Status	Yes
Amendment Flag	false
Entity Small Business	true
Entity Emerging Growth Company	false
Entity Common Stock, Shares Outstanding		50,843,032

CONDENSED CONSOLIDATED BALANCE

CONDENSED CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Current assets:
Cash and cash equivalents	$ 49,699	$ 29,512
Accounts receivable, net of allowance of $3,748 and $3,422 at March 31, 2019 and December 31, 2018, respectively	39,744	37,758
Due from related persons	9,800	7,855
Investments, of which $10,717 and $11,285 are restricted at March 31, 2019 and December 31, 2018, respectively	19,850	20,179
Restricted cash	19,464	19,720
Prepaid expenses and other current assets	22,571	23,029
Assets held for sale	526	0
Total current assets	161,654	138,053
Property and equipment, net	223,195	243,873
Equity investment of an investee	9,102	8,633
Restricted cash	930	923
Restricted investments	8,227	8,073
Right of use assets	1,455,568
Other long term assets	5,375	6,069
Total assets	1,864,051	405,624
Current liabilities:
Revolving credit facility	51,484	51,484
Accounts payable and accrued expenses	82,067	69,667
Current portion of lease liabilities	149,381
Accrued compensation and benefits	43,204	35,421
Due to related persons	36,466	18,883
Mortgage notes payable	344	339
Accrued real estate taxes	10,730	12,959
Security deposits and current portion of continuing care contracts	3,093	3,468
Other current liabilities	29,850	37,472
Total current liabilities	406,619	229,693
Long term liabilities:
Mortgage notes payable	7,445	7,533
Long term portion of lease liabilities	1,307,868
Accrued self insurance obligations	34,898	33,030
Deferred gain on sale and leaseback transaction	0	59,478
Other long term liabilities	1,833	4,721
Total long term liabilities	1,352,044	104,762
Commitments and contingencies
Shareholders’ equity:
Common stock, par value $.01: 75,000,000 shares authorized, 50,843,032 and 50,853,452 shares issued and outstanding at March 31, 2019 and December 31, 2018, respectively	508	508
Additional paid in capital	361,652	361,555
Accumulated deficit	(258,378)	(292,636)
Accumulated other comprehensive income	1,606	1,742
Total shareholders’ equity	105,388	71,169
TOTAL LIABILITIES AND SHAREHOLDERS' EQUITY	$ 1,864,051	$ 405,624

CONDENSED CONSOLIDATED STATEMEN

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Revenues:
Total revenues	$ 355,523	$ 345,517
Operating expenses:
Rent expense	54,542
Rent expense		52,245
General and administrative expenses	26,502	19,963
Depreciation and amortization expense	8,165	8,860
Gain on sale of senior living communities	0	(5,684)
Long lived asset impairment	3,148	0
Total operating expenses	387,360	352,700
Operating loss	(31,837)	(7,183)
Interest, dividend and other income	156	167
Interest and other expense	(906)	(703)
Unrealized gain (loss) on equity investments	366	(50)
Realized gain on sale of debt and equity investments, net of tax	92	32
Loss before income taxes and equity in earnings of an investee	(32,129)	(7,737)
Provision for income taxes	(1,490)	(256)
Equity in earnings of an investee, net of tax	404	44
Net loss	$ (33,215)	$ (7,949)
Weighted average shares outstanding—basic and diluted (in shares)	50,040	49,594
Net loss per share—basic and diluted (in dollars per share)	$ (0.66)	$ (0.16)
Senior living
Revenues:
Total revenues	$ 276,935	$ 274,525
Management fee revenue
Revenues:
Total revenues	3,983	3,622
Reimbursed costs incurred on behalf of managed communities
Revenues:
Total revenues	74,605	67,370
Operating expenses:
Cost of revenues	74,605	67,370
Senior living wages and benefits
Operating expenses:
Cost of revenues	143,630	136,169
Other senior living operating expenses
Operating expenses:
Cost of revenues	$ 76,768	$ 73,777

CONDENSED CONSOLIDATED BALANC_2

CONDENSED CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Statement of Financial Position [Abstract]
Accounts receivable, allowance	$ 3,748	$ 3,422
Investments in available for sale securities, restricted	$ 10,717	$ 11,285
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)	50,843,032	50,853,452
Common stock, shares outstanding (in shares)	50,843,032	50,853,452

CONDENSED CONSOLIDATED STATEM_2

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Statement of Comprehensive Income [Abstract]
Net loss	$ (33,215)	$ (7,949)
Other comprehensive income:
Unrealized loss on investments, net of tax	(205)	(397)
Equity in unrealized gain (loss) of an investee, net of tax	65	(93)
Realized loss (gain) on investments reclassified and included in net loss, net of tax	4	(3)
Other comprehensive loss	(136)	(493)
Comprehensive loss	$ (33,351)	$ (8,442)

CONSOLIDATED STATEMENTS OF SHAR

CONSOLIDATED STATEMENTS OF SHAREHOLDERS' EQUITY - USD ($) $ in Thousands	Total	Common Stock	Additional Paid in Capital	Accumulated Deficit	Accumulated Other Comprehensive Income
Beginning balance at Dec. 31, 2017	$ 144,994	$ 505	$ 360,942	$ (220,489)	$ 4,036
Balance (in shares) at Dec. 31, 2017		50,524,424
Comprehensive loss:
Net loss	(7,949)			(7,949)
Unrealized gain (loss) on investments in available for sale securities, net of tax	(397)				(397)
Realized (gain) loss on investments in available for sale securities reclassified and included in net loss, net of tax	(3)				(3)
Equity in unrealized gain of an investee, net of tax	(93)				(93)
Comprehensive loss	(8,442)			(6,842)	(1,600)
Grants under share award plan and share based compensation	211		211
Grants under share award plan and share based compensation (in shares)		12,500
Ending balance at Mar. 31, 2018	136,763	$ 505	361,153	(227,331)	2,436
Balance (in shares) at Mar. 31, 2018		50,536,924
Beginning balance at Dec. 31, 2018	$ 71,169	$ 508	361,555	(292,636)	1,742
Balance (in shares) at Dec. 31, 2018	50,853,452	50,853,452
Comprehensive loss:
Net loss	$ (33,215)			(33,215)
Unrealized gain (loss) on investments in available for sale securities, net of tax	(205)				(205)
Realized (gain) loss on investments in available for sale securities reclassified and included in net loss, net of tax	4				4
Equity in unrealized gain of an investee, net of tax	65				65
Comprehensive loss	(33,351)			(33,215)	(136)
Grants under share award plan and share based compensation	97		97
Repurchases and forfeitures under share award plan	0	$ 0
Repurchases and forfeitures under share award plan (in shares)		(10,420)
Ending balance at Mar. 31, 2019	$ 105,388	$ 508	$ 361,652	$ (258,378)	$ 1,606
Balance (in shares) at Mar. 31, 2019	50,843,032	50,843,032

CONDENSED CONSOLIDATED STATEM_3

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Cash flows from operating activities:
Net loss	$ (33,215)	$ (7,949)
Adjustments to reconcile net loss to cash provided by (used in) operating activities:
Depreciation and amortization expense	8,165	8,860
Gain on sale of senior living communities	0	(5,684)
Unrealized (gain) loss on equity securities	(366)	50
Realized gain on sale of debt and equity investments	(92)	(32)
Loss on disposal of property and equipment	76	0
Long lived asset impairment	3,148	0
Equity in earnings of an investee, net of tax	(404)	(44)
Stock based compensation	97	211
Provision for losses on receivables	1,045	1,761
Amortization of deferred gain on sale and leaseback transaction	0	(1,653)
Other noncash expense (income) adjustments, net	125	246
Changes in assets and liabilities:
Accounts receivable	(3,031)	(1,222)
Prepaid expenses and other assets	1,062	1,123
Accounts payable and accrued expenses	9,732	(4,971)
Accrued compensation and benefits	7,783	3,126
Due from (to) related persons, net	15,702	(4,511)
Other current and long term liabilities	(1,492)	(1,513)
Cash provided by (used in) operating activities	8,335	(12,202)
Cash flows from investing activities:
Acquisition of property and equipment	(12,056)	(9,639)
Purchases of investments	(1,471)	(300)
Proceeds from sale of property and equipment	22,578	0
Proceeds from sale of communities	0	25,141
Proceeds from sale of investments	2,643	1,425
Cash provided by investing activities	11,694	16,627
Cash flows from financing activities:
Repayments of mortgage notes payable	(91)	(189)
Cash used in financing activities	(91)	(189)
Change in cash and cash equivalents and restricted cash	19,938	4,236
Cash and cash equivalents and restricted cash at beginning of period	50,155	48,478
Cash and cash equivalents and restricted cash at end of period	70,093	52,714
Reconciliation of cash and cash equivalents and restricted cash:
Cash and cash equivalents and restricted cash at end of period	50,155	48,478
Supplemental cash flow information:
Cash paid for interest	780	563
Cash paid for income taxes, net	120	348
Non-cash activities:
Initial recognition of right of use assets for lease liabilities	1,478,958
Real estate sale	0	16,776
Mortgage notes assumed by purchaser in real estate sale	$ 0	$ 16,776

