Diversified Healthcare Trust (DHC) 10-Q 4 Nov 24 2024 Q3 Quarterly report Financial data

Cover

Cover - shares	9 Months Ended
	Sep. 30, 2024	Nov. 01, 2024
Entity Information
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2024
Document Transition Report	false
Entity File Number	1-15319
Entity Registrant Name	DIVERSIFIED HEALTHCARE TRUST
Entity Incorporation, State or Country Code	MD
Entity Tax Identification Number	04-3445278
Entity Address, Address Line One	Two Newton Place, 255 Washington Street, Suite 300,
Entity Address, City or Town	Newton
Entity Address, State or Province	MA
Entity Address, Postal Zip Code	02458-1634
City Area Code	617
Local Phone Number	796 - 8350
Title Of Each Class	Common Shares of Beneficial Interest
Trading Symbol(s)	DHC
Name Of Each Exchange On Which Registered	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Accelerated Filer
Entity Smaller Reporting Company	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding (in shares)		241,275,373
Entity Central Index Key	0001075415
Amendment Flag	false
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2024
Document Fiscal Period Focus	Q3
5.625% Senior Notes due 2042
Entity Information
Title Of Each Class	5.625% Senior Notes due 2042
Trading Symbol(s)	DHCNI
Name Of Each Exchange On Which Registered	NASDAQ
6.25% Senior Notes due 2046
Entity Information
Title Of Each Class	6.25% Senior Notes due 2046
Trading Symbol(s)	DHCNL
Name Of Each Exchange On Which Registered	NASDAQ

CONDENSED CONSOLIDATED BALANCE

CONDENSED CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Sep. 30, 2024		Dec. 31, 2023
Real estate properties:
Land	$ 623,322		$ 652,977
Buildings and improvements	6,049,365		6,165,490
Total real estate properties, gross	6,672,687		6,818,467
Accumulated depreciation	(2,110,692)		(2,020,843)
Total real estate properties, net	4,561,995		4,797,624
Investments in unconsolidated joint ventures	110,513		129,916
Assets of properties held for sale	81,163		9,447
Cash and cash equivalents	256,527		245,939
Restricted cash	4,873	[1]	1,022
Equity method investment	23,758		0
Acquired real estate leases and other intangible assets, net	27,868		33,948
Other assets, net	218,499		228,240
Total assets	5,285,196		5,446,136
Liabilities and Shareholders' Equity
Secured debt and finance leases, net	127,836		13,020
Liabilities of properties held for sale	2,617		32
Accrued interest	22,589		22,847
Other liabilities	266,295		269,517
Total liabilities	3,236,792		3,109,245
Commitments and contingencies
Shareholders' equity:
Common shares of beneficial interest, $.01 par value: 300,000,000 shares authorized, 241,281,373 and 240,423,898 shares issued and outstanding, respectively	2,413		2,405
Additional paid in capital	4,619,990		4,618,470
Cumulative net income	1,495,469		1,778,278
Cumulative other comprehensive income	8		0
Cumulative distributions	(4,069,476)		(4,062,262)
Total shareholders' equity	2,048,404		2,336,891
Total liabilities and shareholders' equity	5,285,196		5,446,136
Secured Debts
Liabilities and Shareholders' Equity
Senior notes	801,315		731,211
Unsecured Debt
Liabilities and Shareholders' Equity
Senior notes	$ 2,016,140		$ 2,072,618
[1]Restricted cash consists of amounts escrowed for real estate taxes, insurance and capital expenditures at certain of our mortgaged properties.

CONDENSED CONSOLIDATED BALANC_2

CONDENSED CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares	Sep. 30, 2024	Dec. 31, 2023
Statement of Financial Position [Abstract]
Common shares of beneficial interest, par value (in dollars per share)	$ 0.01	$ 0.01
Common shares of beneficial interest, shares authorized (in shares)	300,000,000	300,000,000
Common shares of beneficial interest, shares issued (in shares)	241,281,373	240,423,898
Common shares of beneficial interest, shares outstanding (in shares)	241,281,373	240,423,898

CONDENSED CONSOLIDATED STATEMEN

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (LOSS) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Revenues:
Revenues	$ 373,640	$ 356,524	$ 1,115,808	$ 1,048,773
Expenses:
Property operating expenses	309,697	298,432	921,366	870,740
Depreciation and amortization	68,959	67,236	207,449	200,430
General and administrative	13,933	6,954	27,763	20,111
Acquisition and certain other transaction related costs	331	3,676	2,243	9,812
Impairment of assets	23,031	1,156	41,718	18,380
Total expenses	415,951	377,454	1,200,539	1,119,473
Gain (loss) on sale of properties	111	0	(18,976)	1,233
Gains on equity securities, net	0	0	0	8,126
Interest and other income	2,575	3,243	7,215	12,572
Interest expense (including net amortization of debt discounts, premiums and issuance costs of $26,188, $2,293, $76,642 and $6,616, respectively)	(59,443)	(47,758)	(175,721)	(142,922)
Loss on modification or early extinguishment of debt	0	0	(209)	(1,075)
Loss before income tax expense and equity in net earnings (losses) of investees	(99,068)	(65,445)	(272,422)	(192,766)
Income tax expense	(148)	(189)	(505)	(379)
Equity in net earnings (losses) of investees	527	(145)	(9,882)	2,137
Net loss	(98,689)	(65,779)	(282,809)	(191,008)
Other comprehensive income:
Equity in unrealized gains of an investee	34	0	8	0
Other comprehensive income	34	0	8	0
Comprehensive loss	$ (98,655)	$ (65,779)	$ (282,801)	$ (191,008)
Weighted average common shares outstanding (basic) (in shares)	239,667	238,892	239,396	238,722
Weighted average common shares outstanding (diluted) (in shares)	239,667	238,892	239,396	238,722
Per common share amounts (basic and diluted):
Net loss - basic (in dollars per share)	$ (0.41)	$ (0.28)	$ (1.18)	$ (0.80)
Net loss - diluted (in dollars per share)	$ (0.41)	$ (0.28)	$ (1.18)	$ (0.80)
Affiliated Entity
Expenses:
Equity in net earnings (losses) of investees	$ 527	$ (145)	$ (9,882)	$ 2,137
Rental income
Revenues:
Revenues	61,635	63,390	187,155	191,201
Residents fees and services
Revenues:
Revenues	$ 312,005	$ 293,134	$ 928,653	$ 857,572

CONDENSED CONSOLIDATED STATEM_2

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (LOSS) (Parenthetical) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Income Statement [Abstract]
Interest expense (including net amortization of debt premiums, discounts and issuance costs)	$ 26,188	$ 2,293	$ 76,642	$ 6,616

CONDENSED CONSOLIDATED STATEM_3

CONDENSED CONSOLIDATED STATEMENTS OF SHAREHOLDERS' EQUITY - USD ($) $ in Thousands	Total	Common Shares	Additional Paid In Capital	Cumulative Net Income	Cumulative Other Comprehensive Loss	Cumulative Distributions
Beginning balance (in shares) at Dec. 31, 2022		239,694,842
Beginning balance at Dec. 31, 2022	$ 2,638,611	$ 2,397	$ 4,617,031	$ 2,071,850	$ 0	$ (4,052,667)
Increase (Decrease) in Stockholders' Equity
Net loss	(52,658)			(52,658)
Distributions	(2,397)					(2,397)
Share grants	270		270
Share repurchases (in shares)		(5,975)
Share repurchases	(6)		(6)
Share forfeitures (in shares)		(6,400)
Share forfeitures	(1)		(1)
Ending balance (in shares) at Mar. 31, 2023		239,682,467
Ending balance at Mar. 31, 2023	2,583,819	$ 2,397	4,617,294	2,019,192	0	(4,055,064)
Beginning balance (in shares) at Dec. 31, 2022		239,694,842
Beginning balance at Dec. 31, 2022	2,638,611	$ 2,397	4,617,031	2,071,850	0	(4,052,667)
Increase (Decrease) in Stockholders' Equity
Net loss	(191,008)
Equity in unrealized losses (gains) of an investee	0
Ending balance (in shares) at Sep. 30, 2023		240,457,549
Ending balance at Sep. 30, 2023	2,441,526	$ 2,405	4,618,138	1,880,842	0	(4,059,859)
Beginning balance (in shares) at Mar. 31, 2023		239,682,467
Beginning balance at Mar. 31, 2023	2,583,819	$ 2,397	4,617,294	2,019,192	0	(4,055,064)
Increase (Decrease) in Stockholders' Equity
Net loss	(72,571)			(72,571)
Distributions	(2,397)					(2,397)
Share grants (in shares)		140,000
Share grants	568	$ 1	567
Share repurchases (in shares)		(24,513)
Share repurchases	(27)		(27)
Share forfeitures (in shares)		(5,600)
Share forfeitures	(3)		(3)
Ending balance (in shares) at Jun. 30, 2023		239,792,354
Ending balance at Jun. 30, 2023	2,509,389	$ 2,398	4,617,831	1,946,621	0	(4,057,461)
Increase (Decrease) in Stockholders' Equity
Net loss	(65,779)			(65,779)
Equity in unrealized losses (gains) of an investee	0
Distributions	(2,398)					(2,398)
Share grants (in shares)		820,000
Share grants	670	$ 8	662
Share repurchases (in shares)		(151,405)
Share repurchases	(353)	$ (1)	(352)
Share forfeitures (in shares)		(3,400)
Share forfeitures	(3)		(3)
Ending balance (in shares) at Sep. 30, 2023		240,457,549
Ending balance at Sep. 30, 2023	$ 2,441,526	$ 2,405	4,618,138	1,880,842	0	(4,059,859)
Beginning balance (in shares) at Dec. 31, 2023	240,423,898	240,423,898
Beginning balance at Dec. 31, 2023	$ 2,336,891	$ 2,405	4,618,470	1,778,278	0	(4,062,262)
Increase (Decrease) in Stockholders' Equity
Net loss	(86,259)			(86,259)
Equity in unrealized losses (gains) of an investee	(4)				(4)
Distributions	(2,404)					(2,404)
Share grants	558		558
Share repurchases (in shares)		(30,176)
Share repurchases	(79)	$ (1)	(78)
Ending balance (in shares) at Mar. 31, 2024		240,393,722
Ending balance at Mar. 31, 2024	$ 2,248,703	$ 2,404	4,618,950	1,692,019	(4)	(4,064,666)
Beginning balance (in shares) at Dec. 31, 2023	240,423,898	240,423,898
Beginning balance at Dec. 31, 2023	$ 2,336,891	$ 2,405	4,618,470	1,778,278	0	(4,062,262)
Increase (Decrease) in Stockholders' Equity
Net loss	(282,809)
Equity in unrealized losses (gains) of an investee	8
Distributions	$ (7,214)
Ending balance (in shares) at Sep. 30, 2024	241,281,373	241,281,373
Ending balance at Sep. 30, 2024	$ 2,048,404	$ 2,413	4,619,990	1,495,469	8	(4,069,476)
Beginning balance (in shares) at Mar. 31, 2024		240,393,722
Beginning balance at Mar. 31, 2024	2,248,703	$ 2,404	4,618,950	1,692,019	(4)	(4,064,666)
Increase (Decrease) in Stockholders' Equity
Net loss	(97,861)			(97,861)
Equity in unrealized losses (gains) of an investee	(22)				(22)
Distributions	(2,404)					(2,404)
Share grants (in shares)		259,259
Share grants	940	$ 3	937
Share repurchases (in shares)		(17,511)
Share repurchases	(42)	$ (1)	(41)
Share forfeitures (in shares)		(16,000)
Ending balance (in shares) at Jun. 30, 2024		240,619,470
Ending balance at Jun. 30, 2024	2,149,314	$ 2,406	4,619,846	1,594,158	(26)	(4,067,070)
Increase (Decrease) in Stockholders' Equity
Net loss	(98,689)			(98,689)
Equity in unrealized losses (gains) of an investee	34				34
Distributions	(2,406)					(2,406)
Share grants (in shares)		881,767
Share grants	932	$ 9	923
Share repurchases (in shares)		(219,864)
Share repurchases	$ (781)	$ (2)	(779)
Ending balance (in shares) at Sep. 30, 2024	241,281,373	241,281,373
Ending balance at Sep. 30, 2024	$ 2,048,404	$ 2,413	$ 4,619,990	$ 1,495,469	$ 8	$ (4,069,476)

CONDENSED CONSOLIDATED STATEM_4

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
Cash flows from operating activities:
Net loss	$ (282,809)	$ (191,008)
Adjustments to reconcile net loss to cash provided by operating activities:
Depreciation and amortization	207,449	200,430
Net amortization of debt discounts, premiums and issuance costs	76,642	6,616
Straight line rental income	(1,605)	1,333
Amortization of acquired real estate leases and other intangible assets, net	84	(264)
Loss on modification or early extinguishment of debt	209	1,075
Impairment of assets	41,718	18,380
Loss (gain) on sale of properties	18,976	(1,233)
Gains on equity securities, net	0	(8,126)
Other non-cash adjustments, net	(405)	(1,328)
Unconsolidated joint venture distributions	1,231	3,870
Equity in net losses (earnings) of investees	9,882	(2,137)
Change in assets and liabilities:
Deferred leasing costs, net	(2,199)	(7,995)
Other assets	2,828	4,315
Accrued interest	(258)	2,628
Other liabilities	22,285	(8,864)
Net cash provided by operating activities	94,028	17,692
Cash flows from investing activities:
Real estate improvements	(134,966)	(168,400)
Proceeds from sale of properties, net	27,845	3,548
Investment in AlerisLife Inc.	(15,459)	0
Proceeds from insurance recoveries	1,698	0
Proceeds from AlerisLife Inc. tender offer	0	14,006
Net cash used in investing activities	(120,882)	(150,846)
Cash flows from financing activities:
Proceeds from mortgage notes payable	120,000	0
Repayments of borrowings on credit facility	0	(250,000)
Redemption of senior unsecured notes	(60,000)	0
Repayment of other debt	(2,388)	(16,408)
Payment of debt issuance costs	(8,203)	(2,057)
Repurchase of common shares	(902)	(386)
Distributions to shareholders	(7,214)	(7,192)
Net cash provided by (used in) financing activities	41,293	(276,043)
Increase (decrease) in cash and cash equivalents and restricted cash	14,439	(409,197)
Cash and cash equivalents and restricted cash at beginning of period	246,961	688,302
Cash and cash equivalents and restricted cash at end of period	$ 261,400	$ 279,105

CONDENSED CONSOLIDATED STATEM_5

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - Supplemental (Parenthetical) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
Supplemental cash flow information:
Interest paid	$ 99,337	$ 133,695
Income taxes paid	484	677
Non-cash investing activities:
Real estate improvements accrued, not paid	$ 18,603	$ 29,560

CONDENSED CONSOLIDATED STATEM_6

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - Cash and Restricted Cash (Parenthetical) - USD ($) $ in Thousands	Sep. 30, 2024		Dec. 31, 2023	Sep. 30, 2023		Dec. 31, 2022
Statement of Cash Flows [Abstract]
Cash and cash equivalents	$ 256,527		$ 245,939	$ 278,122
Restricted cash	4,873	[1]	1,022	983	[1]
Total cash and cash equivalents and restricted cash shown in our condensed consolidated statements of cash flows	$ 261,400		$ 246,961	$ 279,105		$ 688,302
[1]Restricted cash consists of amounts escrowed for real estate taxes, insurance and capital expenditures at certain of our mortgaged properties.

Basis of Presentation

Basis of Presentation	9 Months Ended
	Sep. 30, 2024
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Presentation	Basis of Presentation The accompanying condensed consolidated financial statements of Diversified Healthcare Trust 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 condensed consolidated financial statements should be read in conjunction with the consolidated financial statements and notes contained in our Annual Report on Form 10-K for the year ended December 31, 2023, or our Annual Report. In the opinion of management, all adjustments (consisting of normal recurring accruals) considered necessary for a fair statement of results for the interim period have been included. All intercompany transactions and balances with or among our consolidated subsidiaries have been eliminated. Operating results for interim periods are not necessarily indicative of the results that may be expected for the full year. The preparation of these financial statements in conformity with GAAP requires us to make estimates and assumptions that affect reported amounts. Actual results could differ from those estimates. Significant estimates in our condensed consolidated financial statements include purchase price allocations, useful lives of fixed assets and impairments of real estate and intangible assets. We have been, are currently, and expect in the future to be involved in claims, lawsuits, and regulatory and other governmental audits, investigations and proceedings arising in the ordinary course of our business. While the outcome of any litigation is inherently uncertain, we do not believe any currently pending litigation or proceedings will have a material adverse effect on our financial condition, results of operations or cash flows.

Recent Accounting Pronouncement

Recent Accounting Pronouncements	9 Months Ended
	Sep. 30, 2024
Accounting Policies [Abstract]
Recent Accounting Pronouncements	Recent Accounting Pronouncements On November 27, 2023, the Financial Accounting Standards Board, or FASB, issued Accounting Standards Update, or ASU, No. 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures , or ASU No. 2023-07, which requires public entities to: (i) provide disclosures of significant segment expenses and other segment items if they are regularly provided to the Chief Operating Decision Maker, or the CODM, and included in each reported measure of segment profit or loss; (ii) provide all annual disclosures about a reportable segment’s profit or loss and assets currently required by Accounting Standards Codification Topic 280, Segment Reporting , or ASC 280, in interim periods; and (iii) disclose the CODM’s title and position, as well as an explanation of how the CODM uses the reported measures and other disclosures. Public entities with a single reportable segment must apply all the disclosure requirements of ASU No. 2023-07, as well as all the existing segment disclosures under ASC 280. The amendments in ASU No. 2023-07 are incremental to the requirements in ASC 280 and do not change how a public entity identifies its operating segments, aggregates those operating segments, or applies the quantitative thresholds to determine its reportable segments. ASU No. 2023-07 should be applied retrospectively to all prior periods presented in the financial statements and is effective for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024. Early adoption is permitted. We expect to include additional disclosures as a result of the implementation of ASU No. 2023-07; however, these changes are not expected to have a material effect on our condensed consolidated financial statements. On December 14, 2023, the FASB issued ASU No. 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures , or ASU No. 2023-09, which requires public entities to enhance their annual income tax disclosures by requiring: (i) consistent categories and greater disaggregation of information in the rate reconciliation, and (ii) income taxes paid disaggregated by jurisdiction. ASU No. 2023-09 should be applied prospectively but entities have the option to apply it retrospectively to all prior periods presented in the financial statements. ASU No. 2023-09 is effective for annual periods beginning after December 15, 2024, with early adoption permitted. We expect to include additional disclosures in the notes to our condensed consolidated financial statements as a result of the implementation of ASU No. 2023-09; however, these changes are not expected to have a material effect on our condensed consolidated financial statements.

Real Estate and Other Investmen

Real Estate and Other Investments	9 Months Ended
	Sep. 30, 2024
Real Estate [Abstract]
Real Estate and Other Investments	Real Estate and Other Investments As of September 30, 2024, we owned 368 properties located in 36 states and Washington, D.C., including 25 properties classified as held for sale and three closed senior living communities, and we owned an equity interest in each of two unconsolidated joint ventures that own medical office and life science properties located in five states. Acquisitions and Dispositions: We did not acquire any properties during the nine months ended September 30, 2024. During the nine months ended September 30, 2024, we sold four properties for an aggregate sales price of $29,075, excluding closing costs, as presented in the table below. The sales of these properties do not represent a significant disposition and we do not believe these sales represent a strategic shift in our business. As a result, the results of operations for these properties are included in continuing operations through the date of sale of such properties in our condensed consolidated statements of comprehensive income (loss). Date of Sale Location Type of Property Number of Properties Sales Price (1) (Loss) Gain on Sale March 2024 Arizona Medical Office 1 $ 3,600 $ (5,874) June 2024 Texas Medical Office 1 4,200 (13,213) July 2024 Illinois and Minnesota Medical Office 2 21,275 111 4 $ 29,075 $ (18,976) (1) Sales price excludes closing costs. As of September 30, 2024, we had 25 properties classified as held for sale in our condensed consolidated balance sheet as follows: Segment Number of Properties Real Estate Properties, Net Medical Office and Life Science 4 $ 33,213 SHOP 3 8,780 Non-Segment (1) 18 35,660 25 $ 77,653 (1) Represents 18 triple net leased senior living communities. Subsequent to September 30, 2024, we sold one of these properties for a sales price of $6,600, excluding closing costs. As of November 4, 2024, we had 28 properties under agreements or letters of intent to sell for an aggregate sales price of $348,080, excluding closing costs. If these sales are completed, approximately $302,100 of the proceeds are required to be used to partially redeem our outstanding senior secured notes due 2026. We may not complete the sales of any or all of the properties we currently plan to sell. Also, we may sell some or all of these properties at amounts that are less than currently expected and/or less than the carrying values of such properties and we may incur losses on any such sales as a result. Impairment: We regularly evaluate our assets for indicators of impairment. Impairment indicators may include declining tenant or resident occupancy, weak or declining profitability from the property, decreasing tenant cash flows or liquidity, our decision to dispose of an asset before the end of its estimated useful life, and legislative, market or industry changes that could permanently reduce the value of an asset. If indicators of impairment are present, we evaluate the carrying value of the affected assets by comparing it to the expected future undiscounted cash flows to be generated from those assets. The future cash flows are subjective and are based in part on assumptions regarding hold periods, market rents and terminal capitalization rates. If the sum of these expected future cash flows is less than the carrying value, we reduce the net carrying value of the asset to its estimated fair value. During the nine months ended September 30, 2024, we recorded impairment charges of $27,173 related to one medical office property and one life science property that were classified as held for sale as of September 30, 2024. We also recorded impairment charges of $14,545 related to two medical office properties that were sold in 2024. Equity Method Investments in Unconsolidated Joint Ventures: As of September 30, 2024, we had equity investments in unconsolidated joint ventures as follows: Joint Venture DHC Ownership DHC Carrying Value of Investment at September 30, 2024 Number of Properties Location Square Feet Seaport Innovation LLC 10% $ 65,590 1 MA 1,134,479 The LSMD Fund REIT LLC 20% 44,923 10 CA, MA, NY, TX, WA 1,068,763 $ 110,513 11 2,203,242 The following table provides a summary of the mortgage debts of these joint ventures: Joint Venture Coupon Rate Maturity Date Principal Balance at September 30, 2024 (1) Mortgage Notes Payable (secured by one property in Massachusetts) (2) (3) 3.53% 11/6/2028 $ 620,000 Mortgage Notes Payable (secured by nine properties in five states) (4) 3.46% 2/11/2032 189,800 Mortgage Notes Payable (secured by one property in California) (4) (5) 6.38% 2/9/2025 266,825 4.22% $ 1,076,625 (1) Amounts are not adjusted for our minority equity interest. (2) We provide certain guaranties on this debt. (3) This mortgage loan requires interest only payments until the anticipated repayment date on August 6, 2026, at which time all accrued and unpaid interest along with the principal balance of $620,000 is expected to be repaid. This mortgage loan matures on November 6, 2028 and any unpaid principal from the anticipated repayment date through the maturity date bears interest at a variable rate of the greater of 6.53% or the then effective U.S. swap rate terminating on the maturity date plus 5.00%. (4) The debt securing these properties is non-recourse to us. (5) This mortgage loan matures on February 9, 2025 and requires interest to be paid at an annual rate of the one month term secured overnight financing rate, or SOFR, plus a premium of 1.90%. This joint venture has also purchased an interest rate cap through February 2025 with a SOFR strike rate equal to 4.48% and an initial premium of $1,200. The maturity date of this mortgage loan is subject to two remaining one-year extension options. We account for the unconsolidated joint venture for 10 medical office and life science properties in which we own a 20% equity interest, or the LSMD JV, and the unconsolidated joint venture for a life science property located in Boston, Massachusetts in which we own a 10% equity interest, or the Seaport JV, using the equity method of accounting under the fair value option. We recognized changes in the fair value of our investments in our unconsolidated joint ventures of $1,707 and $(145) during the three months ended September 30, 2024 and 2023, respectively, and $(18,173) and $2,137 during the nine months ended September 30, 2024 and 2023, respectively. These amounts are included in equity in net earnings (losses) of investees in our condensed consolidated statements of comprehensive income (loss). See Note 6 for further information regarding the valuation of our investment in these joint ventures. Equity Method Investment in AlerisLife: As of September 30, 2024, we owned approximately 34.0% of the outstanding common shares of AlerisLife Inc., or AlerisLife. We account for our 34.0% non-controlling interest in AlerisLife using the equity method of accounting. As of September 30, 2024, our investment in AlerisLife had a carrying value of $23,758. The cost basis of our investment in AlerisLife exceeded our proportionate share of AlerisLife's total stockholders' equity book value on the date of acquisition of our initial interest in AlerisLife, which was February 16, 2024, by an aggregate of $29,500. As required under GAAP, we are amortizing this difference to equity in earnings of an investee over 21 years, the weighted average remaining useful life of the real estate assets owned by AlerisLife and the intangible contract asset with us as of the date of acquisition. We recorded amortization of the basis difference of $351 and $877 for the three and nine months ended September 30, 2024, respectively. We recognized income of $(1,531) and $7,414 related to our investment in AlerisLife for the three and nine months ended September 30, 2024, respectively. These amounts are included in equity in net earnings (losses) of investees in our condensed consolidated statements of comprehensive income (loss). See Note 11 for further information regarding our investment in AlerisLife.