Basis of Presentation and Organ

Basis of Presentation and Organization	3 Months Ended
	Mar. 31, 2019
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, 2018 , 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 March 31, 2019 , we operated 284 senior living communities located in 32 states with 31,956 living units, including 255 primarily independent and assisted living communities with 29,450 living units and 29 SNFs with 2,506 living units. As of March 31, 2019 , we owned and operated 20 of these senior living communities ( 2,108 living units), we leased and operated 188 of these senior living communities ( 20,082 living units) and we managed 76 of these senior living communities ( 9,766 living units). Our 284 senior living communities, as of March 31, 2019 , included 10,893 independent living apartments, 16,393 assisted living suites and 4,670 SNF units. The foregoing numbers exclude living units categorized as out of service. Going Concern 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 the first quarter of 2020. At March 31, 2019 , we had an accumulated deficit of $258,378 and we had incurred operating losses in each of the last three years. In addition, our credit facility is scheduled to expire on June 28, 2019, and we currently have $51,484 of borrowings outstanding under that facility. 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. We currently operate 261 senior living communities under lease and management arrangements with Senior Housing Properties Trust, or, together with its subsidiaries, SNH, or approximately 91.9% of the total communities we operate. In order to address the operating and liquidity challenges we face, on April 1, 2019, we entered into a transaction agreement with SNH, or the Transaction Agreement, pursuant to which we and SNH agreed to modify our existing business arrangements, subject to certain conditions and the receipt of various approvals. For more information regarding the Transaction Agreement and related agreements and the transactions contemplated thereby, see Note 13 to our condensed consolidated financial statements in Part I, Item 1 of this Quarterly Report on Form 10-Q. We are also currently evaluating options to refinance our existing credit facility with unrelated lenders, which is scheduled to expire on June 28, 2019. We cannot be sure that we will obtain any renewed or restructured credit facility, and our ability to do so will likely depend on the lenders’ belief that our prospects, operating leverage and expected future operating results, including the potential impact of the agreed upon modifications of our existing business arrangements with SNH, will permit us to continue as a going concern and to fund our operations, capital investments and debt service and other obligations. The Transaction Agreement and any renewed or restructured credit facility, if completed and obtained, may not result in our realizing improved operating results or liquidity and may not be sufficient to enable us to continue as a going concern. Segment Information As of March 31, 2019 , we have two operating segments: senior living communities and 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 Financial Accounting Standards Board, or FASB, Accounting Standards Codification™, 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	3 Months Ended
	Mar. 31, 2019
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	Summary of Significant Accounting Policies Leases On January 1, 2019, we adopted FASB ASC Topic 842, Leases , or ASC Topic 842, utilizing the modified retrospective transition method with no adjustments to comparative periods presented. Additionally, we elected the practical expedients within FASB Accounting Standards Update, or ASU, No. 2016-02, Leases (Topic 842) , or ASU No. 2016-02, that allow an entity to not reassess as of January 1, 2019 its prior conclusions on whether an existing contract contains a lease, lease classification for existing leases, and whether costs incurred for existing leases qualify as initial direct costs. In accordance with ASC Topic 842, at inception of a contract, we, as lessee, evaluate and determine whether such contract is or contains a lease based on whether such contract conveys the right to control the use of the identified asset. We 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. We have elected to apply the portfolio approach where possible in assessing our leases and performed an assessment of all our leases. In addition, we have elected the practical expedient, by class of underlying asset, not to separate non-lease components from the associated lease component if certain conditions are met. As lessee, we lease senior living communities and our headquarters, and enter into contracts for the use and maintenance of various pieces of equipment that contain a lease. We have determined that none of these leases have met any of the criteria to be classified as a finance lease and, therefore, we have accounted for all of these leases as operating leases. We have determined that our leases for the use and maintenance of equipment are short term leases. In accordance with ASC Topic 842, we have made an accounting policy election for our leases which are determined to be short term leases, whereby we recognize the lease payments on a straight line basis over the lease term and variable lease payments in the period in which the obligations for those payments are incurred. Expense related to these leases is recognized in the statement of operations in other senior living operating expenses and is not material to our condensed consolidated financial statements. We have determined that our leases for senior living communities and our headquarters are long term leases. In accordance with ASC Topic 842, a lessee is required to record a right of use asset and a lease liability for all leases with a term greater than 12 months regardless of their classification. Accordingly, we have recorded a right of use asset and lease liability for all of our leased communities and our headquarters. We determined that the discount rate implicit in the leases was not readily available, and therefore, in accordance with ASC Topic 842, we determined our incremental borrowing rate, or IBR, to calculate the right of use assets and lease liabilities. For purposes of determining the lease term, we concluded that it is not reasonably certain that our lease extensions will be exercised and, therefore, we included payments required to be made under the committed lease term in calculating the right of use assets and lease liabilities. Expense related to these leases is recognized in the statement of operations in rent expense, except for the expense related to our headquarters, which is recorded in general and administrative expenses. We recognize variable lease payments primarily relating to percentage rent paid under our leases with SNH, and operating costs such as insurance and real estate taxes, in the statement of operations in the period in which the obligations for those payments are incurred. We have not capitalized any initial direct costs related to our leases as these costs are not material to our condensed consolidated financial statements. ASC Topic 842 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, ASC Topic 842 clarifies which ASC Topic (Topic 842 or FASB ASC Topic 606, Revenue from Contracts with Customers , or ASC 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 components, the lessor should account for the combined component in accordance with FASB ASC Topic 606. Otherwise, the lessor should account for the combined component as an operating lease in accordance with ASC Topic 842. We have elected this practical expedient and recognized revenue under our resident agreements at our independent living and assisted living communities based upon the predominant component rather than allocating the consideration and separately accounting for it under ASC Topic 842 and ASC Topic 606. We have concluded that the non-lease components of the agreements with respect to our independent and assisted living communities are the predominant component of the leases and, therefore, we recognize revenue for these agreements under ASC Topic 606. Revenue Recognition We recognize revenue from contracts with customers in accordance with ASC Topic 606 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. 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. A substantial portion of our revenue at our independent living and assisted living communities relates to contracts with residents for housing services that are generally short term in nature and initially is subject to ASC Topic 842. As previously discussed, we have concluded that the non-lease components of these agreements are the predominant components of the contracts; therefore, we recognize revenue for these agreements under ASC Topic 606. Our contracts with residents and other customers that are within the scope of ASC Topic 606 are 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 as 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. Revenue for basic housing and support services and 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 23.6% and 23.7% of our senior living revenues for the three months ended March 31, 2019 and 2018 , 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 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) , 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 March 31, 2019 Three Months Ended March 31, 2018 Revenue from contracts with customers: Basic housing and support services (1) $ 162,776 $ 162,106 Medicare and Medicaid programs (1) 65,320 64,966 Additional requested services, and private pay and other third party payer SNF services (1) 48,839 47,453 Management fee revenue 3,983 3,622 Reimbursed costs incurred on behalf of managed communities 74,605 67,370 Total revenues $ 355,523 $ 345,517 (1) Included in senior living revenue in our consolidated statements of operations. Recent Accounting Pronouncements In February 2016, the FASB issued ASU No. 2016-02, 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 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. In accordance with ASC Topic 842, if a previous sale and leaseback transaction was accounted for as a sale and operating leaseback in accordance with FASB ASC Topic 840, Leases , or ASC Topic 840, any deferred gain or loss not resulting from off-market terms shall be recognized as a cumulative-effect adjustment to equity. This ASU is effective for reporting periods beginning after December 15, 2018. In July 2018, the FASB issued ASU No. 2018-11, Leases: Targeted Improvements , or ASU No. 2018-11, 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. We adopted 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. The adoption of ASC Topic 842 resulted in the recognition of lease liabilities and right of use assets of approximately $1.5 billion as of January 1, 2019. Such amount of right of use assets was recognized based upon the amount of the recognized lease liabilities, adjusted for accrued lease payments, which are not material to our condensed consolidated financial statements as of January 1, 2019. We have also concluded that any previously unrecognized right of use assets needed to be reviewed for impairment effective January 1, 2019, which could have resulted in a reduction to the initially recognized right of use assets with a cumulative effect adjustment to beginning retained earnings as of January 1, 2019. We have completed the process of evaluating the initial right of use assets for impairment and have determined there were no indicators of impairment. While the adoption of these ASUs does not affect the rent we pay, the rent expense amounts presented in our condensed consolidated statements of operations and comprehensive loss increased by approximately $1,700 for the three months ended March 31, 2019 as a result of adopting these ASUs primarily due to changes in how we accounted for the deferred gain on our sale and leaseback transaction described above effective with the adoption of these ASUs. On January 1, 2019, we recorded through retained earnings our total deferred gain of $67,473 on our consolidated balance sheets as of December 31, 2018, $55 of which was in accounts payable and accrued expenses, $6,723 of which was in other current liabilities, $1,217 of which was in other long term liabilities and the remaining $59,478 was separately stated on our consolidated balance sheets. For the year ended December 31, 2018, a substantial portion of our senior living revenue at our independent living and assisted living communities related to housing services and was subject to ASC Topic 840, and revenue for additional requested services was recognized in accordance with ASC Topic 606. Upon adoption of Topic 842, we elected the lessor practical expedient within ASU No. 2018-11 and recognized revenue under our resident agreements at our independent living and assisted living communities based upon the predominant component, either the lease or non-lease component, of the contracts rather than allocating the consideration and separately accounting for it under ASC Topic 842 and ASC Topic 606. We have concluded that the non-lease components of the agreements with respect to our independent and assisted living communities are the predominant component of the lease and, therefore, we recognize revenue for these agreements under ASC Topic 606. After the adoption of ASC Topic 842, the timing and pattern of revenue recognition are substantially the same as those prior to the adoption. See also the discussion above under “Leases” and Note 9 for more information regarding the impact of these ASUs on our consolidated financial statements. On January 1, 2019, we adopted FASB 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. The adoption of this ASU did not have a material impact on our consolidated financial statements. On January 1, 2019, we adopted FASB 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. The adoption of this ASU did not have a material impact on our consolidated financial statements. On January 1, 2019, we adopted FASB 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. The adoption of this ASU did not have a material impact on our consolidated financial statements. 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 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 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 assessing the potential impact that the adoption of this ASU will have on our consolidated financial statements.

Property and Equipment

Property and Equipment	3 Months Ended
	Mar. 31, 2019
Property, Plant and Equipment [Abstract]
Property and Equipment	Property and Equipment Property and equipment consists of the following: March 31, 2019 December 31, 2018 Land $ 16,383 $ 16,383 Buildings and improvements 205,818 208,375 Furniture, fixtures and equipment 223,951 239,240 Property and equipment, at cost 446,152 463,998 Accumulated depreciation (222,957 ) (220,125 ) Property and equipment, net $ 223,195 $ 243,873 We recorded depreciation expense relating to our property and equipment of $ 8,165 and $ 8,840 for the three months ended March 31, 2019 and 2018 , 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 $3,148 of impairment charges to certain of our long lived assets for the three months ended March 31, 2019 . As of March 31, 2019 and December 31, 2018 , we had $ 526 and $ 0 , 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 classified as held for sale. As of March 31, 2019 , we had $2,478 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; however, SNH is not obligated to purchase such amounts. See Note 9 for more information regarding our leases and other arrangements with SNH. On April 1, 2019, pursuant to the Transaction Agreement, SNH purchased from us approximately $50,000 of unencumbered fixed assets and improvements related to SNH’s senior living communities leased to and operated by us. See Note 13 for more information regarding the Transaction Agreement and the transactions contemplated thereby.

Accumulated Other Comprehensive

Accumulated Other Comprehensive Income	3 Months Ended
	Mar. 31, 2019
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 three months ended March 31, 2019 : Equity Investment of an Investee Investments Accumulated Other Comprehensive Income Balance at January 1, 2019 $ (266 ) $ 2,008 $ 1,742 Unrealized loss on investments, net of tax — (205 ) (205 ) Equity in unrealized gain of an investee, net of tax 65 — 65 Realized loss on investments reclassified and included in net loss, net of tax — 4 4 Balance at March 31, 2019 $ (201 ) $ 1,807 $ 1,606 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 Affiliates Insurance Company, or AIC. See Note 11 for more information regarding our arrangements with AIC.

Income Taxes

Income Taxes	3 Months Ended
	Mar. 31, 2019
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes We recognized a provision for income taxes of $1,490 and $256 for the three months ended March 31, 2019 and 2018 , respectively. The provision for income taxes for the three months ended March 31, 2019 is due to state income taxes partially offset by the intraperiod tax allocation benefit related to unrealized gains on available for sale securities, and the provision for income taxes for the three months ended March 31, 2018 is due to state income taxes. 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 condensed 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. If our common shares are issued to SNH and SNH’s shareholders as contemplated by the Transaction Agreement, and further described in Note 13, our net operating loss and tax credit carryforwards, which currently are expected to be utilized to offset future taxable income, may be subject to limitations on usage or elimination.