Leases

Leases	9 Months Ended
	Sep. 30, 2024
Leases [Abstract]
Leases	Leases We are a lessor of medical office and life science properties, senior living communities and other healthcare related properties. Our leases provide our tenants with the contractual right to use and economically benefit from all of the premises demised under the leases; therefore, we have determined to evaluate our leases as lease arrangements. Our leases provide for base rent payments and, in addition, may include variable payments. Rental income from operating leases, including any payments derived by index or market based indices, is recognized on a straight line basis over the lease term when we have determined that the collectability of substantially all of the lease payments is probable. Some of our leases have options to extend or terminate the lease exercisable at the option of our tenants, which are considered when determining the lease term. We increased rental income to record revenue on a straight line basis by $658 and $676 for the three months ended September 30, 2024 and 2023, respectively, and $1,605 for the nine months ended September 30, 2024. We decreased rental income to record revenue on a straight line basis by $1,333 for the nine months ended September 30, 2023. Rents receivable, excluding receivables related to our properties classified as held for sale, if any, include $74,088 and $75,306 of straight line rent receivables at September 30, 2024 and December 31, 2023, respectively, and are included in other assets, net in our condensed consolidated balance sheets. We do not include in our measurement of our lease receivables certain variable payments, including changes in the index or market based indices after the inception of the lease, certain tenant reimbursements and other income until the specific events that trigger the variable payments have occurred. Such payments totaled $11,126 and $12,018 for the three months ended September 30, 2024 and 2023, respectively, of which tenant reimbursements totaled $11,083 and $11,965, respectively, and $34,111 and $36,579 for the nine months ended September 30, 2024 and 2023, respectively, of which tenant reimbursements totaled $33,953 and $36,414, respectively. Right of Use Asset and Lease Liability: For leases where we are the lessee, we recognize a right of use asset and a lease liability equal to the present value of the minimum lease payments with rental payments being applied to the lease liability and the right of use asset being amortized over the term of the lease. The values of the right of use assets and related liabilities representing our future obligation under the respective lease arrangements for which we are the lessee were $20,868 and $21,254, respectively, as of September 30, 2024, and $23,366 and $23,748, respectively, as of December 31, 2023. The right of use assets and related lease liabilities are included within other assets, net other liabilities

Indebtedness

Indebtedness	9 Months Ended
	Sep. 30, 2024
Debt Disclosure [Abstract]
Indebtedness	Indebtedness Our principal debt obligations, excluding any debt obligations of our joint ventures, at September 30, 2024 were: (1) $2,040,000 outstanding principal amount of senior unsecured notes; (2) $940,534 outstanding principal amount of senior secured notes with an aggregate net book value of $1,070,598; and (3) $127,889 principal amount of mortgage debt secured by nine properties. The mortgaged properties had an aggregate net book value of $205,750 at September 30, 2024. We also had two properties subject to finance leases that expire in 2026 with lease obligations totaling $2,743 at September 30, 2024; these two properties had an aggregate net book value of $21,815 at September 30, 2024. Until its repayment in full and termination on December 21, 2023, we had a $450,000 credit facility that was fully drawn. The weighted average annual interest rate for borrowings under our former credit facility was 8.3% and 7.8% for the three and nine months ended September 30, 2023, respectively. In January 2023, we repaid $113,627 in outstanding borrowings under our former credit facility and the commitments were reduced to $586,373. In February 2023, we reduced the commitments from $586,373 to $450,000 following our repayment of $136,373 in outstanding borrowings under our former credit facility. As a result of the February 2023 reduction in commitments, we recorded a loss on modification or early extinguishment of debt of $1,075 for the nine months ended September 30, 2023. In May 2024, we executed a $120,000 fixed rate, interest only mortgage loan secured by eight medical office and life science properties. This mortgage loan matures in June 2034 and requires that interest be paid at an annual rate of 6.864%. In June 2024, we redeemed $60,000 of our outstanding 9.75% senior unsecured notes due 2025 using proceeds from the $120,000 mortgage loan executed in May 2024. As a result of this redemption, we recorded a loss on early extinguishment of debt of $209 for the nine months ended September 30, 2024. As of September 30, 2024, all $940,534 of our senior secured notes due 2026 are fully and unconditionally guaranteed, on a joint, several and senior secured basis, by certain of our subsidiaries that own 95 properties, or the Collateral Guarantors, and on a joint, several and unsecured basis, by all our subsidiaries other than the Collateral Guarantors and certain excluded subsidiaries, and all $440,000 of our 9.75% senior notes due 2025 and all $500,000 of our 4.375% senior notes due 2031 were fully and unconditionally guaranteed, on a joint, several and unsecured basis, by all of our subsidiaries except certain excluded subsidiaries. The notes and related guarantees (other than our senior secured notes and the guarantees provided by the Collateral Guarantors) are effectively subordinated to all of our and the subsidiary guarantors' secured indebtedness, respectively, to the extent of the value of the applicable collateral, and the notes and related guarantees are structurally subordinated to all indebtedness and other liabilities and any preferred equity of any of our subsidiaries that do not guarantee the notes. Our remaining $1,100,000 of senior unsecured notes do not have the benefit of any guarantees as of September 30, 2024. We are currently under agreements or letters of intent to sell 22 of the properties securing our senior secured notes due 2026 for an aggregate sales price of $302,100, excluding closing costs. If these sales are completed, the proceeds are required to be used to partially redeem our outstanding senior secured notes due 2026. Our senior secured notes due 2026 and the guarantees provided by the Collateral Guarantors are secured by a first priority lien and security interest in each of the collateral properties and 100% of the equity interests in each of the Collateral Guarantors. No cash interest will accrue on these notes prior to maturity. The accreted value of these notes will increase at a rate of 11.25% per annum compounded semiannually on January 15 and July 15 of each year, such that the accreted value will equal the principal amount at maturity. During the three and nine months ended September 30, 2024, we recognized discount accretion of $22,034 and $64,133, respectively, for our senior secured notes due 2026 in interest expense in our condensed consolidated statements of comprehensive income (loss). We have a one-time option to extend the maturity date of these notes by one year, to January 15, 2027, subject to satisfaction of certain conditions and payment of an extension fee. If we exercise this option, interest payments will be due semiannually during the extension period at an initial interest rate of 11.25% with increases of 50 basis points every 90 days these notes remain outstanding. Based on the significant number of unencumbered properties in our senior housing operating portfolio, or SHOP, segment and our demonstrated ability to execute debt financings, we believe we will likely be able to obtain additional debt financing that will allow us to satisfy the $440,000 outstanding principal amount of our 9.75% senior unsecured notes due June 2025.

Fair Value of Assets and Liabil

Fair Value of Assets and Liabilities	9 Months Ended
	Sep. 30, 2024
Fair Value Disclosures [Abstract]
Fair Value of Assets and Liabilities	Fair Value of Assets and Liabilities The following table presents certain of our assets that are measured at fair value at September 30, 2024 and December 31, 2023, categorized by the level of inputs as defined in the fair value hierarchy under GAAP, used in the valuation of each asset. As of September 30, 2024 As of December 31, 2023 Description Carrying Value Carrying Value Recurring Fair Value Measurements Assets: Investment in unconsolidated joint venture (Level 3) (1) $ 65,590 $ 85,699 Investment in unconsolidated joint venture (Level 3) (2) $ 44,923 $ 44,217 Non-Recurring Fair Value Measurements Assets: Real estate properties held for sale (Level 2) (3) $ 6,286 $ — (1) The 10% equity interest we own in the Seaport JV is included in investments in unconsolidated joint ventures in our condensed consolidated balance sheet, and is reported at fair value, which is based on significant unobservable inputs (Level 3 inputs). The significant unobservable inputs used in the fair value analysis are a discount rate of 7.50%, an exit capitalization rate of 6.00%, a holding period of 10 years and market rents. The assumptions made in the fair value analysis are based on the location, type and nature of the property, and current and anticipated market conditions. See Note 3 for further information regarding this joint venture. (2) The 20% equity interest we own in the LSMD JV is included in investments in unconsolidated joint ventures in our condensed consolidated balance sheet, and is reported at fair value, which is based on significant unobservable inputs (Level 3 inputs). The significant unobservable inputs used in the fair value analysis are discount rates of between 6.50% and 8.00%, exit capitalization rates of between 5.25% and 7.00%, holding periods of 10 to 13 years, direct capitalization rates of 5.00% and market rents. The assumptions we made in the fair value analysis are based on the location, type and nature of each property, and current and anticipated market conditions. See Note 3 for further information regarding this joint venture. (3) We have assets in our condensed consolidated balance sheets that are measured at fair value on a non-recurring basis. During the three months ended September 30, 2024, we recorded impairment charges of $23,031 to reduce the carrying value of one life science property that is classified as held for sale to its estimated sales price, less estimated costs to sell, of $6,286 under an agreement to sell that we have entered into with a third party. See Note 3 for further information about impairment charges and the properties we have classified as held for sale. In addition to the assets described in the table above, our financial instruments at September 30, 2024 and December 31, 2023 included cash and cash equivalents, restricted cash, certain other assets, senior unsecured notes, senior secured notes, secured debt and finance leases and certain other unsecured obligations and liabilities. The fair values of these financial instruments approximated their carrying values in our condensed consolidated financial statements as of such dates, except as follows: As of September 30, 2024 As of December 31, 2023 Description Carrying Amount (1) Estimated Fair Value Carrying Amount (1) Estimated Fair Value Senior unsecured notes, 9.750% coupon rate, due 2025 $ 438,913 $ 440,541 $ 497,454 $ 490,750 Senior secured notes, zero coupon rate, due 2026 801,315 865,837 731,211 771,981 Senior unsecured notes, 4.750% coupon rate, due 2028 495,700 452,500 494,746 384,110 Senior unsecured notes, 4.375% coupon rate, due 2031 494,487 411,635 493,845 375,000 Senior unsecured notes, 5.625% coupon rate, due 2042 343,207 233,940 342,946 211,400 Senior unsecured notes, 6.250% coupon rate, due 2046 243,833 176,000 243,627 154,000 Secured debt and finance leases (2) 127,836 133,423 13,020 12,284 $ 2,945,291 $ 2,713,876 $ 2,816,849 $ 2,399,525 (1) Includes unamortized net discounts, premiums and debt issuance costs, if any. (2) We assumed certain of these secured debts in connection with our acquisition of certain properties. We recorded the assumed mortgage notes at estimated fair value on the date of acquisition and we are amortizing the fair value adjustments, if any, to interest expense over the respective terms of the mortgage notes to adjust interest expense to the estimated market interest rates as of the date of acquisition. We estimated the fair values of our two issuances of senior unsecured notes due 2042 and 2046 based on the closing price on The Nasdaq Stock Market LLC, or Nasdaq, as of September 30, 2024 and December 31, 2023 (Level 1 inputs as defined in the fair value hierarchy under GAAP). We estimated the fair values of our three issuances of senior unsecured notes due 2025, 2028 and 2031 and our issuance of senior secured notes due 2026 using an average of the bid and ask price on Nasdaq on or about September 30, 2024 and December 31, 2023 (Level 2 inputs as defined in the fair value hierarchy under GAAP). We estimated the fair values of our secured debts by using discounted cash flows analyses and currently prevailing market terms as of the measurement date (Level 3 inputs as defined in the fair value hierarchy under GAAP). Because Level 3 inputs are unobservable, our estimated fair values may differ materially from the actual fair values.

Shareholders' Equity

Shareholders' Equity	9 Months Ended
	Sep. 30, 2024
Stockholders' Equity Note [Abstract]
Shareholders' Equity	Shareholders' Equity Common Share Awards: On May 31, 2024, in accordance with our Trustee compensation arrangements, we awarded to each of our seven Trustees 37,037 of our common shares, valued at $2.43 per share, the closing price of our common shares on Nasdaq on that day . On September 11, 2024, we awarded under our equity compensation plan an aggregate of 881,767 of our common shares, valued at $3.35 per share, the closing price of our common shares on Nasdaq on that day, to our officers and certain other employees of The RMR Group LLC, or RMR, and certain employees of AlerisLife. Common Share Purchases: During the three and nine months ended September 30, 2024, we purchased an aggregate of 219,864 and 267,551 of our common shares, respectively, valued at a weighted average share price of $3.52 and $3.34, respectively, from our officers and certain other current and former officers and employees of RMR and certain employees of AlerisLife, in satisfaction of tax withholding and payment obligations in connection with the vesting of awards of our common shares. We withheld and purchased these common shares at their fair market values based upon the trading prices of our common shares at the close of trading on Nasdaq on the applicable purchase dates. Distributions: During the nine months ended September 30, 2024, we declared and paid quarterly distributions to common shareholders as follows: Declaration Date Record Date Payment Date Distribution Per Share Total Distributions January 11, 2024 January 22, 2024 February 15, 2024 $ 0.01 $ 2,404 April 11, 2024 April 22, 2024 May 16, 2024 0.01 2,404 July 11, 2024 July 22, 2024 August 15, 2024 0.01 2,406 $ 0.03 $ 7,214 On October 16, 2024, we declared a quarterly distribution to common shareholders of record on October 28, 2024 of $0.01 per share, or approximately $2,413. We expect to pay this distribution on or about November 14, 2024 using cash on hand.

Segment Reporting

Segment Reporting	9 Months Ended
	Sep. 30, 2024
Segment Reporting [Abstract]
Segment Reporting	Segment Reporting We operate in, and report financial information for, the following two segments: Medical Office and Life Science Portfolio and SHOP. We aggregate the operating results of our properties in these two reporting segments based on their similar operating and economic characteristics. Our Medical Office and Life Science Portfolio segment primarily consists of medical office properties leased to medical providers and other medical related businesses, as well as life science properties primarily leased to biotech laboratories and other similar tenants. Our SHOP segment consists of managed senior living communities that provide short term and long term residential living and, in some instances, care and other services for residents where we pay fees to managers to operate the communities on our behalf. We also report “non-segment” operations, which consists of triple net leased senior living communities and wellness centers that are leased to third party operators from which we receive rents, which we do not consider to be sufficiently material to constitute a separate reporting segment, and any other income or expenses that are not attributable to a specific reporting segment. For the Three Months Ended September 30, 2024 Medical Office and Life Science Portfolio SHOP Non-Segment Consolidated Revenues: Rental income $ 52,901 $ — $ 8,734 $ 61,635 Residents fees and services — 312,005 — 312,005 Total revenues 52,901 312,005 8,734 373,640 Expenses: Property operating expenses 25,074 284,572 51 309,697 Depreciation and amortization 18,773 47,343 2,843 68,959 General and administrative — — 13,933 13,933 Acquisition and certain other transaction related costs — — 331 331 Impairment of assets 23,031 — — 23,031 Total expenses 66,878 331,915 17,158 415,951 Gain on sale of properties 111 — — 111 Interest and other income — — 2,575 2,575 Interest expense (2,319) (54) (57,070) (59,443) Loss before income tax expense and equity in net earnings (losses) of investees (16,185) (19,964) (62,919) (99,068) Income tax expense — — (148) (148) Equity in net earnings (losses) of investees 1,707 — (1,180) 527 Net loss $ (14,478) $ (19,964) $ (64,247) $ (98,689) For the Nine Months Ended September 30, 2024 Medical Office and Life Science Portfolio SHOP Non-Segment Consolidated Revenues: Rental income $ 161,605 $ — $ 25,550 $ 187,155 Residents fees and services — 928,653 — 928,653 Total revenues 161,605 928,653 25,550 1,115,808 Expenses: Property operating expenses 73,253 847,526 587 921,366 Depreciation and amortization 58,488 141,176 7,785 207,449 General and administrative — — 27,763 27,763 Acquisition and certain other transaction related costs — — 2,243 2,243 Impairment of assets 41,718 — — 41,718 Total expenses 173,459 988,702 38,378 1,200,539 Loss on sale of properties (18,976) — — (18,976) Interest and other income — — 7,215 7,215 Interest expense (3,435) (183) (172,103) (175,721) Loss on modification or early extinguishment of debt — — (209) (209) Loss before income tax expense and equity in net (losses) earnings of investees (34,265) (60,232) (177,925) (272,422) Income tax expense — — (505) (505) Equity in net (losses) earnings of investees (18,173) — 8,291 (9,882) Net loss $ (52,438) $ (60,232) $ (170,139) $ (282,809) As of September 30, 2024 Medical Office and Life Science Portfolio SHOP Non-Segment Consolidated Total assets $ 1,726,082 $ 3,111,775 $ 447,339 $ 5,285,196 For the Three Months Ended September 30, 2023 Medical Office and Life Science Portfolio SHOP Non-Segment Consolidated Revenues: Rental income $ 55,058 $ — $ 8,332 $ 63,390 Residents fees and services — 293,134 — 293,134 Total revenues 55,058 293,134 8,332 356,524 Expenses: Property operating expenses 25,784 272,445 203 298,432 Depreciation and amortization 20,175 44,587 2,474 67,236 General and administrative — — 6,954 6,954 Acquisition and certain other transaction related costs — — 3,676 3,676 Impairment of assets 427 729 — 1,156 Total expenses 46,386 317,761 13,307 377,454 Interest and other income — 115 3,128 3,243 Interest expense (119) (79) (47,560) (47,758) Income (loss) before income tax expense and equity in net losses of investees 8,553 (24,591) (49,407) (65,445) Income tax expense — — (189) (189) Equity in net losses of investees (145) — — (145) Net income (loss) $ 8,408 $ (24,591) $ (49,596) $ (65,779) For the Nine Months Ended September 30, 2023 Medical Office and Life Science Portfolio SHOP Non-Segment Consolidated Revenues: Rental income $ 165,448 $ — $ 25,753 $ 191,201 Residents fees and services — 857,572 — 857,572 Total revenues 165,448 857,572 25,753 1,048,773 Expenses: Property operating expenses 73,237 796,733 770 870,740 Depreciation and amortization 63,065 129,891 7,474 200,430 General and administrative — — 20,111 20,111 Acquisition and certain other transaction related costs — — 9,812 9,812 Impairment of assets 14,034 4,346 — 18,380 Total expenses 150,336 930,970 38,167 1,119,473 Gain on sale of properties — 1,233 — 1,233 Gains on equity securities, net — — 8,126 8,126 Interest and other income — 1,581 10,991 12,572 Interest expense (344) (502) (142,076) (142,922) Loss on modification or early extinguishment of debt — — (1,075) (1,075) Income (loss) before income tax expense and equity in net earnings of investees 14,768 (71,086) (136,448) (192,766) Income tax expense — — (379) (379) Equity in net earnings of investees 2,137 — — 2,137 Net income (loss) $ 16,905 $ (71,086) $ (136,827) $ (191,008) As of December 31, 2023 Medical Office and Life Science Portfolio SHOP Non-Segment Consolidated Total assets $ 1,866,422 $ 3,134,978 $ 444,736 $ 5,446,136

Senior Living Community Managem

Senior Living Community Management Agreements	9 Months Ended
	Sep. 30, 2024
Risks and Uncertainties [Abstract]
Senior Living Community Management Agreements	Senior Living Community Management Agreements Our managed senior living communities are operated by third parties pursuant to management agreements. Five Star Senior Living, or Five Star, which is an operating division of AlerisLife, manages many of our SHOP communities. Five Star manages these communities for us pursuant to a master management agreement. AlerisLife guarantees the payment and performance of each of its applicable subsidiary's obligations under the applicable management agreements. In connection with ABP Trust’s acquisition of AlerisLife on March 20, 2023, we amended the master management agreement with AlerisLife to eliminate any change of control default or event of default provisions. See Note 11 for further information regarding ABP Trust's acquisition of AlerisLife. Our Senior Living Communities Managed by Five Star. Five Star managed 119 of our senior living communities as of both September 30, 2024 and 2023. We lease our senior living communities that are managed by Five Star to our taxable REIT subsidiaries, or TRSs. We incurred management fees payable to Five Star of $10,611 and $10,058 for the three months ended September 30, 2024 and 2023, respectively, and $31,462 and $29,962 for the nine months ended September 30, 2024 and 2023, respectively. For the three months ended September 30, 2024 and 2023, $10,060 and $9,457, respectively, of the total management fees were expensed to property operating expenses in our condensed consolidated statements of comprehensive income (loss) and $551 and $601, respectively, were capitalized in our condensed consolidated balance sheets. For the nine months ended September 30, 2024 and 2023, $30,053 and $27,909, respectively, of the total management fees were expensed to property operating expenses in our condensed consolidated statements of comprehensive income (loss) and $1,409 and $2,053, respectively, were capitalized in our condensed consolidated balance sheets. The amounts capitalized are being depreciated over the estimated useful lives of the related capital assets. We incurred fees of $0 and $1,213 for the nine months ended September 30, 2024 and 2023, respectively, with respect to rehabilitation services Five Star provided at our senior living communities that are payable by us. These amounts are included in property operating expenses in our condensed consolidated statements of comprehensive income (loss). We lease space to Five Star at certain of our senior living communities, which, prior to June 17, 2024, Five Star used to provide certain outpatient rehabilitation and wellness services through the Ageility branded business. Beginning on June 17, 2024, Five Star subleases this space to a subsidiary of Fox Rehabilitation, which acquired the Ageility branded business from AlerisLife on that date. Our Senior Living Communities Managed by Other Third Party Managers. Several other third party managers managed 111 of our senior living communities as of both September 30, 2024 and 2023. We lease our senior living communities that are managed by these third party managers to our TRSs. In March 2024, we terminated our management agreement with one of our third party managers which manages certain of our communities located in Wisconsin and Illinois and transitioned these communities to another third party manager with which we have an existing relationship. The terms of the management agreement for these communities are generally consistent with the terms of the existing management agreements with our other third party managers. We paid transition costs, including termination and other fees, of $2,042 related to the transition of these communities during the nine months ended September 30, 2024. We incurred management fees payable to these third party managers of $5,858 and $5,635 for the three months ended September 30, 2024 and 2023, respectively, and $17,341 and $16,230 for the nine months ended September 30, 2024 and 2023, respectively. These amounts are included in property operating expenses in our condensed consolidated statements of comprehensive income (loss). The following table presents residents fees and services revenue from all of our managed senior living communities disaggregated by the type of contract and payer: Three Months Ended September 30, Nine Months Ended September 30, Revenue from contracts with customers: 2024 2023 2024 2023 Basic housing and support services $ 242,787 $ 232,805 $ 727,558 $ 681,598 Medicare and Medicaid programs 25,619 22,568 73,951 65,965 Private pay and other third party payer SNF services 43,599 37,761 127,144 110,009 Total residents fees and services $ 312,005 $ 293,134 $ 928,653 $ 857,572

Business and Property Managemen

Business and Property Management Agreements with RMR	9 Months Ended
	Sep. 30, 2024
Related Party Transactions [Abstract]
Business and Property Management Agreements with RMR	Business and Property Management Agreements with RMR We have no employees. The personnel and various services we require to operate our business are provided to us by RMR. We have two agreements with RMR to provide management services to us: (1) a business management agreement, which relates to our business generally; and (2) a property management agreement, which relates to the property level operations of many of our properties, including our medical office and life science properties, and major renovation or repositioning activities at our senior living communities that we may request RMR to manage from time to time. See Note 11 for further information regarding our relationship, agreements and transactions with RMR. We recognized net business management fees of $11,249 and $3,692 for the three months ended September 30, 2024 and 2023, respectively, and $19,255 and $10,283 for the nine months ended September 30, 2024 and 2023, respectively. The net business management fees we recognized for both the three and nine months ended September 30, 2024 include $6,934 of estimated incentive fees based on our common share total return, as defined in our business management agreement. Although we recognized estimated incentive fees in accordance with GAAP, the actual amount of annual incentive fees for 2024, if any, will be based on our common share total return as defined in our business management agreement, for the three-year period ending December 31, 2024, and will be payable in January 2025. We did not incur any incentive fee payable for the year ended December 31, 2023. We recognize business management and incentive fees, if any, in general and administrative expenses in our condensed consolidated statements of comprehensive income (loss). We recognized aggregate net property management and construction supervision fees of $1,787 and $2,209 for the three months ended September 30, 2024 and 2023, respectively, and $5,411 and $6,403 for the nine months ended September 30, 2024 and 2023, respectively. For the three months ended September 30, 2024 and 2023, $1,358 and $1,363, respectively, of the total property management fees were expensed to property operating expenses in our condensed consolidated statements of comprehensive income (loss) and $429 and $846, respectively, were capitalized as building improvements in our condensed consolidated balance sheets. For the nine months ended September 30, 2024 and 2023, $4,342 and $4,226, respectively, of the total property management fees were expensed to property operating expenses in our condensed consolidated statements of comprehensive income (loss) and $1,069 and $2,177, respectively, were capitalized as building improvements in our condensed consolidated balance sheets. The amounts capitalized are being depreciated over the estimated useful lives of the related capital assets. We are generally responsible for all our operating expenses, including certain expenses incurred or arranged by RMR on our behalf. We are generally not responsible for payment of RMR's employment, office or administrative expenses incurred to provide management services to us, except for the employment and related expenses of RMR's employees assigned to work exclusively or partly at our properties, our share of the wages, benefits and other related costs of RMR's centralized accounting personnel, our share of RMR's costs for providing our internal audit function, or as otherwise agreed. Our property level operating expenses are generally incorporated into the rents charged to our tenants, including certain payroll and related costs incurred by RMR. We reimbursed RMR $4,007 and $3,671 for these expenses and costs for the three months ended September 30, 2024 and 2023, respectively, and $11,448 and $10,765 for the nine months ended September 30, 2024 and 2023, respectively. These amounts are included in property operating expenses or general and administrative expenses, as applicable, in our condensed consolidated statements of comprehensive income (loss) for these periods. Management Agreements between our Joint Ventures and RMR. We have two separate joint venture arrangements with third party institutional investors, the Seaport JV and the LSMD JV. RMR provides management services to both of these joint ventures. Our joint ventures are not our consolidated subsidiaries and, as a result, we are not obligated to pay management fees to RMR under our management agreements with RMR for the services it provides regarding the joint ventures.