Earnings Per Share

Earnings Per Share	3 Months Ended
	Mar. 31, 2019
Earnings Per Share [Abstract]
Earnings Per Share	Earnings Per Share We calculated basic earnings per common share, or EPS, for the three months ended March 31, 2019 and 2018 using the weighted average number of shares of 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 March 31, 2019 and 2018 had 1,082,100 and 1,265,770 , 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	3 Months Ended
	Mar. 31, 2019
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 March 31, 2019 and December 31, 2018 categorized by the level of inputs used in the valuation of each asset. As of March 31, 2019 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) $ 23,611 $ 23,611 $ — $ — Investments: Equity investments (2) Financial services industry 1,763 1,763 — — REIT industry 83 83 — — Other 3,884 3,884 — — Total equity investments 5,730 5,730 — — Debt investments: (3) International bond fund (4) 2,588 — 2,588 — High yield fund (5) 2,855 — 2,855 — Industrial bonds 1,411 — 1,411 — Technology bonds 2,131 — 2,131 — Government bonds 9,826 9,826 — — Energy bonds 612 — 612 — Financial bonds 1,927 — 1,927 — Other 997 — 997 — Total debt investments 22,347 9,826 12,521 — Total investments 28,077 15,556 12,521 — Total $ 51,688 $ 39,167 $ 12,521 $ — As of December 31, 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) $ 23,390 $ 23,390 $ — $ — Investments: Equity investments (2) Financial services industry 1,686 1,686 — — REIT industry 105 105 — — Other 3,675 3,675 — — Total equity investments 5,466 5,466 — — Debt investments (3) International bond fund (4) 2,537 — 2,537 — High yield fund (5) 2,669 — 2,669 — Industrial bonds 1,692 — 1,692 — Technology bonds 2,375 — 2,375 — Government bonds 9,791 9,791 — — Energy bonds 595 — 595 — Financial bonds 1,858 — 1,858 — Other 1,268 — 1,268 — Total debt investments 22,785 9,791 12,994 — Total investments 28,251 15,257 12,994 — Total $ 51,641 $ 38,647 $ 12,994 $ — (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 $ 19,470 and $ 19,529 of balances that are restricted at March 31, 2019 and December 31, 2018 , respectively. (2) The fair value of our equity investments is readily determinable. During the three months ended March 31, 2019 and 2018 , we received gross proceeds of $1,115 and $ 220 , respectively, in connection with the sales of equity investments and recorded gross realized gains totaling $136 and $34 , respectively, and gross realized losses totaling $40 and $5 , respectively. (3) As of March 31, 2019 , our debt investments, which are classified as available for sale, had a fair value of $ 22,347 with an amortized cost of $ 20,826 ; the difference between the fair value and amortized cost amounts resulted from unrealized gains of $ 1,602 , net of unrealized losses of $ 81 . As of December 31, 2018 , our debt investments had a fair value of $ 22,785 with an amortized cost of $ 21,806 ; the difference between the fair value and amortized cost amounts resulted from unrealized gains of $ 1,276 , net of unrealized losses of $ 296 . Debt investments include $13,186 and $13,943 of balances that are restricted as of March 31, 2019 and December 31, 2018 , respectively. At March 31, 2019 , two of the securities we hold, with a fair value of $ 305 , have been in a loss position for less than 12 months and 37 of the investments we hold, with a fair value of $ 9,996 , 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 three months ended March 31, 2019 and 2018 , we received gross proceeds of $ 1,528 and $ 1,205 , respectively, in connection with the sales of debt investments and recorded gross realized gains totaling $ 2 and $ 6 , respectively, and gross realized losses totaling $ 6 and $ 3 , 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 three months ended March 31, 2019 , 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 three months ended March 31, 2019 . The carrying value of accounts receivable and accounts payable approximates fair value as of March 31, 2019 and December 31, 2018 . The carrying value and fair value of our mortgage notes payable were $ 7,789 and $ 9,118 , respectively, as of March 31, 2019 and $ 7,872 and $ 8,986 , respectively, as of December 31, 2018 , 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. Non-Recurring Fair Value Measures We review the carrying value of our long lived assets, including our right of use assets, 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	3 Months Ended
	Mar. 31, 2019
Debt Disclosure [Abstract]
Indebtedness	Indebtedness We have a revolving secured credit facility, or our credit facility, with unrelated lenders. The aggregate amount of commitments available under our credit facility is $54,000 and the stated maturity date of our credit facility is June 28, 2019. The agreement governing our credit facility, or our credit agreement, requires us to pay interest at a rate based on, at our option, LIBOR or a base rate, plus a premium, or 4.99% and 7.00% , respectively, per annum as of March 31, 2019 , 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. The weighted average annual interest rate for borrowings under our credit facility was 5.00% for the three months ended March 31, 2019 . As of March 31, 2019 , we had outstanding borrowings of $51,484 , letters of credit issued in an aggregate amount of $2,516 and no availability for further borrowing under our credit facility. We incurred aggregate interest expense and other associated costs related to our credit facilities of $772 and $266 for the three months ended March 31, 2019 and 2018 , 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. 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. Our credit agreement contains financial and other covenants, including those that restrict our ability to pay dividends or make other distributions to our stockholders in certain circumstances. We are currently evaluating options to refinance our existing credit facility, which is scheduled to expire on June 28, 2019. We cannot be sure that we will obtain any renewed or restructured credit facility, and our ability to do so will likely depend on the lenders’ belief that our prospects, operating leverage and expected future operating results, including the potential impact of the agreed upon modifications of our existing business arrangements with SNH, as further described in Note 13, will permit us to continue as a going concern and to fund our operations, capital investments and debt service and other obligations. At March 31, 2019 , 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 $17,983 of cash equivalents and $5,758 of debt and equity investments. This letter of credit currently expires in June 2019 and is automatically extended for one year terms unless notice of nonrenewal is provided by the issuing bank prior to the end of the applicable term. We expect that our workers' compensation insurance program will require an increase in the value of this letter of credit in June 2019. At March 31, 2019 , 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 March 31, 2019 , totaling $2,516 , secure certain of our other obligations. These letters of credit were scheduled to mature between June 2019 and October 2019 and are required to be renewed annually. As of March 31, 2019 , our obligations under these six letters of credit, totaling $2,516 , were issued and outstanding under our credit facility and there was no availability for further borrowing under our credit facility. At March 31, 2019 , 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 note as part of our acquisition of the community secured by this mortgage note 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 note requires payments of principal and interest monthly until maturity. The following table is a summary of this mortgage note as of March 31, 2019 : Balance as of Contractual Stated Effective Monthly March 31, 2019 Interest Rate Interest Rate Maturity Date Payment Lender Type $ 8,060 (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 $271 . We incurred mortgage interest expense, net of discount amortization, of $134 and $437 for the three months ended March 31, 2019 and 2018 , respectively. Our mortgage debt requires monthly payments into escrows for taxes, insurance and property replacement funds; certain withdrawals from 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 note 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. As of March 31, 2019 , we believe we were in compliance with all applicable covenants under our credit facility and mortgage debts. See Note 13 for information regarding the $25,000 credit facility we obtained from SNH on April 1, 2019.

Leases and Management Agreement

Leases and Management Agreements with SNH	3 Months Ended
	Mar. 31, 2019
Leases [Abstract]
Leases and Management Agreements with SNH	Leases with SNH and HCP 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 March 31, 2019 and 2018 , we leased 184 and 185 senior living communities from SNH, respectively. We lease senior living communities from SNH pursuant to five master leases with SNH. Under our master leases with SNH, we pay SNH annual rent plus percentage rent equal to 4.0% of the increase in gross revenues at the applicable senior living communities over base year gross revenues as specified in the applicable lease. Our obligation to pay percentage rent under Lease No. 5 commenced in 2018. Different base years apply to those communities that pay percentage rent. The base year is usually the first full calendar year after each community is initially leased. Our total annual rent payable to SNH as of March 31, 2019 and 2018 was $209,565 and $ 206,908 , respectively, excluding percentage rent. Our total rent expense under all of our leases with SNH, which for the three months ended March 31, 2018 was net of lease inducement amortization and the amortization of the deferred gain associated with the sale and leaseback transaction with SNH in June 2016, as described below, was $53,782 and $51,522 for the three months ended March 31, 2019 and 2018 , respectively, which amounts included estimated percentage rent of $1,549 and $1,391 for the three months ended March 31, 2019 and 2018 , respectively. Pursuant to the Transaction Agreement, our rent payable to SNH was reduced by a total of $14,379 in aggregate for February and March 2019 and we did not pay such amount to SNH. However, as the Transaction Agreement was not entered into until April 1, 2019, our rent expense for the three months ended March 31, 2019 was not adjusted for the rent reduction for February and March 2019. On March 11, 2019, we entered into a letter agreement with SNH, pursuant to which, with respect to our master leases with SNH, SNH agreed to defer, until March 31, 2019, payment of the aggregate minimum rent due and payable by us to SNH under the master leases for February 2019. As of March 31, 2019 and December 31, 2018 , we had outstanding rent due and payable to SNH of $36,379 and $18,781 , respectively, which amounts are included in due to related persons in our condensed consolidated balance sheets. The rent due and payable as of March 31, 2019 included rent due and payable for February 2019 that was deferred and payable for March 2019. The rent due and payable as of March 31, 2019 includes $14,379 that we are not required to pay as a result of the modification of our leases with SNH pursuant to the Transaction Agreement, which was effective April 1, 2019. Our leases with SNH are “triple net” leases, which generally require us to pay rent and all property operating expenses, to obtain, maintain and comply with all applicable permits and licenses necessary to operate the leased communities, to indemnify SNH from liability which may arise by reason of its ownership of the communities, to maintain the communities at our expense, to remove and dispose of hazardous substances on the communities in compliance with applicable law and to maintain insurance on the communities for SNH’s and our benefit. SNH’s consent is generally required for any direct or indirect assignment or sublease of any of the communities. Also, in the event of any assignment or subletting, we remain liable under the terms of the applicable lease. In the event of any damage, or immaterial condemnation, of a leased community, we are generally required to rebuild with insurance or condemnation proceeds or, if such proceeds are insufficient, other amounts made available by SNH, if any, but if other amounts are made available by SNH, our rent will be increased accordingly. In the event of any material or total condemnation of a leased community, the lease will terminate with respect to that leased community, in which event SNH will be entitled to the condemnation proceeds and our rent will be reduced accordingly. In the event of any material or total destruction of a leased community, we may terminate the lease with respect to that leased community, in which event we are required to pay to SNH any shortfall in the amount of proceeds SNH receives from insurance compared to the replacement cost of that leased community and our rent will be reduced accordingly. We may not enter any management agreement affecting any leased community without the prior written consent of SNH. Our leases may be subordinated to any mortgages on communities leased from SNH. As of March 31, 2019, none of our leases were subordinated to any mortgage notes. Under our leases with SNH, we are required to operate continuously and maintain, at our expense, the leased communities in good order and repair, including structural and non-structural components. We may request that SNH purchase certain improvements to the leased communities in return for increases in annual rent in accordance with a formula specified in the applicable lease; however, SNH is not obligated to purchase such improvements and we are not obligated to sell them to SNH. Pursuant to the terms of our leases with SNH, for the three months ended March 31, 2019 and 2018 , we sold to SNH $22,578 and $0 , respectively, of improvements to communities leased from SNH. Pursuant to the Transaction Agreement, our monthly minimum rent, which is set at $11,000 for the period February 1, 2019 through December 31, 2019, subject to extension, will not increase as a result of capital improvements that SNH purchases from us during that period. The sales of capital improvements that we made to SNH for the three months ended March 31, 2019 occurred after February 1, 2019. At the end of each lease term, we are required to surrender the leased communities in substantially the same condition as that existed on the commencement date of the lease, subject to any permitted alterations and ordinary wear and tear. As of March 31, 2019 , our property and equipment included $2,478 for similar improvements to communities leased from SNH that we expect to request SNH to purchase from us. Events of default under each lease generally include failure to pay rent or any money due under the lease when it is due, failure to maintain the insurance required under such lease, failure to comply with certain ownership, change in control and Board election restrictions, the occurrence of certain events with respect to our insolvency or dissolution, and our being declared ineligible to receive reimbursement under Medicare or Medicaid programs among other licensing requirements. Upon the occurrence of any event of default, remedies under each lease provide that, among other things, SNH may, accelerate the rent, terminate the lease in whole or in part, enter the community and take possession of any and all our personal property and retain or sell the same at a public or private sale, make any payment or perform any act required to be performed by us under the lease, rent the community and recover from us any deficiency between the amount of rent which would have been due under the lease and the rent received from the re‑letting. Many of our debt and lease documents contain cross default provisions so that a default under one of these instruments could cause a default under other debt and lease documents (including documents with other lenders and lessors). In accordance with FASB ASC Topic 840, Leases, the sale and leaseback transaction we completed in June 2016 with SNH qualified for sale-leaseback accounting and we classified the related lease as an operating lease. Accordingly, the gain generated from the sale of $82,644 was deferred and was being amortized as a reduction of rent expense over the initial term of the related lease. In accordance with our adoption of Topic 842 effective January 1, 2019, we recorded through retained earnings our total deferred gain as of that date. In April 2019, we and SNH entered into an agreement to sell to a third party two SNFs located in Wisconsin that SNH owns and leases to us for an aggregate sales price of approximately $11,000 , excluding closing costs. These sales are subject to conditions; as a result, these sales may not occur, they may be delayed or their terms may change. In May 2019, we and SNH sold to a third party three SNFs located in California that SNH owned and leased to us for an aggregate sales price of approximately $21,500 , excluding closing costs. In accordance with FASB ASC Topic 360, Property, Plant and Equipment, or ASC Topic 360, these SNFs we and SNH had agreed to sell and have since sold, met the conditions to be classified as held for sale as of March 31, 2019 . These communities, while leased by us, generated income from operations before income taxes of $290 and $140 for the three months ended March 31, 2019 and 2018, respectively. In June 2018, we and SNH sold one SNF to a third party, which had been previously leased to us, located in California with 97 living units for a sales price of approximately $6,500 , excluding closing costs. This community, while leased by us, generated a loss from operations before income taxes of $0 and $21 for the three months ended March 31, 2019 and 2018, respectively. Pursuant to the terms of our lease with SNH, as a result of this sale, our annual rent payable to SNH decreased by 10.0% of the net proceeds that SNH received from this sale, in accordance with the terms of the applicable lease. We did not receive any proceeds from this sale. 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 Leased from HCP . As of March 31, 2019, we leased four senior living communities under one lease with HCP, Inc., or HCP. This lease is also a “triple net” lease which requires that we pay all costs incurred in the operation of the communities, including the cost of insurance and real estate taxes, maintaining the communities, and indemnifying the landlord for any liability which may arise from the operations during the lease term. Our lease with HCP contains a minimum annual escalator of 2.0% , but not greater than 4.0% , depending on increases in certain cost of living indexes and expires on April 30, 2028 and includes one 10 year renewal option. Rent expense is recognized for actual rent paid plus or minus a straight line adjustment for the minimum lease escalators, which amount is not material to our condensed consolidated financial statements. The right of use asset balance has been decreased for the amount of accrued lease payments, which amounts are not material to our consolidated financial statements. The following table is a summary of our leases with SNH and with HCP as of March 31, 2019: Future Minimum Rents for the Twelve Months Ending March 31, Number of Properties Current Expiration Date Remaining Renewal Options Annual Minimum Rent as of March 31, 2019 2020 2021 2022 2023 2024 Thereafter Total IBR Lease Liability (1) 1. Lease No. 1 for SNFs and independent and assisted living communities 82 December 31, 2024 Two 15-year renewal options. $ 59,654 $ 59,654 $ 59,654 $ 59,654 $ 59,654 $ 59,654 $ 44,741 $ 343,011 4.53 % $ 301,522 2. Lease No. 2 for SNFs and independent and assisted living communities 47 June 30, 2026 Two 10-year renewal options. 67,725 67,725 67,725 67,725 67,725 67,725 152,382 491,007 4.64 % 416,275 3. Lease No. 3 for independent and assisted living communities 17 December 31, 2028 Two 15-year renewal options. 36,340 36,340 36,340 36,340 36,340 36,340 172,614 354,314 4.6 % 285,084 4. Lease No. 4 for SNFs and independent and assisted living communities 29 April 30, 2032 Two 15-year renewal options. 35,944 35,944 35,944 35,944 35,944 35,944 290,548 470,268 4.64 % 352,119 5. Lease No. 5 for independent and assisted living communities 9 December 31, 2028 Two 15-year renewal options. 9,902 9,902 9,902 9,902 9,902 9,902 47,034 96,544 4.6 % 77,680 6. One HCP lease 4 April 30, 2028 One 10-year renewal option. 2,760 2,811 2,867 2,924 2,983 3,043 13,066 27,694 4.6 % 22,450 Totals 188 $ 212,325 $ 212,376 $ 212,432 $ 212,489 $ 212,548 $ 212,608 $ 720,385 $ 1,782,838 $ 1,455,130 (1) Total lease liability does not include the lease liability related to our headquarters of $2,119 . Senior Living Communities Managed for the Account of SNH and its Related Entities . As of March 31, 2019 and 2018 , we managed 76 and 72 senior living communities, respectively, for the account of SNH. We earned base management fees of $3,718 and $3,423 from the senior living communities we managed for the account of SNH for the three months ended March 31, 2019 and 2018 , respectively. In addition, we earned fees for our management of capital expenditure projects at the communities we managed for the account of SNH of $195 and $128 for the three months ended March 31, 2019 and 2018 , respectively. These amounts are included in management fee revenue in our condensed consolidated statements of operations. As further described in Note 13, pursuant to the Transaction Agreement, we and SNH have agreed to replace our long term management and pooling agreements with new management agreements, subject to certain conditions and the receipt of various approvals. In the first quarter of 2018, we sold two senior living communities pursuant to a transaction agreement we entered with SNH in November 2017 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. We also provide certain other services to residents at some of the senior living communities we manage for the account of 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 $1,675 and $1,699 for the three months ended March 31, 2019 and 2018 , 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 March 31, 2019 , 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 $70 and $71 for the three months ended March 31, 2019 and 2018 , 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	3 Months Ended
	Mar. 31, 2019
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 incurred aggregate fees payable to RMR LLC of $2,293 and $2,257 for the three months ended March 31, 2019 and 2018 , respectively. In addition, we incurred internal audit costs of $71 and $69 for the three months ended March 31, 2019 and 2018 , respectively, that we reimbursed RMR LLC pursuant to our business management agreement. These amounts are included in general and administrative expenses in our condensed consolidated statements of operations. For further information about our relationship with RMR LLC, see our Annual Report.