Related Person Transactions

Related Person Transactions	9 Months Ended
	Sep. 30, 2024
Related Party Transactions [Abstract]
Related Person Transactions	Related Person Transactions We have relationships and historical and continuing transactions with RMR, RMR Inc., AlerisLife (including Five Star) and others related to them, including other companies to which RMR or its subsidiaries provide management services and some of which have trustees, directors or officers who are also our Trustees or officers. RMR is a majority owned subsidiary of RMR Inc. The Chair of our Board of Trustees and one of our Managing Trustees, Adam D. Portnoy, is the sole trustee, an officer and the controlling shareholder of ABP Trust, which is the controlling shareholder of RMR Inc., the chair of the board of directors, a managing director and the president and chief executive officer of RMR Inc., an officer and employee of RMR and, until the acquisition of AlerisLife by ABP Trust on March 20, 2023, the chair of the board of directors and a managing director of AlerisLife, and currently the sole director of AlerisLife. Christopher J. Bilotto, our other Managing Trustee and President and Chief Executive Officer, and Matthew C. Brown, our Chief Financial Officer and Treasurer, are also officers and employees of RMR. Jennifer F. Francis, our former Managing Trustee and our former President and Chief Executive Officer, served as an officer of RMR until December 31, 2023 and remained an employee of RMR until her retirement on July 1, 2024. Jennifer B. Clark, our Secretary and former Managing Trustee, also serves as a managing director and the executive vice president, general counsel and secretary of RMR Inc., an officer and employee of RMR, an officer of ABP Trust and secretary of AlerisLife and, until March 20, 2023, a managing director of AlerisLife. Jeffrey Leer, the president and chief executive officer of AlerisLife, is an executive officer of RMR. Some of our Independent Trustees also serve as independent trustees of other public companies to which RMR or its subsidiaries provide management services. Mr. Portnoy serves as the chair of the board and as a managing trustee of these companies. Other officers of RMR, including Ms. Clark and certain of our officers, serve as managing trustees or officers of certain of these companies. In addition, officers of RMR and RMR Inc. serve as our officers and officers of other companies to which RMR or its subsidiaries provide management services. As of September 30, 2024, ABP Trust and Mr. Portnoy owned 9.8% of our outstanding common shares. AlerisLife. Until March 20, 2023, we were AlerisLife's largest stockholder, owning approximately 31.9% of AlerisLife's outstanding common shares, and ABP Acquisition LLC, or ABP Acquisition, a subsidiary of ABP Trust, together with ABP Trust, owned approximately 6.1% of AlerisLife's outstanding common shares. Five Star is an operating division of AlerisLife. Five Star manages certain of the senior living communities we own. RMR provides management services to both us and AlerisLife. On February 2, 2023, AlerisLife entered into an Agreement and Plan of Merger, or the ALR Merger Agreement, with certain subsidiaries of ABP Trust, pursuant to which ABP Trust acquired all of the publicly held outstanding AlerisLife common shares at a price of $1.31 per share by tender offer. In connection with the ALR Merger Agreement, on February 2, 2023, we agreed to tender all the AlerisLife common shares that we and our subsidiary then owned, into the tender offer at the tender offer price, subject to the right, but not the obligation, to purchase, on or before December 31, 2023, AlerisLife common shares at the tender offer price, and otherwise pursuant to a stockholders agreement to be entered into at the time of any such purchase. On December 20, 2023, we and ABP Trust extended our right to purchase AlerisLife common shares until March 31, 2024. On February 16, 2024, we exercised this purchase right and acquired, together with our applicable TRS, approximately 34.0% of the then outstanding AlerisLife common shares from ABP Trust at the tender offer price, for a total purchase price of $14,890, excluding transaction related costs, and we, our applicable TRS, ABP Trust and AlerisLife entered into a stockholders agreement. Following this acquisition, ABP Trust owns the remaining approximately 66.0% of AlerisLife. In connection with AlerisLife's sale of its Ageility branded business to a subsidiary of Fox Rehabilitation on June 17, 2024, we approved Five Star's sublease to a subsidiary of Fox Rehabilitation of space at certain of our senior living communities, which is used to provide certain outpatient rehabilitation and wellness services. See Note 9 for further information regarding our relationships, agreements and transactions with AlerisLife (including Five Star). Our Joint Ventures. In connection with our entering into the LSMD JV in January 2022, we paid mortgage escrow amounts and closing costs that were payable by that joint venture. The remaining costs totaled $6,080 as of September 30, 2024 and are included in other assets, net, in our condensed consolidated balance sheet. RMR provides management services to each of the Seaport JV and the LSMD JV. See Note 10 for further information regarding those management agreements with RMR. Our Manager, RMR. We have two agreements with RMR to provide management services to us. See Note 10 for further information regarding our management agreements with RMR. Leases with RMR. We lease office space to RMR in certain of our properties for RMR’s property management offices. We recognized rental income from RMR for this leased office space of $97 and $58 for the three months ended September 30, 2024 and 2023, respectively, and $354 and $132 for the nine months ended September 30, 2024 and 2023, respectively. For further information about these and other such relationships and certain other related person transactions, see our Annual Report.

Income Taxes

Income Taxes	9 Months Ended
	Sep. 30, 2024
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes We have elected to be taxed as a real estate investment trust, or REIT, under the Internal Revenue Code of 1986, as amended, and, as such, are generally not subject to federal and most state income taxation on our operating income provided we distribute our taxable income to our shareholders and meet certain organization and operating requirements. We do, however, lease our managed senior living communities to our wholly owned TRSs that, unlike most of our subsidiaries, file a separate consolidated federal corporate income tax return and are subject to federal and state income taxes. Our consolidated income tax provision includes the income tax provision related to the operations of our TRSs and certain state income taxes we incur despite our taxation as a REIT. Our current income tax expense (or benefit) fluctuates from period to period based primarily on the timing of our income, including gains on the disposition of properties or losses in a particular quarter. For the three months ended September 30, 2024 and 2023, we recognized income tax expense of $148 and $189, respectively, and for the nine months ended September 30, 2024 and 2023, we recognized income tax expense of $505 and $379, respectively.

Weighted Average Common Shares

Weighted Average Common Shares	9 Months Ended
	Sep. 30, 2024
Earnings Per Share [Abstract]
Weighted Average Common Shares	Weighted Average Common Share s We calculate basic earnings per common share using the two class method. We calculate diluted earnings per share using the more dilutive of the two class method or the treasury stock method. Unvested share awards and other potentially dilutive common shares, together with the related impact on earnings, are considered when calculating diluted earnings per share.

Recent Accounting Pronounceme_2

Recent Accounting Pronouncements (Policies)	9 Months Ended
	Sep. 30, 2024
Accounting Policies [Abstract]
Recent Accounting Pronouncements	On November 27, 2023, the Financial Accounting Standards Board, or FASB, issued Accounting Standards Update, or ASU, No. 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures , or ASU No. 2023-07, which requires public entities to: (i) provide disclosures of significant segment expenses and other segment items if they are regularly provided to the Chief Operating Decision Maker, or the CODM, and included in each reported measure of segment profit or loss; (ii) provide all annual disclosures about a reportable segment’s profit or loss and assets currently required by Accounting Standards Codification Topic 280, Segment Reporting , or ASC 280, in interim periods; and (iii) disclose the CODM’s title and position, as well as an explanation of how the CODM uses the reported measures and other disclosures. Public entities with a single reportable segment must apply all the disclosure requirements of ASU No. 2023-07, as well as all the existing segment disclosures under ASC 280. The amendments in ASU No. 2023-07 are incremental to the requirements in ASC 280 and do not change how a public entity identifies its operating segments, aggregates those operating segments, or applies the quantitative thresholds to determine its reportable segments. ASU No. 2023-07 should be applied retrospectively to all prior periods presented in the financial statements and is effective for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024. Early adoption is permitted. We expect to include additional disclosures as a result of the implementation of ASU No. 2023-07; however, these changes are not expected to have a material effect on our condensed consolidated financial statements. On December 14, 2023, the FASB issued ASU No. 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures , or ASU No. 2023-09, which requires public entities to enhance their annual income tax disclosures by requiring: (i) consistent categories and greater disaggregation of information in the rate reconciliation, and (ii) income taxes paid disaggregated by jurisdiction. ASU No. 2023-09 should be applied prospectively but entities have the option to apply it retrospectively to all prior periods presented in the financial statements. ASU No. 2023-09 is effective for annual periods beginning after December 15, 2024, with early adoption permitted. We expect to include additional disclosures in the notes to our condensed consolidated financial statements as a result of the implementation of ASU No. 2023-09; however, these changes are not expected to have a material effect on our condensed consolidated financial statements.

Real Estate and Other Investm_2

Real Estate and Other Investments (Tables)	9 Months Ended
	Sep. 30, 2024
Real Estate [Abstract]
Schedule of Disposal Groups	Date of Sale Location Type of Property Number of Properties Sales Price (1) (Loss) Gain on Sale March 2024 Arizona Medical Office 1 $ 3,600 $ (5,874) June 2024 Texas Medical Office 1 4,200 (13,213) July 2024 Illinois and Minnesota Medical Office 2 21,275 111 4 $ 29,075 $ (18,976) (1) Sales price excludes closing costs. As of September 30, 2024, we had 25 properties classified as held for sale in our condensed consolidated balance sheet as follows: Segment Number of Properties Real Estate Properties, Net Medical Office and Life Science 4 $ 33,213 SHOP 3 8,780 Non-Segment (1) 18 35,660 25 $ 77,653 (1) Represents 18 triple net leased senior living communities.
Schedule of Joint Ventures	As of September 30, 2024, we had equity investments in unconsolidated joint ventures as follows: Joint Venture DHC Ownership DHC Carrying Value of Investment at September 30, 2024 Number of Properties Location Square Feet Seaport Innovation LLC 10% $ 65,590 1 MA 1,134,479 The LSMD Fund REIT LLC 20% 44,923 10 CA, MA, NY, TX, WA 1,068,763 $ 110,513 11 2,203,242 The following table provides a summary of the mortgage debts of these joint ventures: Joint Venture Coupon Rate Maturity Date Principal Balance at September 30, 2024 (1) Mortgage Notes Payable (secured by one property in Massachusetts) (2) (3) 3.53% 11/6/2028 $ 620,000 Mortgage Notes Payable (secured by nine properties in five states) (4) 3.46% 2/11/2032 189,800 Mortgage Notes Payable (secured by one property in California) (4) (5) 6.38% 2/9/2025 266,825 4.22% $ 1,076,625 (1) Amounts are not adjusted for our minority equity interest. (2) We provide certain guaranties on this debt. (3) This mortgage loan requires interest only payments until the anticipated repayment date on August 6, 2026, at which time all accrued and unpaid interest along with the principal balance of $620,000 is expected to be repaid. This mortgage loan matures on November 6, 2028 and any unpaid principal from the anticipated repayment date through the maturity date bears interest at a variable rate of the greater of 6.53% or the then effective U.S. swap rate terminating on the maturity date plus 5.00%. (4) The debt securing these properties is non-recourse to us. (5) This mortgage loan matures on February 9, 2025 and requires interest to be paid at an annual rate of the one month term secured overnight financing rate, or SOFR, plus a premium of 1.90%. This joint venture has also purchased an interest rate cap through February 2025 with a SOFR strike rate equal to 4.48% and an initial premium of $1,200. The maturity date of this mortgage loan is subject to two remaining one-year extension options.

Fair Value of Assets and Liab_2

Fair Value of Assets and Liabilities (Tables)	9 Months Ended
	Sep. 30, 2024
Fair Value Disclosures [Abstract]
Schedule of Assets and Liabilities Recurring and Nonrecurring Measured at Fair Value	The following table presents certain of our assets that are measured at fair value at September 30, 2024 and December 31, 2023, categorized by the level of inputs as defined in the fair value hierarchy under GAAP, used in the valuation of each asset. As of September 30, 2024 As of December 31, 2023 Description Carrying Value Carrying Value Recurring Fair Value Measurements Assets: Investment in unconsolidated joint venture (Level 3) (1) $ 65,590 $ 85,699 Investment in unconsolidated joint venture (Level 3) (2) $ 44,923 $ 44,217 Non-Recurring Fair Value Measurements Assets: Real estate properties held for sale (Level 2) (3) $ 6,286 $ — (1) The 10% equity interest we own in the Seaport JV is included in investments in unconsolidated joint ventures in our condensed consolidated balance sheet, and is reported at fair value, which is based on significant unobservable inputs (Level 3 inputs). The significant unobservable inputs used in the fair value analysis are a discount rate of 7.50%, an exit capitalization rate of 6.00%, a holding period of 10 years and market rents. The assumptions made in the fair value analysis are based on the location, type and nature of the property, and current and anticipated market conditions. See Note 3 for further information regarding this joint venture. (2) The 20% equity interest we own in the LSMD JV is included in investments in unconsolidated joint ventures in our condensed consolidated balance sheet, and is reported at fair value, which is based on significant unobservable inputs (Level 3 inputs). The significant unobservable inputs used in the fair value analysis are discount rates of between 6.50% and 8.00%, exit capitalization rates of between 5.25% and 7.00%, holding periods of 10 to 13 years, direct capitalization rates of 5.00% and market rents. The assumptions we made in the fair value analysis are based on the location, type and nature of each property, and current and anticipated market conditions. See Note 3 for further information regarding this joint venture. (3) We have assets in our condensed consolidated balance sheets that are measured at fair value on a non-recurring basis. During the three months ended September 30, 2024, we recorded impairment charges of $23,031 to reduce the carrying value of one life science property that is classified as held for sale to its estimated sales price, less estimated costs to sell, of $6,286 under an agreement to sell that we have entered into with a third party. See Note 3 for further information about impairment charges and the properties we have classified as held for sale.
Schedule of Carrying Value and Fair Value of the Financial Instruments	The fair values of these financial instruments approximated their carrying values in our condensed consolidated financial statements as of such dates, except as follows: As of September 30, 2024 As of December 31, 2023 Description Carrying Amount (1) Estimated Fair Value Carrying Amount (1) Estimated Fair Value Senior unsecured notes, 9.750% coupon rate, due 2025 $ 438,913 $ 440,541 $ 497,454 $ 490,750 Senior secured notes, zero coupon rate, due 2026 801,315 865,837 731,211 771,981 Senior unsecured notes, 4.750% coupon rate, due 2028 495,700 452,500 494,746 384,110 Senior unsecured notes, 4.375% coupon rate, due 2031 494,487 411,635 493,845 375,000 Senior unsecured notes, 5.625% coupon rate, due 2042 343,207 233,940 342,946 211,400 Senior unsecured notes, 6.250% coupon rate, due 2046 243,833 176,000 243,627 154,000 Secured debt and finance leases (2) 127,836 133,423 13,020 12,284 $ 2,945,291 $ 2,713,876 $ 2,816,849 $ 2,399,525 (1) Includes unamortized net discounts, premiums and debt issuance costs, if any. (2) We assumed certain of these secured debts in connection with our acquisition of certain properties. We recorded the assumed mortgage notes at estimated fair value on the date of acquisition and we are amortizing the fair value adjustments, if any, to interest expense over the respective terms of the mortgage notes to adjust interest expense to the estimated market interest rates as of the date of acquisition.

Shareholders' Equity (Tables)

Shareholders' Equity (Tables)	9 Months Ended
	Sep. 30, 2024
Stockholders' Equity Note [Abstract]
Schedule of Dividends Declared and Paid	During the nine months ended September 30, 2024, we declared and paid quarterly distributions to common shareholders as follows: Declaration Date Record Date Payment Date Distribution Per Share Total Distributions January 11, 2024 January 22, 2024 February 15, 2024 $ 0.01 $ 2,404 April 11, 2024 April 22, 2024 May 16, 2024 0.01 2,404 July 11, 2024 July 22, 2024 August 15, 2024 0.01 2,406 $ 0.03 $ 7,214

Segment Reporting (Tables)

Segment Reporting (Tables)	9 Months Ended
	Sep. 30, 2024
Segment Reporting [Abstract]
Schedule of Segment Reporting Information	For the Three Months Ended September 30, 2024 Medical Office and Life Science Portfolio SHOP Non-Segment Consolidated Revenues: Rental income $ 52,901 $ — $ 8,734 $ 61,635 Residents fees and services — 312,005 — 312,005 Total revenues 52,901 312,005 8,734 373,640 Expenses: Property operating expenses 25,074 284,572 51 309,697 Depreciation and amortization 18,773 47,343 2,843 68,959 General and administrative — — 13,933 13,933 Acquisition and certain other transaction related costs — — 331 331 Impairment of assets 23,031 — — 23,031 Total expenses 66,878 331,915 17,158 415,951 Gain on sale of properties 111 — — 111 Interest and other income — — 2,575 2,575 Interest expense (2,319) (54) (57,070) (59,443) Loss before income tax expense and equity in net earnings (losses) of investees (16,185) (19,964) (62,919) (99,068) Income tax expense — — (148) (148) Equity in net earnings (losses) of investees 1,707 — (1,180) 527 Net loss $ (14,478) $ (19,964) $ (64,247) $ (98,689) For the Nine Months Ended September 30, 2024 Medical Office and Life Science Portfolio SHOP Non-Segment Consolidated Revenues: Rental income $ 161,605 $ — $ 25,550 $ 187,155 Residents fees and services — 928,653 — 928,653 Total revenues 161,605 928,653 25,550 1,115,808 Expenses: Property operating expenses 73,253 847,526 587 921,366 Depreciation and amortization 58,488 141,176 7,785 207,449 General and administrative — — 27,763 27,763 Acquisition and certain other transaction related costs — — 2,243 2,243 Impairment of assets 41,718 — — 41,718 Total expenses 173,459 988,702 38,378 1,200,539 Loss on sale of properties (18,976) — — (18,976) Interest and other income — — 7,215 7,215 Interest expense (3,435) (183) (172,103) (175,721) Loss on modification or early extinguishment of debt — — (209) (209) Loss before income tax expense and equity in net (losses) earnings of investees (34,265) (60,232) (177,925) (272,422) Income tax expense — — (505) (505) Equity in net (losses) earnings of investees (18,173) — 8,291 (9,882) Net loss $ (52,438) $ (60,232) $ (170,139) $ (282,809) As of September 30, 2024 Medical Office and Life Science Portfolio SHOP Non-Segment Consolidated Total assets $ 1,726,082 $ 3,111,775 $ 447,339 $ 5,285,196 For the Three Months Ended September 30, 2023 Medical Office and Life Science Portfolio SHOP Non-Segment Consolidated Revenues: Rental income $ 55,058 $ — $ 8,332 $ 63,390 Residents fees and services — 293,134 — 293,134 Total revenues 55,058 293,134 8,332 356,524 Expenses: Property operating expenses 25,784 272,445 203 298,432 Depreciation and amortization 20,175 44,587 2,474 67,236 General and administrative — — 6,954 6,954 Acquisition and certain other transaction related costs — — 3,676 3,676 Impairment of assets 427 729 — 1,156 Total expenses 46,386 317,761 13,307 377,454 Interest and other income — 115 3,128 3,243 Interest expense (119) (79) (47,560) (47,758) Income (loss) before income tax expense and equity in net losses of investees 8,553 (24,591) (49,407) (65,445) Income tax expense — — (189) (189) Equity in net losses of investees (145) — — (145) Net income (loss) $ 8,408 $ (24,591) $ (49,596) $ (65,779) For the Nine Months Ended September 30, 2023 Medical Office and Life Science Portfolio SHOP Non-Segment Consolidated Revenues: Rental income $ 165,448 $ — $ 25,753 $ 191,201 Residents fees and services — 857,572 — 857,572 Total revenues 165,448 857,572 25,753 1,048,773 Expenses: Property operating expenses 73,237 796,733 770 870,740 Depreciation and amortization 63,065 129,891 7,474 200,430 General and administrative — — 20,111 20,111 Acquisition and certain other transaction related costs — — 9,812 9,812 Impairment of assets 14,034 4,346 — 18,380 Total expenses 150,336 930,970 38,167 1,119,473 Gain on sale of properties — 1,233 — 1,233 Gains on equity securities, net — — 8,126 8,126 Interest and other income — 1,581 10,991 12,572 Interest expense (344) (502) (142,076) (142,922) Loss on modification or early extinguishment of debt — — (1,075) (1,075) Income (loss) before income tax expense and equity in net earnings of investees 14,768 (71,086) (136,448) (192,766) Income tax expense — — (379) (379) Equity in net earnings of investees 2,137 — — 2,137 Net income (loss) $ 16,905 $ (71,086) $ (136,827) $ (191,008) As of December 31, 2023 Medical Office and Life Science Portfolio SHOP Non-Segment Consolidated Total assets $ 1,866,422 $ 3,134,978 $ 444,736 $ 5,446,136

Senior Living Community Manag_2

Senior Living Community Management Agreements (Tables)	9 Months Ended
	Sep. 30, 2024
Risks and Uncertainties [Abstract]
Schedule of Disaggregation of Revenue	The following table presents residents fees and services revenue from all of our managed senior living communities disaggregated by the type of contract and payer: Three Months Ended September 30, Nine Months Ended September 30, Revenue from contracts with customers: 2024 2023 2024 2023 Basic housing and support services $ 242,787 $ 232,805 $ 727,558 $ 681,598 Medicare and Medicaid programs 25,619 22,568 73,951 65,965 Private pay and other third party payer SNF services 43,599 37,761 127,144 110,009 Total residents fees and services $ 312,005 $ 293,134 $ 928,653 $ 857,572

Real Estate and Other Investm_3

Real Estate and Other Investments - Additional Information (Details)	9 Months Ended
	Sep. 30, 2024 property jointVenture state
Real Estate
Number of properties owned (property)	368
Number of states in which properties are located | state	36
Number of states | state	5
Joint Venture
Real Estate
Number of unconsolidated joint ventures | jointVenture	2
SHOP
Real Estate
Number of properties closed	3
Held for sale
Real Estate
Number of properties owned (property)	25

Real Estate and Other Investm_4

Real Estate and Other Investments - Acquisitions and Dispositions Narrative (Details) $ in Thousands		1 Months Ended		9 Months Ended
	Nov. 04, 2024 USD ($) property	Nov. 04, 2024 USD ($) property	Mar. 31, 2024 USD ($) property	Sep. 30, 2024 USD ($) property	Sep. 30, 2023 USD ($)
Real Estate
Number of properties acquired				0
Number of properties owned (property)				368
Redemption of senior notes | $				$ 60,000	$ 0
Subsequent Event | Senior Secured Note due 2026
Real Estate
Redemption of senior notes | $	$ 302,100
Disposed of by sale
Real Estate
Number of properties owned (property)				4
Sales price | $				$ 29,075
Disposed of by sale | Subsequent Event
Real Estate
Number of properties owned (property)	1	1
Sales price | $		$ 6,600
Held for sale
Real Estate
Number of properties owned (property)				25
Held for sale | Senior Secured Note due 2026
Real Estate
Number of properties owned (property)				22
Sales price | $				$ 302,100
Held for sale | Subsequent Event
Real Estate
Number of properties owned (property)	28	28
Sales price | $	$ 348,080
Medical Office | Arizona | Disposed of by sale
Real Estate
Number of properties owned (property)			1	4
Sales price | $			$ 3,600	$ 29,075

Real Estate and Other Investm_5

Real Estate and Other Investments - Schedule of Disposal Groups (Details) $ in Thousands	1 Months Ended			9 Months Ended
	Jul. 31, 2024 USD ($) property	Jun. 30, 2024 USD ($) property	Mar. 31, 2024 USD ($) property	Sep. 30, 2024 USD ($) property
Real Estate
Number of Properties | property				368
Disposed of by sale
Real Estate
Number of Properties | property				4
Sale Price				$ 29,075
(Loss) Gain on Sale				$ (18,976)
Held for sale
Real Estate
Number of Properties | property				25
Real Estate Properties, Net				$ 77,653
Held for sale | Operating Segments | Medical Office and Life Science Portfolio
Real Estate
Number of Properties | property				4
Real Estate Properties, Net				$ 33,213
Held for sale | Operating Segments | SHOP
Real Estate
Number of Properties | property				3
Real Estate Properties, Net				$ 8,780
Held for sale | Non-Segment
Real Estate
Number of Properties | property				18
Real Estate Properties, Net				$ 35,660
Triple Net Leased Senior Living Communities | Held for sale | Non-Segment
Real Estate
Number of Properties | property				18
Arizona | Medical Office | Disposed of by sale
Real Estate
Number of Properties | property			1	4
Sale Price			$ 3,600	$ 29,075
(Loss) Gain on Sale			$ (5,874)
TEXAS | Medical Office | Disposed of by sale
Real Estate
Number of Properties | property		1
Sale Price		$ 4,200
(Loss) Gain on Sale		$ (13,213)
Illinois and Minnesota | Medical Office | Disposed of by sale
Real Estate
Number of Properties | property	2
Sale Price	$ 21,275
(Loss) Gain on Sale	$ 111

Real Estate and Other Investm_6

Real Estate and Other Investments - Impairment Narrative (Details) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024 USD ($) property	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($) property	Sep. 30, 2023 USD ($)
Real Estate
Impairment of assets	$ 23,031	$ 1,156	$ 41,718	$ 18,380
Medical Office and Life Science | Held for sale
Real Estate
Impairment of assets			$ 27,173
Medical Office | Held for sale
Real Estate
Number of properties impaired | property	1		1
Medical Office | Disposed of by sale
Real Estate
Impairment of assets			$ 14,545
Number of properties impaired | property	2		2
Life Sciences Property
Real Estate
Impairment of assets	$ 23,031
Life Sciences Property | Held for sale
Real Estate
Number of properties impaired | property	1		1

Real Estate and Other Investm_7

Real Estate and Other Investments - Equity Method Investments in Unconsolidated Joint Ventures (Details) $ in Thousands	Sep. 30, 2024 USD ($) ft² property	Dec. 31, 2023 USD ($)
Real Estate
DHC carrying value | $	$ 110,513	$ 129,916
Number of properties owned (property) | property	368
Corporate Joint Venture
Real Estate
DHC carrying value | $	$ 110,513
Number of properties owned (property) | property	11
Area of real estate properties (in square feet) | ft²	2,203,242
Seaport Innovation LLC | Corporate Joint Venture
Real Estate
Equity method investment ownership percentage	10%
DHC carrying value | $	$ 65,590
Number of properties owned (property) | property	1
Area of real estate properties (in square feet) | ft²	1,134,479
The LSMD Fund REIT LLC | Corporate Joint Venture
Real Estate
Equity method investment ownership percentage	20%
DHC carrying value | $	$ 44,923
Number of properties owned (property) | property	10
Area of real estate properties (in square feet) | ft²	1,068,763