Related Person Transactions

Related Person Transactions	3 Months Ended
	Mar. 31, 2019
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 March 31, 2019 , 4,235,000 of our common shares, or approximately 8.3% 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. SNH’s executive officers are officers of RMR LLC. Our President and Chief Executive Officer and Executive Vice President, Chief Financial Officer and Treasurer are officers and employees of RMR LLC. On April 1, 2019, we entered into the Transaction Agreement with SNH, pursuant to which we agreed to modify our existing business arrangements with SNH, subject to certain conditions and the receipt of various approvals. See Notes 1, 9 and 13 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. ABP Acquisition LLC, a subsidiary of ABP Trust is our largest stockholder, owning, as of March 31, 2019 , 17,999,999 of our common shares, or approximately 35.4% of our outstanding common shares. Adam 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 $520 and $464 for the three months ended March 31, 2019 and 2018 , respectively. The adoption of Topic 842 resulted in the recognition of a lease liability and right of use asset, which amount was $2,119 as of March 31, 2019, with respect to our headquarters lease, using an IBR of 4.4% . The right of use asset balance has been decreased for the amount of accrued lease payments, which amounts are not material to our condensed consolidated financial statements. 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. As of March 31, 2019 and December 31, 2018 , our investment in AIC had a carrying value of $9,102 and $8,633 , 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. Other . Pursuant to a separation agreement with Bruce J. Mackey Jr., our former President and Chief Executive Officer, we made a cash payment to him in the amount of $600 in January 2019. Additionally, we made the first of four , equal quarterly release payments of $138 to Mr. Mackey, in cash, in March 2019 and made monthly transition payments to him, in cash, totaling $30 for the three months ended March 31, 2019. RMR LLC paid 20% and we paid 80% of the release and transition payments to Mr. Mackey pursuant to his separation agreement. Mr. Mackey will continue to receive quarterly release payments and monthly transition payments until December 31, 2019, and we will pay 80% and RMR LLC will pay 20% of those payment amounts. Pursuant to a separation agreement with R. Scott Herzig, our former Senior Vice President of Senior Living Operations, we made a cash payment to him in the amount of $510 on January 11, 2019. For further information about these and other such relationships and certain other related person transactions, see our Annual Report.

Legal Proceedings and Claims

Legal Proceedings and Claims	3 Months Ended
	Mar. 31, 2019
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 . Under FASB 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 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 related to this matter 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 March 31, 2019 . 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 $13 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 March 31, 2019 , excluding revenue reserves, was $682 , $559 of which remained accrued and unpaid at March 31, 2019 .

Subsequent Events

Subsequent Events	3 Months Ended
	Mar. 31, 2019
Subsequent Events [Abstract]
Subsequent Events	Subsequent Events In April 2019, we began managing for SNH’s account a senior living community that SNH owns located in Oregon with 318 living units, pursuant to a management agreement with SNH on terms substantially similar to those of existing management agreements between us and SNH. The April 2019 Transaction Agreement with SNH . In April 2019, we entered into the Transaction Agreement. Among other things, the Transaction Agreement provides that, subject to approval by our stockholders of the Share Issuances (as defined below) and receipt of other required approvals, effective January 1, 2020 (or January 1, 2021 if extended under the Transaction Agreement), or the Conversion Time: • our five existing master leases with SNH for all of SNH's senior living communities that are leased by us, as well as our existing management agreements and pooling agreements with SNH for SNH's senior living communities that are operated by us, will be terminated and replaced, or the Conversion, with new management agreements for all of these senior living communities, or collectively, the New Management Agreements; • we will issue to SNH such number of our common shares as is necessary to cause SNH to own, when considered together with SNH's then owned common shares, approximately 34% of our then outstanding common shares, and SNH will declare a pro rata distribution to holders of its common shares of beneficial interest of the right to receive, and we will issue on a pro rata basis to such holders, a number of common shares which equals approximately 51% of our then outstanding common shares, or, together, the Share Issuances; the noted percentage ownership amounts are post-issuance, giving effect to the Share Issuances; and • as consideration for the Share Issuances, SNH will provide to us $75,000 of additional consideration, or, collectively with the Conversion and the Share Issuances, the Restructuring Transactions. In accordance with ASC Topic 360, the senior living communities under the five existing master leases with SNH that will terminate, as described above, will meet the conditions to be classified as held for sale in reporting periods subsequent to our entry into the Transaction Agreement; however, as of March 31, 2019, we have not classified these senior living communities as held for sale. Also pursuant to the Transaction Agreement: (1) commencing February 1, 2019 through December 31, 2019, the aggregate amount of monthly minimum rent payable to SNH by us under our master leases with SNH is $11,000 , subject to adjustment and extension, and no additional rent is payable to SNH by us from such date to the Conversion Time; and (2) on April 1, 2019, SNH purchased from us approximately $50,000 of unencumbered Qualifying PP&E (as defined in the Transaction Agreement) related to SNH's senior living communities leased and operated by us, which amount is subject to adjustment but will not exceed $60,000 . The Restructuring Transactions are subject to conditions, including, among others: (1) approval of the Share Issuances by at least a majority of the votes cast, in person or by proxy, by the holders of our outstanding common shares at any meeting of our stockholders held for that purpose, or the Stockholder Approval; (2) the receipt of all Required Licenses (as defined in the Transaction Agreement) and any other third party consent or approval required for the consummation of the Restructuring Transactions; (3) the effectiveness of the registration statement on Form S-1 to be filed by us with the Securities and Exchange Commission, or SEC, to register our common shares to be issued pursuant to the Share Issuances; and (4) approval by The Nasdaq Stock Market LLC, or Nasdaq, of the listing of our common shares to be issued pursuant to the Share Issuances, subject to official notice of issuance. If any required approval (other than the Stockholder Approval) is not obtained by December 31, 2019, and the failure to obtain such approval is not the result of a breach or default by us under the Transaction Agreement, we and SNH have agreed to work in good faith to determine an alternative to allow the Restructuring Transactions to occur on January 1, 2020; provided SNH is not required to agree to any alternative that would adversely affect SNH's qualification for taxation as a REIT under the Internal Revenue Code of 1986, as amended. If we and SNH do not agree to any such alternative, and, as of January 1, 2020, the failure to obtain a required approval is the only remaining condition under the Transaction Agreement, the Conversion Time will be automatically extended to January 1, 2021. If the Stockholder Approval is not obtained by December 31, 2019, and SNH does not elect to extend the Transaction Agreement, the Transaction Agreement will terminate, our existing master leases and management agreements and pooling agreements with SNH will remain in effect, and the amount of monthly minimum rent payable to SNH by us under our existing master leases with SNH will return to the rate provided for therein and additional rent again will be payable to SNH by us in accordance therewith. If the Stockholder Approval is obtained by December 31, 2019, our existing master leases with SNH will remain at $11,000 per month, subject to adjustment, regardless of whether the Transaction Agreement is extended and/or is terminated. We have agreed to, within six months following the Conversion Time, expand our Board of Directors to add an Independent Director (as defined in our Bylaws) reasonably satisfactory to SNH. In addition, SNH and ABP Trust, on behalf of ABP Acquisition LLC, a wholly owned subsidiary of ABP Trust and our largest stockholder, have each agreed to vote all our common shares that SNH and ABP Trust beneficially own in favor of approval of the Share Issuances at any meeting of our stockholders held for that purpose, in the case of ABP Trust, pursuant to a voting agreement we entered into with ABP Trust on April 1, 2019, or the Voting Agreement. Pursuant to the New Management Agreements, we will receive a management fee equal to 5% of the gross revenues realized at the applicable senior living communities plus reimbursement for our direct costs and expenses related to such communities, as well as an annual incentive fee equal to 15% of the amount by which the annual earnings before interest, taxes, depreciation and amortization, or EBITDA, of all communities on a combined basis exceeds the target EBITDA for all communities on a combined basis for such calendar year, provided that in no event shall the incentive fee be greater than 1.5% of the gross revenues realized at all communities on a combined basis for such calendar year. The New Management Agreements provide for 15 year terms, subject to our right to extend for two consecutive five year terms if we achieve certain performance targets for the combined managed communities portfolio. The New Management Agreements also provide SNH with the right to terminate the New Management Agreement for any community that does not earn 90% of the target EBITDA for such community for two consecutive calendar years or in any two of three consecutive calendar years, with the measurement period commencing January 1, 2021 (and the first termination not possible until the beginning of calendar year 2023), provided SNH may not in any calendar year terminate communities representing more than 20% of the combined revenues for all communities for the calendar year prior to such termination. In connection with the Transaction Agreement, we entered into a credit agreement with SNH pursuant to which SNH extended to us a $25,000 line of credit, or the SNH credit facility. The SNH credit facility matures on January 1, 2020, or January 1, 2021 if the Conversion Time is extended pursuant to the Transaction Agreement. The SNH credit facility provides for interest to be paid on borrowed amounts at a rate of 6% per year and is secured by real estate mortgages on six senior living communities owned by certain of our subsidiaries that guarantee our obligations under the SNH credit facility, and certain personal property owned by those and certain other of our subsidiaries. The SNH credit facility provides for acceleration of payment of all amounts outstanding under the SNH credit facility upon the occurrence and continuation of certain events of default, including a default by us under the Transaction Agreement and certain other agreements. The agreement governing the SNH credit facility contains covenants, including those that restrict our ability to incur debt or to pay dividends or make other distributions to our stockholders in certain circumstances. In accordance with ASC Topic 855, Subsequent Events , and ASC Topic 842, the impact of the modification of our leases with SNH pursuant to the Transaction Agreement is not included in our condensed consolidated statement of operations or balance sheet as of and for the three months ended March 31, 2019, because the agreement was not effective until April 1, 2019. We incurred transaction costs of $7,675 related to the Transaction Agreement for the three months ended March 31, 2019.