Real Estate and Other Investm_8

Real Estate and Other Investments - Mortgage Debt Joint Venture (Details)	9 Months Ended
	Sep. 30, 2024 USD ($) state property option
Real Estate
Number of states in which properties are located | state	36
Corporate Joint Venture
Real Estate
Interest rate (as a percent)	4.22%
Principal balance	$ 1,076,625,000
Corporate Joint Venture | Seaport Innovation LLC
Real Estate
Aggregate principal amount of mortgage debt	$ 620,000,000
Seaport Innovation LLC | Corporate Joint Venture | Minimum
Real Estate
Interest rate (as a percent)	6.53%
Seaport Innovation LLC | Corporate Joint Venture | US Swap Rate
Real Estate
Basis points per annum (as a percent)	5%
Seaport Innovation LLC | Corporate Joint Venture | Massachusetts
Real Estate
Encumbered properties (property) | property	1
Interest rate (as a percent)	3.53%
Principal balance	$ 620,000,000
The LSMD Fund REIT LLC | Corporate Joint Venture
Real Estate
Encumbered properties (property) | property	9
Number of states in which properties are located | state	5
Interest rate (as a percent)	3.46%
Principal balance	$ 189,800,000
The LSMD Fund REIT LLC | Corporate Joint Venture | California
Real Estate
Encumbered properties (property) | property	1
Interest rate (as a percent)	6.38%
Principal balance	$ 266,825,000
Number of extension options | option	2
Extension term	1 year
The LSMD Fund REIT LLC | Corporate Joint Venture | California | SOFR
Real Estate
Basis points per annum (as a percent)	1.90%
Initial premium	$ 1,200,000
The LSMD Fund REIT LLC | Corporate Joint Venture | California | SOFR | Interest Rate Cap
Real Estate
Basis points per annum (as a percent)	4.48%

Real Estate and Other Investm_9

Real Estate and Other Investments - Unconsolidated Joint Venture Narrative (Details) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024 USD ($)	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($) property	Sep. 30, 2023 USD ($)
Real Estate
Equity in net earnings (losses) of investees	$ 527	$ (145)	$ (9,882)	$ 2,137
Corporate Joint Venture
Real Estate
Equity in net earnings (losses) of investees	$ 1,707	$ (145)	$ (18,173)	$ 2,137
Corporate Joint Venture | The LSMD Fund REIT LLC
Real Estate
Equity method investment ownership percentage	20%		20%
Corporate Joint Venture | Seaport Innovation LLC
Real Estate
Equity method investment ownership percentage	10%		10%
Corporate Joint Venture | Medical Office Building and Life Science Building
Real Estate
Number of properties included in joint venture agreement | property			10

Real Estate and Other Invest_10

Real Estate and Other Investments - Equity Method Investment in AlerisLife (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023
Real Estate
Equity method investment	$ 23,758		$ 23,758		$ 0
Equity in net earnings (losses) of investees	527	$ (145)	(9,882)	$ 2,137
AlerisLife Inc
Real Estate
Equity method investment, difference between carrying amount and underlying equity	$ 29,500		$ 29,500
AlerisLife Inc
Real Estate
Equity method investment ownership percentage	34%		34%
Equity method investment	$ 23,758		$ 23,758
Equity in net earnings (losses) of investees	(1,531)		7,414
AlerisLife Inc | Equity Method Investments
Real Estate
Amortization	$ 351		$ 877

Leases (Details)

Leases (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023
Leases [Abstract]
Increase (decrease) in straight line rental income	$ 658	$ 676	$ 1,605	$ (1,333)
Straight line rental income, excluding properties held-for-sale	74,088		74,088		$ 75,306
Variable lease, payment	11,126	12,018	34,111	36,579
Reimbursement revenue lease	11,083	$ 11,965	33,953	$ 36,414
Operating lease, right-of-use asset	20,868		20,868		23,366
Operating lease, liability	$ 21,254		$ 21,254		$ 23,748
Operating Lease, Right-of-Use Asset, Statement of Financial Position	Other assets, net		Other assets, net		Other assets, net
Operating Lease, Liability, Statement of Financial Position	Other liabilities		Other liabilities		Other liabilities

Indebtedness (Details)

Indebtedness (Details)	1 Months Ended		3 Months Ended		9 Months Ended
	Feb. 28, 2023 USD ($)	Jan. 31, 2023 USD ($)	Sep. 30, 2024 USD ($) property	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($) property	Sep. 30, 2023 USD ($)	Jun. 30, 2024 USD ($)	May 31, 2024 USD ($) property	Dec. 31, 2023 USD ($)	Dec. 21, 2023 USD ($)
Indebtedness
Number of properties owned (property) | property			368		368
Aggregate net book value			$ 4,561,995,000		$ 4,561,995,000				$ 4,797,624,000
Repayments of lines of credit					0	$ 250,000,000
Loss on modification or early extinguishment of debt			$ 0	$ 0	$ 209,000	$ 1,075,000
Held for sale
Indebtedness
Number of properties owned (property) | property			25		25
Finance Leased Properties
Indebtedness
Number of properties owned (property) | property			2		2
Finance lease obligations			$ 2,743,000		$ 2,743,000
Finance leased asset, net			21,815,000		21,815,000
Mortgages
Indebtedness
Debt face amount								$ 120,000,000
Aggregate principal amount of mortgage debt			$ 127,889,000		$ 127,889,000
Number of properties owned (property) | property			9		9
Aggregate net book value			$ 205,750,000		$ 205,750,000
Fixed annual interest rate								6.864%
Mortgages | Medical Office And Life Science
Indebtedness
Number of properties owned (property) | property								8
Senior Unsecured Notes, 9.75% due 2025
Indebtedness
Loss on modification or early extinguishment of debt					$ 209,000
Senior Secured Note due 2026 | Held for sale
Indebtedness
Number of properties owned (property) | property			22		22
Sales price					$ 302,100,000
Unsecured Debt
Indebtedness
Debt face amount			$ 2,040,000,000		2,040,000,000
Unsecured Debt | Unsecured Revolving Credit Facility
Indebtedness
Unsecured revolving credit facility, maximum borrowing capacity	$ 450,000,000	$ 586,373,000								$ 450,000,000
Weighted average annual interest rate				8.30%		7.80%
Repayments of lines of credit	$ 136,373,000	$ 113,627,000
Loss on modification or early extinguishment of debt						$ 1,075,000
Secured Debts
Indebtedness
Debt face amount			940,534,000		940,534,000
Outstanding principal amount			1,070,598,000		1,070,598,000
Secured Debts | Senior Secured Note due 2026
Indebtedness
Debt face amount			$ 940,534,000		$ 940,534,000
Number of real estate properties collateralized | property			95		95
Equity interest in each collateral guarantee					100%
Accreted value increase rate			11.25%		11.25%
Amortization of debt discount			$ 22,034,000		$ 64,133,000
Debt extension term					1 year
Initial extension period interest rate			11.25%		11.25%
Increase in interest rate			0.50%		0.50%
Senior Notes | Senior Unsecured Notes, 9.75% due 2025
Indebtedness
Debt face amount			$ 440,000,000		$ 440,000,000
Fixed annual interest rate			9.75%		9.75%		9.75%
Debt instrument redeemed							$ 60,000,000
Senior Notes | Senior Unsecured Notes due 2031
Indebtedness
Debt face amount			$ 500,000,000		$ 500,000,000
Fixed annual interest rate			4.375%		4.375%
Unsecured Debt, Not Guaranteed
Indebtedness
Debt face amount			$ 1,100,000,000		$ 1,100,000,000
Senior Unsecured Notes | Senior Unsecured Notes, 9.75% due 2025
Indebtedness
Outstanding principal amount			$ 440,000,000		$ 440,000,000
Fixed annual interest rate			9.75%		9.75%
Senior Unsecured Notes | Senior Unsecured Notes due 2031
Indebtedness
Fixed annual interest rate			4.375%		4.375%

Fair Value of Assets and Liab_3

Fair Value of Assets and Liabilities - Assets and Liabilities (Details) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024 USD ($) property	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($) property	Sep. 30, 2023 USD ($)	Dec. 31, 2023 USD ($)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Impairment of assets | $	$ 23,031	$ 1,156	$ 41,718	$ 18,380
Number of Properties | property	368		368
Held for sale
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Number of Properties | property	25		25
Life Sciences Property
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Impairment of assets | $	$ 23,031
Corporate Joint Venture
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Number of Properties | property	11		11
Corporate Joint Venture | Seaport Innovation LLC
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Equity method investment ownership percentage	10%		10%
Holding period			10 years
Number of Properties | property	1		1
Corporate Joint Venture | Seaport Innovation LLC | Discount Rate
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Measurement input	0.0750		0.0750
Corporate Joint Venture | Seaport Innovation LLC | Exit Capitalization Rate
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Measurement input	0.0600		0.0600
Corporate Joint Venture | The LSMD Fund REIT LLC
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Equity method investment ownership percentage	20%		20%
Number of Properties | property	10		10
Corporate Joint Venture | The LSMD Fund REIT LLC | Minimum
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Holding period			10 years
Corporate Joint Venture | The LSMD Fund REIT LLC | Maximum
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Holding period			13 years
Corporate Joint Venture | The LSMD Fund REIT LLC | Discount Rate | Minimum
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Measurement input	0.0650		0.0650
Corporate Joint Venture | The LSMD Fund REIT LLC | Discount Rate | Maximum
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Measurement input	0.0800		0.0800
Corporate Joint Venture | The LSMD Fund REIT LLC | Exit Capitalization Rate | Minimum
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Measurement input	0.0525		0.0525
Corporate Joint Venture | The LSMD Fund REIT LLC | Exit Capitalization Rate | Maximum
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Measurement input	0.0700		0.0700
Corporate Joint Venture | The LSMD Fund REIT LLC | Direct Capitalization Rate
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Measurement input	0.0500		0.0500
Recurring Fair Value Measurements Assets | Level 3 | Joint Venture | Carrying Value | Seaport Innovation LLC
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Investments in affiliates, fair value | $	$ 65,590		$ 65,590		$ 85,699
Recurring Fair Value Measurements Assets | Level 3 | Joint Venture | Carrying Value | The LSMD Fund REIT LLC
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Investments in affiliates, fair value | $	44,923		44,923		44,217
Non-Recurring Fair Value Measurements Assets | Life Sciences Property
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Aggregate sales price | $	$ 6,286		$ 6,286
Non-Recurring Fair Value Measurements Assets | Life Sciences Property | Held for sale
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Number of Properties | property	1		1
Non-Recurring Fair Value Measurements Assets | Level 2 | Carrying Value
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Real estate properties held for sale | $	$ 6,286		$ 6,286		$ 0

Fair Value of Assets and Liab_4

Fair Value of Assets and Liabilities - Liabilities (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Senior Unsecured Notes | Senior unsecured notes, 9.750% coupon rate, due 2025
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Coupon rate	9.75%
Senior Unsecured Notes | Senior unsecured notes, 4.750% coupon rate, due 2028
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Coupon rate	4.75%
Senior Unsecured Notes | Senior Unsecured Notes due 2031
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Coupon rate	4.375%
Senior Unsecured Notes | Senior unsecured notes, 5.625% coupon rate, due 2042
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Coupon rate	5.625%
Senior Unsecured Notes | Senior unsecured notes, 6.250% coupon rate, due 2046
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Coupon rate	6.25%
Senior Secured Notes | Senior secured notes, zero coupon rate, due 2026
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Coupon rate	0%
Carrying Value
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Fair value disclosure	$ 2,945,291	$ 2,816,849
Carrying Value | Senior Unsecured Notes | Senior unsecured notes, 9.750% coupon rate, due 2025
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Fair value disclosure	438,913	497,454
Carrying Value | Senior Unsecured Notes | Senior unsecured notes, 4.750% coupon rate, due 2028
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Fair value disclosure	495,700	494,746
Carrying Value | Senior Unsecured Notes | Senior Unsecured Notes due 2031
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Fair value disclosure	494,487	493,845
Carrying Value | Senior Unsecured Notes | Senior unsecured notes, 5.625% coupon rate, due 2042
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Fair value disclosure	343,207	342,946
Carrying Value | Senior Unsecured Notes | Senior unsecured notes, 6.250% coupon rate, due 2046
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Fair value disclosure	243,833	243,627
Carrying Value | Senior Secured Notes | Senior secured notes, zero coupon rate, due 2026
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Fair value disclosure	801,315	731,211
Carrying Value | Secured debt and finance leases
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Fair value disclosure	127,836	13,020
Estimated Fair Value
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Fair value disclosure	2,713,876	2,399,525
Estimated Fair Value | Senior Unsecured Notes | Senior unsecured notes, 9.750% coupon rate, due 2025
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Fair value disclosure	440,541	490,750
Estimated Fair Value | Senior Unsecured Notes | Senior unsecured notes, 4.750% coupon rate, due 2028
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Fair value disclosure	452,500	384,110
Estimated Fair Value | Senior Unsecured Notes | Senior Unsecured Notes due 2031
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Fair value disclosure	411,635	375,000
Estimated Fair Value | Senior Unsecured Notes | Senior unsecured notes, 5.625% coupon rate, due 2042
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Fair value disclosure	233,940	211,400
Estimated Fair Value | Senior Unsecured Notes | Senior unsecured notes, 6.250% coupon rate, due 2046
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Fair value disclosure	176,000	154,000
Estimated Fair Value | Senior Secured Notes | Senior secured notes, zero coupon rate, due 2026
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Fair value disclosure	865,837	771,981
Estimated Fair Value | Secured debt and finance leases
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Fair value disclosure	$ 133,423	$ 12,284