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	3 Months Ended
	Mar. 31, 2019
Accounting Policies [Abstract]
Leases	Leases On January 1, 2019, we adopted FASB ASC Topic 842, Leases , or ASC Topic 842, utilizing the modified retrospective transition method with no adjustments to comparative periods presented. Additionally, we elected the practical expedients within FASB Accounting Standards Update, or ASU, No. 2016-02, Leases (Topic 842) , or ASU No. 2016-02, that allow an entity to not reassess as of January 1, 2019 its prior conclusions on whether an existing contract contains a lease, lease classification for existing leases, and whether costs incurred for existing leases qualify as initial direct costs. In accordance with ASC Topic 842, at inception of a contract, we, as lessee, evaluate and determine whether such contract is or contains a lease based on whether such contract conveys the right to control the use of the identified asset. We 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. We have elected to apply the portfolio approach where possible in assessing our leases and performed an assessment of all our leases. In addition, we have elected the practical expedient, by class of underlying asset, not to separate non-lease components from the associated lease component if certain conditions are met. As lessee, we lease senior living communities and our headquarters, and enter into contracts for the use and maintenance of various pieces of equipment that contain a lease. We have determined that none of these leases have met any of the criteria to be classified as a finance lease and, therefore, we have accounted for all of these leases as operating leases. We have determined that our leases for the use and maintenance of equipment are short term leases. In accordance with ASC Topic 842, we have made an accounting policy election for our leases which are determined to be short term leases, whereby we recognize the lease payments on a straight line basis over the lease term and variable lease payments in the period in which the obligations for those payments are incurred. Expense related to these leases is recognized in the statement of operations in other senior living operating expenses and is not material to our condensed consolidated financial statements. We have determined that our leases for senior living communities and our headquarters are long term leases. In accordance with ASC Topic 842, a lessee is required to record a right of use asset and a lease liability for all leases with a term greater than 12 months regardless of their classification. Accordingly, we have recorded a right of use asset and lease liability for all of our leased communities and our headquarters. We determined that the discount rate implicit in the leases was not readily available, and therefore, in accordance with ASC Topic 842, we determined our incremental borrowing rate, or IBR, to calculate the right of use assets and lease liabilities. For purposes of determining the lease term, we concluded that it is not reasonably certain that our lease extensions will be exercised and, therefore, we included payments required to be made under the committed lease term in calculating the right of use assets and lease liabilities. Expense related to these leases is recognized in the statement of operations in rent expense, except for the expense related to our headquarters, which is recorded in general and administrative expenses. We recognize variable lease payments primarily relating to percentage rent paid under our leases with SNH, and operating costs such as insurance and real estate taxes, in the statement of operations in the period in which the obligations for those payments are incurred. We have not capitalized any initial direct costs related to our leases as these costs are not material to our condensed consolidated financial statements. ASC Topic 842 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, ASC Topic 842 clarifies which ASC Topic (Topic 842 or FASB ASC Topic 606, Revenue from Contracts with Customers , or ASC 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 components, the lessor should account for the combined component in accordance with FASB ASC Topic 606. Otherwise, the lessor should account for the combined component as an operating lease in accordance with ASC Topic 842. We have elected this practical expedient and recognized revenue under our resident agreements at our independent living and assisted living communities based upon the predominant component rather than allocating the consideration and separately accounting for it under ASC Topic 842 and ASC Topic 606. We have concluded that the non-lease components of the agreements with respect to our independent and assisted living communities are the predominant component of the leases and, therefore, we recognize revenue for these agreements under ASC Topic 606.
Leases	Leases On January 1, 2019, we adopted FASB ASC Topic 842, Leases , or ASC Topic 842, utilizing the modified retrospective transition method with no adjustments to comparative periods presented. Additionally, we elected the practical expedients within FASB Accounting Standards Update, or ASU, No. 2016-02, Leases (Topic 842) , or ASU No. 2016-02, that allow an entity to not reassess as of January 1, 2019 its prior conclusions on whether an existing contract contains a lease, lease classification for existing leases, and whether costs incurred for existing leases qualify as initial direct costs. In accordance with ASC Topic 842, at inception of a contract, we, as lessee, evaluate and determine whether such contract is or contains a lease based on whether such contract conveys the right to control the use of the identified asset. We 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. We have elected to apply the portfolio approach where possible in assessing our leases and performed an assessment of all our leases. In addition, we have elected the practical expedient, by class of underlying asset, not to separate non-lease components from the associated lease component if certain conditions are met. As lessee, we lease senior living communities and our headquarters, and enter into contracts for the use and maintenance of various pieces of equipment that contain a lease. We have determined that none of these leases have met any of the criteria to be classified as a finance lease and, therefore, we have accounted for all of these leases as operating leases. We have determined that our leases for the use and maintenance of equipment are short term leases. In accordance with ASC Topic 842, we have made an accounting policy election for our leases which are determined to be short term leases, whereby we recognize the lease payments on a straight line basis over the lease term and variable lease payments in the period in which the obligations for those payments are incurred. Expense related to these leases is recognized in the statement of operations in other senior living operating expenses and is not material to our condensed consolidated financial statements. We have determined that our leases for senior living communities and our headquarters are long term leases. In accordance with ASC Topic 842, a lessee is required to record a right of use asset and a lease liability for all leases with a term greater than 12 months regardless of their classification. Accordingly, we have recorded a right of use asset and lease liability for all of our leased communities and our headquarters. We determined that the discount rate implicit in the leases was not readily available, and therefore, in accordance with ASC Topic 842, we determined our incremental borrowing rate, or IBR, to calculate the right of use assets and lease liabilities. For purposes of determining the lease term, we concluded that it is not reasonably certain that our lease extensions will be exercised and, therefore, we included payments required to be made under the committed lease term in calculating the right of use assets and lease liabilities. Expense related to these leases is recognized in the statement of operations in rent expense, except for the expense related to our headquarters, which is recorded in general and administrative expenses. We recognize variable lease payments primarily relating to percentage rent paid under our leases with SNH, and operating costs such as insurance and real estate taxes, in the statement of operations in the period in which the obligations for those payments are incurred. We have not capitalized any initial direct costs related to our leases as these costs are not material to our condensed consolidated financial statements. ASC Topic 842 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, ASC Topic 842 clarifies which ASC Topic (Topic 842 or FASB ASC Topic 606, Revenue from Contracts with Customers , or ASC 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 components, the lessor should account for the combined component in accordance with FASB ASC Topic 606. Otherwise, the lessor should account for the combined component as an operating lease in accordance with ASC Topic 842. We have elected this practical expedient and recognized revenue under our resident agreements at our independent living and assisted living communities based upon the predominant component rather than allocating the consideration and separately accounting for it under ASC Topic 842 and ASC Topic 606. We have concluded that the non-lease components of the agreements with respect to our independent and assisted living communities are the predominant component of the leases and, therefore, we recognize revenue for these agreements under ASC Topic 606.
Revenue Recognition	Revenue Recognition We recognize revenue from contracts with customers in accordance with ASC Topic 606 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. 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. A substantial portion of our revenue at our independent living and assisted living communities relates to contracts with residents for housing services that are generally short term in nature and initially is subject to ASC Topic 842. As previously discussed, we have concluded that the non-lease components of these agreements are the predominant components of the contracts; therefore, we recognize revenue for these agreements under ASC Topic 606. Our contracts with residents and other customers that are within the scope of ASC Topic 606 are 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 as 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. Revenue for basic housing and support services and 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 23.6% and 23.7% of our senior living revenues for the three months ended March 31, 2019 and 2018 , 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 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) , 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 In February 2016, the FASB issued ASU No. 2016-02, 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 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. In accordance with ASC Topic 842, if a previous sale and leaseback transaction was accounted for as a sale and operating leaseback in accordance with FASB ASC Topic 840, Leases , or ASC Topic 840, any deferred gain or loss not resulting from off-market terms shall be recognized as a cumulative-effect adjustment to equity. This ASU is effective for reporting periods beginning after December 15, 2018. In July 2018, the FASB issued ASU No. 2018-11, Leases: Targeted Improvements , or ASU No. 2018-11, 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. We adopted 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. The adoption of ASC Topic 842 resulted in the recognition of lease liabilities and right of use assets of approximately $1.5 billion as of January 1, 2019. Such amount of right of use assets was recognized based upon the amount of the recognized lease liabilities, adjusted for accrued lease payments, which are not material to our condensed consolidated financial statements as of January 1, 2019. We have also concluded that any previously unrecognized right of use assets needed to be reviewed for impairment effective January 1, 2019, which could have resulted in a reduction to the initially recognized right of use assets with a cumulative effect adjustment to beginning retained earnings as of January 1, 2019. We have completed the process of evaluating the initial right of use assets for impairment and have determined there were no indicators of impairment. While the adoption of these ASUs does not affect the rent we pay, the rent expense amounts presented in our condensed consolidated statements of operations and comprehensive loss increased by approximately $1,700 for the three months ended March 31, 2019 as a result of adopting these ASUs primarily due to changes in how we accounted for the deferred gain on our sale and leaseback transaction described above effective with the adoption of these ASUs. On January 1, 2019, we recorded through retained earnings our total deferred gain of $67,473 on our consolidated balance sheets as of December 31, 2018, $55 of which was in accounts payable and accrued expenses, $6,723 of which was in other current liabilities, $1,217 of which was in other long term liabilities and the remaining $59,478 was separately stated on our consolidated balance sheets. For the year ended December 31, 2018, a substantial portion of our senior living revenue at our independent living and assisted living communities related to housing services and was subject to ASC Topic 840, and revenue for additional requested services was recognized in accordance with ASC Topic 606. Upon adoption of Topic 842, we elected the lessor practical expedient within ASU No. 2018-11 and recognized revenue under our resident agreements at our independent living and assisted living communities based upon the predominant component, either the lease or non-lease component, of the contracts rather than allocating the consideration and separately accounting for it under ASC Topic 842 and ASC Topic 606. We have concluded that the non-lease components of the agreements with respect to our independent and assisted living communities are the predominant component of the lease and, therefore, we recognize revenue for these agreements under ASC Topic 606. After the adoption of ASC Topic 842, the timing and pattern of revenue recognition are substantially the same as those prior to the adoption. See also the discussion above under “Leases” and Note 9 for more information regarding the impact of these ASUs on our consolidated financial statements. On January 1, 2019, we adopted FASB 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. The adoption of this ASU did not have a material impact on our consolidated financial statements. On January 1, 2019, we adopted FASB 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. The adoption of this ASU did not have a material impact on our consolidated financial statements. On January 1, 2019, we adopted FASB 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. The adoption of this ASU did not have a material impact on our consolidated financial statements. 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 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 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 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)	3 Months Ended
	Mar. 31, 2019
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 March 31, 2019 Three Months Ended March 31, 2018 Revenue from contracts with customers: Basic housing and support services (1) $ 162,776 $ 162,106 Medicare and Medicaid programs (1) 65,320 64,966 Additional requested services, and private pay and other third party payer SNF services (1) 48,839 47,453 Management fee revenue 3,983 3,622 Reimbursed costs incurred on behalf of managed communities 74,605 67,370 Total revenues $ 355,523 $ 345,517 (1) Included in senior living revenue in our consolidated statements of operations.

Property and Equipment (Tables)

Property and Equipment (Tables)	3 Months Ended
	Mar. 31, 2019
Property, Plant and Equipment [Abstract]
Schedule of property and equipment	Property and equipment consists of the following: March 31, 2019 December 31, 2018 Land $ 16,383 $ 16,383 Buildings and improvements 205,818 208,375 Furniture, fixtures and equipment 223,951 239,240 Property and equipment, at cost 446,152 463,998 Accumulated depreciation (222,957 ) (220,125 ) Property and equipment, net $ 223,195 $ 243,873

Accumulated Other Comprehensi_2

Accumulated Other Comprehensive Income (Tables)	3 Months Ended
	Mar. 31, 2019
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 three months ended March 31, 2019 : Equity Investment of an Investee Investments Accumulated Other Comprehensive Income Balance at January 1, 2019 $ (266 ) $ 2,008 $ 1,742 Unrealized loss on investments, net of tax — (205 ) (205 ) Equity in unrealized gain of an investee, net of tax 65 — 65 Realized loss on investments reclassified and included in net loss, net of tax — 4 4 Balance at March 31, 2019 $ (201 ) $ 1,807 $ 1,606

Fair Values of Assets and Lia_2

Fair Values of Assets and Liabilities (Tables)	3 Months Ended
	Mar. 31, 2019
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 March 31, 2019 and December 31, 2018 categorized by the level of inputs used in the valuation of each asset. As of March 31, 2019 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) $ 23,611 $ 23,611 $ — $ — Investments: Equity investments (2) Financial services industry 1,763 1,763 — — REIT industry 83 83 — — Other 3,884 3,884 — — Total equity investments 5,730 5,730 — — Debt investments: (3) International bond fund (4) 2,588 — 2,588 — High yield fund (5) 2,855 — 2,855 — Industrial bonds 1,411 — 1,411 — Technology bonds 2,131 — 2,131 — Government bonds 9,826 9,826 — — Energy bonds 612 — 612 — Financial bonds 1,927 — 1,927 — Other 997 — 997 — Total debt investments 22,347 9,826 12,521 — Total investments 28,077 15,556 12,521 — Total $ 51,688 $ 39,167 $ 12,521 $ — As of December 31, 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) $ 23,390 $ 23,390 $ — $ — Investments: Equity investments (2) Financial services industry 1,686 1,686 — — REIT industry 105 105 — — Other 3,675 3,675 — — Total equity investments 5,466 5,466 — — Debt investments (3) International bond fund (4) 2,537 — 2,537 — High yield fund (5) 2,669 — 2,669 — Industrial bonds 1,692 — 1,692 — Technology bonds 2,375 — 2,375 — Government bonds 9,791 9,791 — — Energy bonds 595 — 595 — Financial bonds 1,858 — 1,858 — Other 1,268 — 1,268 — Total debt investments 22,785 9,791 12,994 — Total investments 28,251 15,257 12,994 — Total $ 51,641 $ 38,647 $ 12,994 $ — (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 $ 19,470 and $ 19,529 of balances that are restricted at March 31, 2019 and December 31, 2018 , respectively. (2) The fair value of our equity investments is readily determinable. During the three months ended March 31, 2019 and 2018 , we received gross proceeds of $1,115 and $ 220 , respectively, in connection with the sales of equity investments and recorded gross realized gains totaling $136 and $34 , respectively, and gross realized losses totaling $40 and $5 , respectively. (3) As of March 31, 2019 , our debt investments, which are classified as available for sale, had a fair value of $ 22,347 with an amortized cost of $ 20,826 ; the difference between the fair value and amortized cost amounts resulted from unrealized gains of $ 1,602 , net of unrealized losses of $ 81 . As of December 31, 2018 , our debt investments had a fair value of $ 22,785 with an amortized cost of $ 21,806 ; the difference between the fair value and amortized cost amounts resulted from unrealized gains of $ 1,276 , net of unrealized losses of $ 296 . Debt investments include $13,186 and $13,943 of balances that are restricted as of March 31, 2019 and December 31, 2018 , respectively. At March 31, 2019 , two of the securities we hold, with a fair value of $ 305 , have been in a loss position for less than 12 months and 37 of the investments we hold, with a fair value of $ 9,996 , 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 three months ended March 31, 2019 and 2018 , we received gross proceeds of $ 1,528 and $ 1,205 , respectively, in connection with the sales of debt investments and recorded gross realized gains totaling $ 2 and $ 6 , respectively, and gross realized losses totaling $ 6 and $ 3 , 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)	3 Months Ended
	Mar. 31, 2019
Debt Disclosure [Abstract]
Summary of mortgages	The following table is a summary of this mortgage note as of March 31, 2019 : Balance as of Contractual Stated Effective Monthly March 31, 2019 Interest Rate Interest Rate Maturity Date Payment Lender Type $ 8,060 (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 $271 .

Leases and Management Agreeme_2

Leases and Management Agreements with SNH (Tables)	3 Months Ended
	Mar. 31, 2019
Leases [Abstract]
Lease Summary	The following table is a summary of our leases with SNH and with HCP as of March 31, 2019: Future Minimum Rents for the Twelve Months Ending March 31, Number of Properties Current Expiration Date Remaining Renewal Options Annual Minimum Rent as of March 31, 2019 2020 2021 2022 2023 2024 Thereafter Total IBR Lease Liability (1) 1. Lease No. 1 for SNFs and independent and assisted living communities 82 December 31, 2024 Two 15-year renewal options. $ 59,654 $ 59,654 $ 59,654 $ 59,654 $ 59,654 $ 59,654 $ 44,741 $ 343,011 4.53 % $ 301,522 2. Lease No. 2 for SNFs and independent and assisted living communities 47 June 30, 2026 Two 10-year renewal options. 67,725 67,725 67,725 67,725 67,725 67,725 152,382 491,007 4.64 % 416,275 3. Lease No. 3 for independent and assisted living communities 17 December 31, 2028 Two 15-year renewal options. 36,340 36,340 36,340 36,340 36,340 36,340 172,614 354,314 4.6 % 285,084 4. Lease No. 4 for SNFs and independent and assisted living communities 29 April 30, 2032 Two 15-year renewal options. 35,944 35,944 35,944 35,944 35,944 35,944 290,548 470,268 4.64 % 352,119 5. Lease No. 5 for independent and assisted living communities 9 December 31, 2028 Two 15-year renewal options. 9,902 9,902 9,902 9,902 9,902 9,902 47,034 96,544 4.6 % 77,680 6. One HCP lease 4 April 30, 2028 One 10-year renewal option. 2,760 2,811 2,867 2,924 2,983 3,043 13,066 27,694 4.6 % 22,450 Totals 188 $ 212,325 $ 212,376 $ 212,432 $ 212,489 $ 212,548 $ 212,608 $ 720,385 $ 1,782,838 $ 1,455,130 (1) Total lease liability does not include the lease liability related to our headquarters of $2,119 .

Basis of Presentation and Org_2

Basis of Presentation and Organization (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2019USD ($)living_unitsegmentstatecommunitybedpropertysuiteapartment	Dec. 31, 2018USD ($)
Real estate properties
Number of properties leased and operated	188,000
Accumulated deficit | $	$ 258,378	$ 292,636
Number of operating segments | segment	2
Number of reportable segments | segment	1
Senior living communities
Real estate properties
Number of properties operated	284
Number of states in which real estate properties are located | state	32
Number of properties owned and operated	20
Number of living units in properties owned and operated | living_unit	2,108
Number of properties leased and operated	188
Number of units in properties leased and operated | living_unit	20,082
Number of properties managed	76
Number of units in properties managed | living_unit	9,766
Number of living units in properties operated | living_unit	31,956
Independent and assisted living communities
Real estate properties
Number of properties operated	255
Number of living units in properties operated | living_unit	29,450
SNF
Real estate properties
Number of properties operated	29
Number of living units in properties operated | living_unit	2,506
Independent living apartment
Real estate properties
Number of living units in properties operated | apartment	10,893
Assisted living suites
Real estate properties
Number of living units in properties operated | suite	16,393
Skilled nursing units
Real estate properties
Number of living units in properties operated | bed	4,670
Revolving credit facility | Line of Credit | Revolving secured credit facility
Real estate properties
Debt outstanding | $	$ 51,484
SNH | Senior living communities
Real estate properties
Number of properties operated | community	261
Percentage of real estate properties operated	91.90%

Summary of Significant Accoun_4

Summary of Significant Accounting Policies (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018	Jan. 01, 2019	Dec. 31, 2018	Jan. 01, 2018	Jun. 30, 2016
Disaggregation of Revenue [Line Items]
Percentage senior living revenues	23.60%	23.70%
Revenue from contracts with customers	$ 355,523	$ 345,517
Right of use assets	1,455,568
Lease liability	1,455,130
Rent expense	54,542
Cumulative effect in connection with the adoption of FASB ASU			$ 67,473		$ 0
Deferred gain on sale and leaseback transaction	0			$ 59,478		$ 82,644
Accounting Standards Update 2016-02
Disaggregation of Revenue [Line Items]
Right of use assets			1,500,000
Lease liability			1,500,000
Rent expense	1,700
Basic housing and support services
Disaggregation of Revenue [Line Items]
Revenue from contracts with customers	162,776	162,106
Medicare and Medicaid programs
Disaggregation of Revenue [Line Items]
Revenue from contracts with customers	65,320	64,966
Additional requested services, and private pay and other third party payer SNF services
Disaggregation of Revenue [Line Items]
Revenue from contracts with customers	48,839	47,453
Management fee revenue
Disaggregation of Revenue [Line Items]
Revenue from contracts with customers	3,983	3,622
Reimbursed costs incurred on behalf of managed communities
Disaggregation of Revenue [Line Items]
Revenue from contracts with customers	$ 74,605	$ 67,370
Minimum
Disaggregation of Revenue [Line Items]
Payment terms	30 days
Maximum
Disaggregation of Revenue [Line Items]
Payment terms	1 year
Accounts payable and accrued expenses
Disaggregation of Revenue [Line Items]
Deferred gain on sale and leaseback transaction				55
Other current liabilities
Disaggregation of Revenue [Line Items]
Deferred gain on sale and leaseback transaction				6,723
Other long term liabilities
Disaggregation of Revenue [Line Items]
Deferred gain on sale and leaseback transaction				1,217
Deferred gain on sale and leaseback transaction
Disaggregation of Revenue [Line Items]
Deferred gain on sale and leaseback transaction				$ 59,478
Accumulated Deficit
Disaggregation of Revenue [Line Items]
Cumulative effect in connection with the adoption of FASB ASU			67,473		$ 1,107
Accumulated Deficit | Accounting Standards Update 2016-02
Disaggregation of Revenue [Line Items]
Cumulative effect in connection with the adoption of FASB ASU			$ 67,473

Property and Equipment (Details

Property and Equipment (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018	Apr. 30, 2019	Dec. 31, 2018
Property and Equipment
Property and equipment, gross	$ 446,152			$ 463,998
Accumulated depreciation	(222,957)			(220,125)
Property and equipment, net	223,195			243,873
Depreciation expense	8,165	$ 8,840
Long lived asset impairment	3,148	$ 0
Land
Property and Equipment
Property and equipment, gross	16,383			16,383
Buildings and improvements
Property and Equipment
Property and equipment, gross	205,818			208,375
Furniture, fixtures and equipment
Property and Equipment
Property and equipment, gross	223,951			239,240
Disposal Group, Held-for-sale, Not Discontinued Operations
Property and Equipment
Property plant and equipment held for sale or disposed	526			$ 0
Disposal Group, Held-for-sale, Not Discontinued Operations | SNH
Property and Equipment
Property plant and equipment held for sale or disposed	$ 2,478
Transaction Agreement | Subsequent Event | Disposal Group, Disposed of by Sale, Not Discontinued Operations | SNH
Property and Equipment
Property plant and equipment held for sale or disposed			$ 50,000

Accumulated Other Comprehensi_3

Accumulated Other Comprehensive Income (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Changes in accumulated other comprehensive income
Beginning balance	$ 71,169	$ 144,994
Unrealized loss on investments, net of tax	(205)	(397)
Equity in unrealized gain of an investee, net of tax	65
Realized loss on investments reclassified and included in net loss, net of tax	4
Ending balance	105,388	136,763
Equity Investment of an Investee
Changes in accumulated other comprehensive income
Beginning balance	(266)
Unrealized loss on investments, net of tax	0
Equity in unrealized gain of an investee, net of tax	65
Realized loss on investments reclassified and included in net loss, net of tax	0
Ending balance	(201)
Investments
Changes in accumulated other comprehensive income
Beginning balance	2,008
Unrealized loss on investments, net of tax	(205)
Equity in unrealized gain of an investee, net of tax	0
Realized loss on investments reclassified and included in net loss, net of tax	4
Ending balance	1,807
Accumulated Other Comprehensive Income
Changes in accumulated other comprehensive income
Beginning balance	1,742	4,036
Ending balance	$ 1,606	$ 2,436