Fair Value of Assets and Liab_5

Fair Value of Assets and Liabilities - Narrative (Details) - security	Sep. 30, 2024	Dec. 31, 2023
Quoted Prices in Active Markets for Identical Assets (Level 1)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Fair value measurement, number of debt securities	2	2
Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Fair value measurement, number of debt securities	3	3

Shareholders' Equity - Narrativ

Shareholders' Equity - Narrative (Details) $ / shares in Units, $ in Thousands				3 Months Ended						9 Months Ended
	Oct. 16, 2024 USD ($) $ / shares	Sep. 11, 2024 $ / shares shares	May 31, 2024 trustee $ / shares shares	Sep. 30, 2024 USD ($) $ / shares shares	Jun. 30, 2024 USD ($) $ / shares	Mar. 31, 2024 USD ($) $ / shares	Sep. 30, 2023 USD ($)	Jun. 30, 2023 USD ($)	Mar. 31, 2023 USD ($)	Sep. 30, 2024 USD ($) $ / shares shares
Share-based Compensation Arrangement by Share-based Payment Award
Distributions to common shareholders declared (in dollars per share)				$ 0.01	$ 0.01	$ 0.01				$ 0.03
Common stock distributions | $				$ 2,406	$ 2,404	$ 2,404	$ 2,398	$ 2,397	$ 2,397	$ 7,214
Subsequent Event
Share-based Compensation Arrangement by Share-based Payment Award
Distributions to common shareholders declared (in dollars per share)	$ 0.01
Common stock distributions | $	$ 2,413
RMR
Share-based Compensation Arrangement by Share-based Payment Award
Number of shares (in shares) | shares				219,864						267,551
Weighted average share price (in dollars per share)				$ 3.52						$ 3.34
Share Award Plans | Trustees | RMR
Share-based Compensation Arrangement by Share-based Payment Award
Number of trustees | trustee			7
Common shares awarded (in shares) | shares			37,037
Share price (in dollars per share)			$ 2.43
Share Award Plans | Officers And Other Employees | RMR
Share-based Compensation Arrangement by Share-based Payment Award
Common shares awarded (in shares) | shares		881,767
Share price (in dollars per share)		$ 3.35

Shareholders' Equity (Details)

Shareholders' Equity (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2024
Stockholders' Equity Note [Abstract]
Distribution per share (in dollars per share)	$ 0.01	$ 0.01	$ 0.01				$ 0.03
Total Distributions	$ 2,406	$ 2,404	$ 2,404	$ 2,398	$ 2,397	$ 2,397	$ 7,214

Segment Reporting - Narrative (

Segment Reporting - Narrative (Details)	9 Months Ended
	Sep. 30, 2024 segment
Segment Reporting [Abstract]
Number of operating segments	2

Segment Reporting - Income Stat

Segment Reporting - Income Statements (Details) - USD ($) $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2024	Sep. 30, 2023
Revenues:
Total revenues	$ 373,640			$ 356,524			$ 1,115,808	$ 1,048,773
Expenses:
Property operating expenses	309,697			298,432			921,366	870,740
Depreciation and amortization	68,959			67,236			207,449	200,430
General and administrative	13,933			6,954			27,763	20,111
Acquisition and certain other transaction related costs	331			3,676			2,243	9,812
Impairment of assets	23,031			1,156			41,718	18,380
Total expenses	415,951			377,454			1,200,539	1,119,473
Gain (loss) on sale of properties	111			0			(18,976)	1,233
Gains on equity securities, net	0			0			0	8,126
Interest and other income	2,575			3,243			7,215	12,572
Interest expense	(59,443)			(47,758)			(175,721)	(142,922)
Loss on modification or early extinguishment of debt	0			0			(209)	(1,075)
Loss before income tax expense and equity in net earnings (losses) of investees	(99,068)			(65,445)			(272,422)	(192,766)
Income tax expense	(148)			(189)			(505)	(379)
Equity in net earnings (losses) of investees	527			(145)			(9,882)	2,137
Net loss	(98,689)	$ (97,861)	$ (86,259)	(65,779)	$ (72,571)	$ (52,658)	(282,809)	(191,008)
Rental income
Revenues:
Total revenues	61,635			63,390			187,155	191,201
Residents fees and services
Revenues:
Total revenues	312,005			293,134			928,653	857,572
Operating Segments | Medical Office and Life Science Portfolio
Revenues:
Total revenues	52,901			55,058			161,605	165,448
Expenses:
Property operating expenses	25,074			25,784			73,253	73,237
Depreciation and amortization	18,773			20,175			58,488	63,065
General and administrative	0			0			0	0
Acquisition and certain other transaction related costs	0			0			0	0
Impairment of assets	23,031			427			41,718	14,034
Total expenses	66,878			46,386			173,459	150,336
Gain (loss) on sale of properties	111						(18,976)	0
Gains on equity securities, net								0
Interest and other income	0			0			0	0
Interest expense	(2,319)			(119)			(3,435)	(344)
Loss on modification or early extinguishment of debt							0	0
Loss before income tax expense and equity in net earnings (losses) of investees	(16,185)			8,553			(34,265)	14,768
Income tax expense	0			0			0	0
Equity in net earnings (losses) of investees	1,707			(145)			(18,173)	2,137
Net loss	(14,478)			8,408			(52,438)	16,905
Operating Segments | SHOP
Revenues:
Total revenues	312,005			293,134			928,653	857,572
Expenses:
Property operating expenses	284,572			272,445			847,526	796,733
Depreciation and amortization	47,343			44,587			141,176	129,891
General and administrative	0			0			0	0
Acquisition and certain other transaction related costs	0			0			0	0
Impairment of assets	0			729			0	4,346
Total expenses	331,915			317,761			988,702	930,970
Gain (loss) on sale of properties	0						0	1,233
Gains on equity securities, net								0
Interest and other income	0			115			0	1,581
Interest expense	(54)			(79)			(183)	(502)
Loss on modification or early extinguishment of debt							0	0
Loss before income tax expense and equity in net earnings (losses) of investees	(19,964)			(24,591)			(60,232)	(71,086)
Income tax expense	0			0			0	0
Equity in net earnings (losses) of investees	0			0			0	0
Net loss	(19,964)			(24,591)			(60,232)	(71,086)
Operating Segments | Rental income | Medical Office and Life Science Portfolio
Revenues:
Total revenues	52,901			55,058			161,605	165,448
Operating Segments | Rental income | SHOP
Revenues:
Total revenues	0			0			0	0
Operating Segments | Residents fees and services | Medical Office and Life Science Portfolio
Revenues:
Total revenues	0			0			0	0
Operating Segments | Residents fees and services | SHOP
Revenues:
Total revenues	312,005			293,134			928,653	857,572
Non-Segment
Revenues:
Total revenues	8,734			8,332			25,550	25,753
Expenses:
Property operating expenses	51			203			587	770
Depreciation and amortization	2,843			2,474			7,785	7,474
General and administrative	13,933			6,954			27,763	20,111
Acquisition and certain other transaction related costs	331			3,676			2,243	9,812
Impairment of assets	0			0			0	0
Total expenses	17,158			13,307			38,378	38,167
Gain (loss) on sale of properties	0						0	0
Gains on equity securities, net								8,126
Interest and other income	2,575			3,128			7,215	10,991
Interest expense	(57,070)			(47,560)			(172,103)	(142,076)
Loss on modification or early extinguishment of debt							(209)	(1,075)
Loss before income tax expense and equity in net earnings (losses) of investees	(62,919)			(49,407)			(177,925)	(136,448)
Income tax expense	(148)			(189)			(505)	(379)
Equity in net earnings (losses) of investees	(1,180)			0			8,291	0
Net loss	(64,247)			(49,596)			(170,139)	(136,827)
Non-Segment | Rental income
Revenues:
Total revenues	8,734			8,332			25,550	25,753
Non-Segment | Residents fees and services
Revenues:
Total revenues	$ 0			$ 0			$ 0	$ 0

Segment Reporting - Assets (Det

Segment Reporting - Assets (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Segment reporting
Total assets	$ 5,285,196	$ 5,446,136
Operating Segments | Medical Office and Life Science Portfolio
Segment reporting
Total assets	1,726,082	1,866,422
Operating Segments | SHOP
Segment reporting
Total assets	3,111,775	3,134,978
Non-Segment
Segment reporting
Total assets	$ 447,339	$ 444,736

Senior Living Community Manag_3

Senior Living Community Management Agreements - Narrative (Details) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024 USD ($)	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($) community	Sep. 30, 2023 USD ($) community
Property operating expenses	$ 309,697	$ 298,432	$ 921,366	$ 870,740
Affiliated Entity | Five Star
Property management agreement expense	10,611	10,058	31,462	29,962
Related party transaction capitalized amount	551	601	1,409	2,053
Affiliated Entity | Five Star | Rehabilitation Services
Property operating expenses			0	1,213
Affiliated Entity | Five Star | Operating Expense
Property management agreement expense	10,060	9,457	$ 30,053	$ 27,909
Senior Living Communities | Affiliated Entity | Five Star
Number of communities managed | community			119	119
Senior Living Communities | Affiliated Entity | Third Party Managers
Number of communities managed | community			111	111
Property management agreement expense	$ 5,858	$ 5,635	$ 17,341	$ 16,230
Termination and other fees			$ 2,042

Senior Living Community Manag_4

Senior Living Community Management Agreements - Schedule of Disaggregation of Revenue (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Disaggregation of Revenue
Revenues	$ 373,640	$ 356,524	$ 1,115,808	$ 1,048,773
Residents fees and services
Disaggregation of Revenue
Revenues	312,005	293,134	928,653	857,572
Residents fees and services | Basic housing and support services
Disaggregation of Revenue
Revenues	242,787	232,805	727,558	681,598
Residents fees and services | Medicare and Medicaid programs
Disaggregation of Revenue
Revenues	25,619	22,568	73,951	65,965
Residents fees and services | Private pay and other third party payer SNF services
Disaggregation of Revenue
Revenues	$ 43,599	$ 37,761	$ 127,144	$ 110,009

Business and Property Managem_2

Business and Property Management Agreements with RMR (Details) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024 USD ($) employee	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($) employee jointVenture_arrangement agreement	Sep. 30, 2023 USD ($)
Related person transactions
Number of employees | employee	0		0
Property management and construction supervision fees	$ 1,787	$ 2,209	$ 5,411	$ 6,403
Property management and construction supervision fees paid	4,007	3,671	11,448	10,765
RMR
Related person transactions
Business management fees incurred	11,249	3,692	19,255	10,283
Reversal of estimated incentive fees	6,934		$ 6,934
Period of actual amount of incentive fees			3 years
Property management and construction supervision fees	1,358	1,363	$ 4,342	4,226
Party transaction property management and construction supervision fees capitalized	$ 429	$ 846	$ 1,069	$ 2,177
Number joint venture arrangements | jointVenture_arrangement			2
Senior Living Communities | RMR
Related person transactions
Number of consecutive renewal terms of agreement | agreement			2

Related Person Transactions (De

Related Person Transactions (Details) $ / shares in Units, $ in Thousands			3 Months Ended		9 Months Ended
	Feb. 16, 2024 USD ($)	Feb. 02, 2023 $ / shares	Sep. 30, 2024 USD ($) agreement	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($) agreement	Sep. 30, 2023 USD ($)	Mar. 20, 2023
Related person transactions
Revenues			$ 373,640	$ 356,524	$ 1,115,808	$ 1,048,773
Rental income
Related person transactions
Revenues			61,635	63,390	187,155	191,201
Reit Management And Research L L C | Rental income
Related person transactions
Revenues			$ 97	$ 58	354	$ 132
AlerisLife Inc
Related person transactions
Step acquisition, ownership percentage including subsequent acquisition	34%
Purchase price	$ 14,890
Related Party | Reit Management And Research L L C
Related person transactions
Related party transaction, closing cost					$ 6,080
Number of management agreements | agreement			2		2
AlerisLife Inc
Related person transactions
Investment owned balance per shares | $ / shares		$ 1.31
AlerisLife Inc | Related Party
Related person transactions
Investment owned, percentage of total shares outstanding							31.90%
Diversified Healthcare Trust | ABP Trust And Adam D. Portnoy
Related person transactions
Noncontrolling interest, ownership percentage by parent			9.80%		9.80%
AlerisLife Inc | AlerisLife Inc
Related person transactions
Noncontrolling interest, ownership percentage by parent							6.10%
AlerisLife Inc | ABP Trust
Related person transactions
Ownership interest by parent	66%

Income Taxes (Details)

Income Taxes (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Income Tax Disclosure [Abstract]
Income tax expense (benefit)	$ 148	$ 189	$ 505	$ 379