Income Taxes (Details)

Income Taxes (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Income Tax Disclosure [Abstract]
Provision for income taxes	$ 1,490	$ 256

Earnings Per Share (Details)

Earnings Per Share (Details) - shares	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Earnings Per Share [Abstract]
Antidilutive securities excluded from computation of earnings per share (in shares)	1,082,100	1,265,770

Fair Values of Assets and Lia_3

Fair Values of Assets and Liabilities - Recurring Measurements (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2019USD ($)security	Mar. 31, 2018USD ($)	Dec. 31, 2018USD ($)
Fair Values of Assets and Liabilities
Cash equivalents	$ 23,611		$ 23,390
Equity investments	5,730		5,466
Debt investments	22,347		22,785
Total investments	28,077		28,251
Total	51,688		51,641
Restricted cash	19,470		19,529
Gross proceeds from sale of equity securities	1,115	$ 220
Gross realized gains recorded on sale of equity securities	136	34
Gross realized losses recorded on sale of equity securities	40	5
Amortized cost of available for sale debt securities	20,826		21,806
Unrealized gains on available for sale debt securities	1,602		1,276
Unrealized losses on available for sale debt securities	$ 81		296
Number of available for sale debt securities in a loss position less than 12 months | security	2
Fair value of debt securities which are in loss position for less than 12 months	$ 305
Number of available for sale debt securities in a loss position 12 months or longer | security	37
Fair value of debt securities which are in loss position for greater than 12 months	$ 9,996
Gross proceeds from sale of available for sale debt securities	1,528	1,205
Gross realized gains recorded on sale of debt securities	2	6
Gross realized losses recorded on sale of debt securities	6	$ 3
Financial services industry
Fair Values of Assets and Liabilities
Equity investments	1,763		1,686
REIT industry
Fair Values of Assets and Liabilities
Equity investments	83		105
Other
Fair Values of Assets and Liabilities
Equity investments	3,884		3,675
International bond fund
Fair Values of Assets and Liabilities
Debt investments	2,588		2,537
High yield fund
Fair Values of Assets and Liabilities
Debt investments	2,855		2,669
Industrial bonds
Fair Values of Assets and Liabilities
Debt investments	1,411		1,692
Technology bonds
Fair Values of Assets and Liabilities
Debt investments	2,131		2,375
Government bonds
Fair Values of Assets and Liabilities
Debt investments	9,826		9,791
Energy bonds
Fair Values of Assets and Liabilities
Debt investments	612		595
Financial bonds
Fair Values of Assets and Liabilities
Debt investments	1,927		1,858
Other
Fair Values of Assets and Liabilities
Debt investments	997		1,268
Restricted debt securities
Fair Values of Assets and Liabilities
Debt investments	13,186		13,943
Quoted Prices in Active Markets for Identical Assets
Fair Values of Assets and Liabilities
Cash equivalents	23,611		23,390
Equity investments	5,730		5,466
Debt investments	9,826		9,791
Total investments	15,556		15,257
Total	39,167		38,647
Quoted Prices in Active Markets for Identical Assets | Financial services industry
Fair Values of Assets and Liabilities
Equity investments	1,763		1,686
Quoted Prices in Active Markets for Identical Assets | REIT industry
Fair Values of Assets and Liabilities
Equity investments	83		105
Quoted Prices in Active Markets for Identical Assets | Other
Fair Values of Assets and Liabilities
Equity investments	3,884		3,675
Quoted Prices in Active Markets for Identical Assets | International bond fund
Fair Values of Assets and Liabilities
Debt investments	0		0
Quoted Prices in Active Markets for Identical Assets | High yield fund
Fair Values of Assets and Liabilities
Debt investments	0		0
Quoted Prices in Active Markets for Identical Assets | Industrial bonds
Fair Values of Assets and Liabilities
Debt investments	0		0
Quoted Prices in Active Markets for Identical Assets | Technology bonds
Fair Values of Assets and Liabilities
Debt investments	0		0
Quoted Prices in Active Markets for Identical Assets | Government bonds
Fair Values of Assets and Liabilities
Debt investments	9,826		9,791
Quoted Prices in Active Markets for Identical Assets | Energy bonds
Fair Values of Assets and Liabilities
Debt investments	0		0
Quoted Prices in Active Markets for Identical Assets | Financial bonds
Fair Values of Assets and Liabilities
Debt investments	0		0
Quoted Prices in Active Markets for Identical Assets | Other
Fair Values of Assets and Liabilities
Debt investments	0		0
Significant Other Observable Inputs
Fair Values of Assets and Liabilities
Cash equivalents	0		0
Equity investments	0		0
Debt investments	12,521		12,994
Total investments	12,521		12,994
Total	12,521		12,994
Significant Other Observable Inputs | Financial services industry
Fair Values of Assets and Liabilities
Equity investments	0		0
Significant Other Observable Inputs | REIT industry
Fair Values of Assets and Liabilities
Equity investments	0		0
Significant Other Observable Inputs | Other
Fair Values of Assets and Liabilities
Equity investments	0		0
Significant Other Observable Inputs | International bond fund
Fair Values of Assets and Liabilities
Debt investments	2,588		2,537
Significant Other Observable Inputs | High yield fund
Fair Values of Assets and Liabilities
Debt investments	2,855		2,669
Significant Other Observable Inputs | Industrial bonds
Fair Values of Assets and Liabilities
Debt investments	1,411		1,692
Significant Other Observable Inputs | Technology bonds
Fair Values of Assets and Liabilities
Debt investments	2,131		2,375
Significant Other Observable Inputs | Government bonds
Fair Values of Assets and Liabilities
Debt investments	0		0
Significant Other Observable Inputs | Energy bonds
Fair Values of Assets and Liabilities
Debt investments	612		595
Significant Other Observable Inputs | Financial bonds
Fair Values of Assets and Liabilities
Debt investments	1,927		1,858
Significant Other Observable Inputs | Other
Fair Values of Assets and Liabilities
Debt investments	997		1,268
Significant Unobservable Inputs
Fair Values of Assets and Liabilities
Cash equivalents	0		0
Equity investments	0		0
Debt investments	0		0
Total investments	0		0
Total	0		0
Significant Unobservable Inputs | Financial services industry
Fair Values of Assets and Liabilities
Equity investments	0		0
Significant Unobservable Inputs | REIT industry
Fair Values of Assets and Liabilities
Equity investments	0		0
Significant Unobservable Inputs | Other
Fair Values of Assets and Liabilities
Equity investments	0		0
Significant Unobservable Inputs | International bond fund
Fair Values of Assets and Liabilities
Debt investments	0		0
Significant Unobservable Inputs | High yield fund
Fair Values of Assets and Liabilities
Debt investments	0		0
Significant Unobservable Inputs | Industrial bonds
Fair Values of Assets and Liabilities
Debt investments	0		0
Significant Unobservable Inputs | Technology bonds
Fair Values of Assets and Liabilities
Debt investments	0		0
Significant Unobservable Inputs | Government bonds
Fair Values of Assets and Liabilities
Debt investments	0		0
Significant Unobservable Inputs | Energy bonds
Fair Values of Assets and Liabilities
Debt investments	0		0
Significant Unobservable Inputs | Financial bonds
Fair Values of Assets and Liabilities
Debt investments	0		0
Significant Unobservable Inputs | Other
Fair Values of Assets and Liabilities
Debt investments	$ 0		$ 0

Fair Values of Assets and Lia_4

Fair Values of Assets and Liabilities - Non-recurring Measurements (Details) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Carrying value and fair value
Mortgage notes payable	$ 7,445	$ 7,533
Carrying value
Carrying value and fair value
Mortgage notes payable	7,789	7,872
Estimated fair value | Significant Unobservable Inputs
Carrying value and fair value
Mortgage notes payable	$ 9,118	$ 8,986

Indebtedness - Debt Instruments

Indebtedness - Debt Instruments Summary (Details)	1 Months Ended	3 Months Ended
	Feb. 28, 2018USD ($)community	Mar. 31, 2019USD ($)living_unitcommunityagreement	Mar. 31, 2018USD ($)	Apr. 01, 2019USD ($)	Jun. 30, 2018USD ($)	May 31, 2018USD ($)
Indebtedness
Letters of credit outstanding		$ 25,216,000
Mortgage notes
Indebtedness
Interest expense and other associated costs incurred		$ 134,000	$ 437,000
Senior living communities | Mortgage notes
Indebtedness
Number of real estate properties mortgaged | community		1
Standby letters of credit
Indebtedness
Number of irrevocable standby letters of credit agreements | agreement		7
Standby letters of credit | Workers' compensation insurance program
Indebtedness
Letter of credit amount securing workers' compensation insurance program					$ 22,700,000	$ 17,800,000
Extension term		1 year
Standby letters of credit | Certain of our other obligations
Indebtedness
Letters of credit outstanding		$ 2,516,000
Number of irrevocable standby letters of credit agreements | agreement		6
Revolving secured 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
Revolving secured credit facility | Revolving credit facility | Line of Credit
Indebtedness
Maximum borrowing capacity		$ 54,000,000
Quarterly commitment fee on the unused part of borrowing availability		0.35%
Weighted average annual interest rate		5.00%
Debt outstanding		$ 51,484,000
Letters of credit outstanding		2,516,000
Interest expense and other associated costs incurred		$ 772,000	$ 266,000
Revolving secured credit facility | LIBOR | Revolving credit facility | Line of Credit
Indebtedness
Interest rate at period end		4.99%
Revolving secured credit facility | Base Rate | Revolving credit facility | Line of Credit
Indebtedness
Interest rate at period end		7.00%
Federal National Mortgage Association mortgage | Senior living communities | Mortgage notes
Indebtedness
Number of properties sold | community	1
Early repayment of debt	$ 16,776,000
Contractual stated interest rate	6.64%
Gain on early extinguishment of debt	$ 543,000
SNH Credit Facility | Line of Credit
Indebtedness
Maximum borrowing capacity				$ 25,000,000
Cash Equivalents | Standby letters of credit | Workers' compensation insurance program
Indebtedness
Collateral securing workers' compensation insurance program					17,983,000
Debt and Equity Investments | Standby letters of credit | Workers' compensation insurance program
Indebtedness
Collateral securing workers' compensation insurance program					$ 5,758,000

Indebtedness - Payments of Prin

Indebtedness - Payments of Principal and Interest (Details) - September 2032 $ in Thousands	3 Months Ended
	Mar. 31, 2019USD ($)
Indebtedness
Unamortized discount and debt issuance costs	$ 271
Mortgage notes
Indebtedness
Balances	$ 8,060
Contractual Stated Interest Rate	6.20%
Effective Interest Rate	6.70%
Monthly Payment	$ 72

Leases and Management Agreeme_3

Leases and Management Agreements with SNH - Narrative (Details) $ in Thousands	Apr. 01, 2019USD ($)	Jun. 30, 2018USD ($)	May 30, 2019USD ($)property	Apr. 30, 2019USD ($)leaseproperty	Jun. 30, 2018USD ($)living_unitcommunityproperty	Mar. 31, 2019USD ($)communityleaserenewal_termproperty	Mar. 31, 2018USD ($)community	Dec. 31, 2018USD ($)	Jun. 30, 2016USD ($)
Leases
Number of properties leased and operated | property						188,000
Total annual rent payable						$ 212,325
Total rent expense						54,542
Total rent expense							$ 52,245
Deferred gain on sale and leaseback transaction						0		$ 59,478	$ 82,644
Revenues						355,523	345,517
Management fee revenue
Leases
Revenues						$ 3,983	3,622
SNH
Leases
Percentage rent						4.00%
Total annual rent payable						$ 209,565	206,908
Total rent expense						53,782
Total rent expense							51,522
Reduction in rent payable						14,379
Outstanding rent due and payable						36,379		18,781
Decrease in outstanding rent due and payable	$ 14,379
Monthly minimum rent						11,000
SNH | Other Services Provided to Residents at Managed Communities
Leases
Rehabilitation service revenue						1,675	1,699
SNH | Improvements to communities
Leases
Leasehold improvements sold to lessor						22,578	0
SNH | Management fee revenue
Leases
Revenues						$ 3,718	$ 3,423
Senior living communities
Leases
Number of properties leased and operated | property						188
Senior living communities | SNH
Leases
Number of properties leased and operated | community						184	185
Number of leases | lease						5
Percentage rent						$ 1,549
Percentage rent							$ 1,391
Number of communities managed | community						76	72
Senior living communities | SNH | D&R Yonkers LLC
Leases
Number of communities managed | community						1
Senior living communities | SNH | May 2019 Sale of Skilled Nursing Facilities in California
Leases
Income (loss) from operations earned by properties leased						$ 290	$ 140
Senior living communities | SNH | June 2018 Sale of Skilled Nursing Facility in California
Leases
Sales price					$ 6,500
Income (loss) from operations earned by properties leased						0	(21)
Senior living communities | SNH | June 2018 Florida Living Unit Leased Acquired by Related Party
Leases
Increase (decrease) in annual lease rent payable		$ 14
Senior living communities | SNH | January and February 2018 sales group | 2017 Transaction Agreement
Leases
Sales price							$ 41,917
Related party transaction, number of properties sold to, and subsequently managed for related party | community							2
Aggregate carrying value of communities sold							$ 19,425
Debt outstanding							17,356
Principle transferred							16,776
Gain generated from sale of communities							5,684
Senior living communities | SNH | June 2018 Sales Group | 2017 Transaction Agreement
Leases
Sales price					$ 23,300
Related party transaction, number of properties sold to, and subsequently managed for related party | community					2
Aggregate carrying value of communities sold					$ 5,163
Debt outstanding		$ 17,226			17,226
Principle transferred					16,588
Gain generated from sale of communities					$ 1,549
Senior living communities | SNH | Management fee revenue
Leases
Revenues						195	128
Senior living communities | SNH | Management fee revenue | D&R Yonkers LLC
Leases
Revenues						$ 70	$ 71
Senior living communities | SNH | June 2018 Sale of Skilled Nursing Facility in California
Leases
Number of properties sold | property					1
Number of living units sold | living_unit					97
Change in annual rent payable					(10.00%)
Senior living communities | Subsequent Event | SNH
Leases
Number of leases | lease				5
Senior living communities | Subsequent Event | SNH | April 2019 Sale of Skilled Nursing Facilities in Wisconsin
Leases
Sales price				$ 11,000
Number of properties sold | property				2
Senior living communities | Subsequent Event | SNH | May 2019 Sale of Skilled Nursing Facilities in California
Leases
Sales price			$ 21,500
Number of properties sold | property			3
HCP | Senior living communities
Leases
Number of properties leased and operated | community						4
Number of renewal options | renewal_term						1
Renewal option						10 years
Minimum | HCP | Senior living communities
Leases
Annual escalator						2.00%
Maximum | HCP | Senior living communities
Leases
Annual escalator						4.00%
Disposal Group, Held-for-sale, Not Discontinued Operations
Leases
Property plant and equipment held for sale or disposed						$ 526		$ 0
Disposal Group, Held-for-sale, Not Discontinued Operations | SNH
Leases
Property plant and equipment held for sale or disposed						$ 2,478

Leases and Management Agreeme_4

Leases and Management Agreements with SNH - Summary of Leases (Details) property in Thousands, $ in Thousands	Mar. 31, 2019USD ($)renewal_termproperty
Lessee, Lease, Description [Line Items]
Number of Properties | property	188
Annual Minimum Rent as of March 31, 2019	$ 212,325
2020	212,376
2021	212,432
2022	212,489
2023	212,548
2024	212,608
Thereafter	720,385
Total	1,782,838
Lease Liability	$ 1,455,130
Lease No. 1 for SNFs and independent and assisted living communities
Lessee, Lease, Description [Line Items]
Number of Properties | property	82
Number of renewal options | renewal_term	2
Renewal option	15 years
Annual Minimum Rent as of March 31, 2019	$ 59,654
2020	59,654
2021	59,654
2022	59,654
2023	59,654
2024	59,654
Thereafter	44,741
Total	$ 343,011
IBR	4.53%
Lease Liability	$ 301,522
Lease No. 2 for SNFs and independent and assisted living communities
Lessee, Lease, Description [Line Items]
Number of Properties | property	47
Number of renewal options | renewal_term	2
Renewal option	10 years
Annual Minimum Rent as of March 31, 2019	$ 67,725
2020	67,725
2021	67,725
2022	67,725
2023	67,725
2024	67,725
Thereafter	152,382
Total	$ 491,007
IBR	4.64%
Lease Liability	$ 416,275
Lease No. 3 for independent and assisted living communities
Lessee, Lease, Description [Line Items]
Number of Properties | property	17
Number of renewal options | renewal_term	2
Renewal option	15 years
Annual Minimum Rent as of March 31, 2019	$ 36,340
2020	36,340
2021	36,340
2022	36,340
2023	36,340
2024	36,340
Thereafter	172,614
Total	$ 354,314
IBR	4.60%
Lease Liability	$ 285,084
Lease No. 4 for SNFs and independent and assisted living communities
Lessee, Lease, Description [Line Items]
Number of Properties | property	29
Number of renewal options | renewal_term	2
Renewal option	15 years
Annual Minimum Rent as of March 31, 2019	$ 35,944
2020	35,944
2021	35,944
2022	35,944
2023	35,944
2024	35,944
Thereafter	290,548
Total	$ 470,268
IBR	4.64%
Lease Liability	$ 352,119
Lease No. 5 for independent and assisted living communities
Lessee, Lease, Description [Line Items]
Number of Properties | property	9
Number of renewal options | renewal_term	2
Renewal option	15 years
Annual Minimum Rent as of March 31, 2019	$ 9,902
2020	9,902
2021	9,902
2022	9,902
2023	9,902
2024	9,902
Thereafter	47,034
Total	$ 96,544
IBR	4.60%
Lease Liability	$ 77,680
One HCP lease
Lessee, Lease, Description [Line Items]
Number of Properties | property	4
Number of renewal options | renewal_term	1
Renewal option	10 years
Annual Minimum Rent as of March 31, 2019	$ 2,760
2020	2,811
2021	2,867
2022	2,924
2023	2,983
2024	3,043
Thereafter	13,066
Total	$ 27,694
IBR	4.60%
Lease Liability	$ 22,450
Headquarters
Lessee, Lease, Description [Line Items]
Lease Liability	$ 2,119

Business Management Agreement_2

Business Management Agreement with RMR LLC - Narrative (Details) - RMR LLC - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Business Management Agreement [Line Items]
Business management fees	$ 2,293	$ 2,257
Reimbursable expenses, internal audit costs	$ 71	$ 69

Related Person Transactions (De

Related Person Transactions (Details) $ in Thousands	Jan. 11, 2019USD ($)	Jan. 31, 2019USD ($)	Mar. 31, 2019USD ($)companyshares	Mar. 31, 2018USD ($)	Dec. 31, 2019installment_payment	Dec. 31, 2018USD ($)
Related Party Transaction [Line Items]
Rent expense				$ 52,245
Lease liability			$ 1,455,130
Right of use assets			1,455,568
Equity investment of an investee			$ 9,102			$ 8,633
SNH
Related Party Transaction [Line Items]
Number of shares owned (in shares) | shares			4,235,000
Percentage of outstanding common shares owned			8.30%
Rent expense				51,522
ABP Trust
Related Party Transaction [Line Items]
Number of shares owned (in shares) | shares			17,999,999
Percentage of outstanding common shares owned			35.40%
Rent expense			$ 520	$ 464
Lease liability			2,119
Right of use assets			$ 2,119
Incremental borrowing rate			4.40%
AIC
Related Party Transaction [Line Items]
Number of companies in related party entity | company			4
Equity investment of an investee			$ 9,102			$ 8,633
Severance, Cash Payment | Chief Executive Officer
Related Party Transaction [Line Items]
Cash payments for severance		$ 600
Severance, Release Payments | Chief Executive Officer
Related Party Transaction [Line Items]
Cash payments for severance			138
Severance, Release Payments | Subsequent Event | Chief Executive Officer
Related Party Transaction [Line Items]
Number of installment payments | installment_payment					4
Severance | Senior Vice President
Related Party Transaction [Line Items]
Cash payments for severance	$ 510
Chief Executive Officer | Severance, Transition Payments
Related Party Transaction [Line Items]
Cash payments for severance			$ 30
Chief Executive Officer | Severance
Related Party Transaction [Line Items]
Percentage of severance payments paid			80.00%
Chief Executive Officer | Severance | Subsequent Event
Related Party Transaction [Line Items]
Percentage of severance payments paid					80.00%
RMR LLC | Chief Executive Officer | Severance
Related Party Transaction [Line Items]
Percentage of severance payments paid			20.00%
RMR LLC | Chief Executive Officer | Severance | Subsequent Event
Related Party Transaction [Line Items]
Percentage of severance payments paid					20.00%

Legal Proceedings and Claims (D

Legal Proceedings and Claims (Details) $ in Thousands	Dec. 31, 2017USD ($)	Mar. 31, 2018USD ($)	Mar. 31, 2019USD ($)property	Sep. 30, 2018USD ($)	Jun. 30, 2018USD ($)	Mar. 31, 2018USD ($)
Loss Contingencies [Line Items]
Estimated minimum loss			$ 0
Unfavorable regulatory action | Office of the Inspector General
Loss Contingencies [Line Items]
Accrual for loss contingency			559
Litigation expense			682
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
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				$ 13	$ 20	$ 55
Senior living communities | SNF, California | SNH
Loss Contingencies [Line Items]
Number of communities | property			1

Subsequent Events (Details)

Subsequent Events (Details)	1 Months Ended	3 Months Ended
	Apr. 30, 2019USD ($)living_unitleaserenewal_termyear	Mar. 31, 2019USD ($)lease	Apr. 01, 2019USD ($)property
SNH
Subsequent Event [Line Items]
Monthly minimum rent		$ 11,000,000
SNH | Subsequent Event
Subsequent Event [Line Items]
Number of additional living units managed | living_unit	318
Senior living communities | SNH
Subsequent Event [Line Items]
Number of leases | lease		5
Senior living communities | SNH | Subsequent Event
Subsequent Event [Line Items]
Number of leases | lease	5
SNH Credit Facility | Line of Credit
Subsequent Event [Line Items]
Maximum borrowing capacity			$ 25,000,000
Transaction Agreement | SNH | Subsequent Event
Subsequent Event [Line Items]
Monthly minimum rent	$ 11,000,000
Management fee as a percent of gross revenues	5.00%
Incentive management fee threshold	15.00%
Incentive management fee maximum	1.50%
Management fee term	15 years
Management fee, number of renewal terms | renewal_term	2
Management fee renewal term	5 years
Management fee EBITDA threshold	90.00%
Management fee EBITDA threshold, consecutive measurement period	2 years
Management fee EBITDA threshold, measurement period | year	2
Management fee EBITDA threshold, measurement period, number of years	3 years
Termination fee threshold	20.00%
Transaction Agreement | Shares Issued to SNH | Subsequent Event
Subsequent Event [Line Items]
Ownership percentage after stock issuance	34.00%
Transaction Agreement | Shares Issued to SNH Common Stockholders | Subsequent Event
Subsequent Event [Line Items]
Ownership percentage after stock issuance	51.00%
Transaction Agreement | Shares Issued | Subsequent Event
Subsequent Event [Line Items]
Consideration received from stock issuance	$ 75,000,000
Transaction Agreement | SNH Credit Facility | Line of Credit
Subsequent Event [Line Items]
Maximum borrowing capacity			$ 25,000,000
Contractual stated interest rate			6.00%
Number of properties securing mortgages | property			6
Transaction Agreement, Transaction Costs | SNH
Subsequent Event [Line Items]
Amount of transaction		$ 7,675,000
Disposal Group, Disposed of by Sale, Not Discontinued Operations | Transaction Agreement | SNH | Subsequent Event
Subsequent Event [Line Items]
Property plant and equipment disposed	50,000,000
Disposal Group, Disposed of by Sale, Not Discontinued Operations | Transaction Agreement | Maximum | SNH | Subsequent Event
Subsequent Event [Line Items]
Property plant and equipment disposed	$ 60,000,000

Uncategorized Items - fve-20190

Label	Element	Value
Restricted Cash and Cash Equivalents	us-gaap_RestrictedCashAndCashEquivalents	$ 21,528,000
Restricted Cash and Cash Equivalents	us-gaap_RestrictedCashAndCashEquivalents	20,394,000
AOCI Attributable to Parent [Member]
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	$ (1,107,000)