Welltower (WELL) 10-Q 30 Oct 18 2018 Q3 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	9 Months Ended
	Sep. 30, 2018	Oct. 25, 2018
Document And Entity Information [Abstract]
Entity Registrant Name	WELLTOWER INC. /DE/
Entity Central Index Key	766,704
Document Type	10-Q
Document Period End Date	Sep. 30, 2018
Amendment Flag	false
Document Fiscal Year Focus	2,018
Document Fiscal Period Focus	Q3
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Entity Common Stock, Shares Outstanding		375,644,415

Consolidated Balance Sheets (Un

Consolidated Balance Sheets (Unaudited) - USD ($) $ in Thousands	Sep. 30, 2018	Dec. 31, 2017
Real property owned:
Land and land improvements	$ 3,193,555	$ 2,734,467
Buildings and improvements	27,980,830	25,373,117
Acquired lease intangibles	1,562,650	1,502,471
Real property held for sale, net of accumulated depreciation	619,141	734,147
Construction in progress	135,343	237,746
Gross real property owned	33,491,519	30,581,948
Less accumulated depreciation and amortization	(5,394,274)	(4,838,370)
Net real property owned	28,097,245	25,743,578
Real estate loans receivable:
Real estate loans receivable	409,196	495,871
Less allowance for losses on loans receivable	(68,372)	(68,372)
Net real estate loans receivable	340,824	427,499
Net real estate investments	28,438,069	26,171,077
Other assets:
Investments in unconsolidated entities	423,192	445,585
Goodwill	68,321	68,321
Cash and cash equivalents	191,199	243,777
Restricted cash	90,086	65,526
Straight-line rent receivable	388,045	389,168
Receivables and other assets	650,207	560,991
Total other assets	1,811,050	1,773,368
Total assets	30,249,119	27,944,445
Liabilities:
Borrowings under primary unsecured credit facility, Carrying Value	1,312,000	719,000
Senior unsecured notes	9,655,022	8,331,722
Secured debt	2,465,661	2,608,976
Capital lease obligations	71,377	72,238
Accrued expenses and other liabilities	1,074,994	911,863
Total liabilities	14,579,054	12,643,799
Redeemable noncontrolling interests	400,864	375,194
Equity:
Preferred stock	718,498	718,503
Common stock	376,353	372,449
Capital in excess of par value	17,889,514	17,662,681
Treasury stock	(68,753)	(64,559)
Cumulative net income	6,008,095	5,316,580
Cumulative dividends	(10,478,020)	(9,471,712)
Accumulated other comprehensive income (loss)	(138,491)	(111,465)
Other equity	489	670
Total Welltower Inc. stockholders’ equity	14,307,685	14,423,147
Noncontrolling interests	961,516	502,305
Total equity	15,269,201	14,925,452
Total liabilities and equity	$ 30,249,119	$ 27,944,445

Consolidated Statements of Inco

Consolidated Statements of Income (Unaudited) - USD ($) $ in Thousands		3 Months Ended		9 Months Ended
		Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Revenues:
Total revenues		$ 1,236,379	$ 1,091,483	$ 3,459,256	$ 3,212,383
Expenses:
Interest expense		138,032	122,578	382,223	357,405
Property operating expenses		657,157	523,997	1,782,373	1,536,021
Depreciation and amortization		243,149	230,138	707,625	683,262
General and administrative		28,746	29,913	95,282	93,643
Loss (gain) on derivatives and financial instruments, net		8,991	324	(5,642)	2,284
Loss (gain) on extinguishment of debt, net		4,038	0	16,044	36,870
Impairment of assets		6,740	0	39,557	24,662
Other expenses		88,626	99,595	102,396	117,608
Total expenses		1,175,479	1,006,545	3,119,858	2,851,755
Income (loss) from continuing operations before income taxes and income from unconsolidated entities, total		60,900	84,938	339,398	360,628
Income tax (expense) benefit		(1,741)	(669)	(7,170)	5,535
Income (loss) from unconsolidated entities		344	3,408	(836)	(23,676)
Income from continuing operations		59,503	87,677	331,392	342,487
Gain (loss) on real estate dispositions, net		24,723	1,622	373,662	287,869
Net income		84,226	89,299	705,054	630,356
Less: Preferred stock dividends		11,676	11,676	35,028	37,734
Less: Preferred stock redemption charge		0	0	0	9,769
Less: Net income (loss) attributable to noncontrolling interests	[1]	8,166	3,580	13,539	7,735
Net income (loss) attributable to common stockholders		$ 64,384	$ 74,043	$ 656,487	$ 575,118
Average number of common shares outstanding:
Basic (in shares)		373,023,000	369,089,000	372,052,000	366,096,000
Diluted (in shares)		374,487,000	370,740,000	373,638,000	367,894,000
Basic:
Income (loss) from continuing operations attributable to common stockholders, including real estate dispositions (in USD per share)		$ 0.16	$ 0.24	$ 0.89	$ 0.94
Net income (loss) attributable to common stockholders, total (in USD per share)		0.17	0.20	1.76	1.57
Diluted:
Income (loss) from continuing operations attributable to common stockholders, including real estate dispositions (in USD per share)		0.16	0.24	0.89	0.93
Net income (loss) attributable to common stockholders, total (in USD per share)		0.17	0.20	1.76	1.56
Dividends declared and paid per common share (in USD per share)		$ 0.87	$ 0.87	$ 2.6100	$ 2.6100
Rental income
Revenues:
Total revenues		$ 342,887	$ 362,880	$ 1,019,857	$ 1,085,621
Resident fees and services
Revenues:
Total revenues		875,171	702,380	2,374,450	2,049,757
Interest income
Revenues:
Total revenues		14,622	20,187	42,732	61,836
Other income
Revenues:
Total revenues		$ 3,699	$ 6,036	$ 22,217	$ 15,169
[1]	Includes amounts attributable to redeemable noncontrolling interests.

Consolidated Statements of Comp

Consolidated Statements of Comprehensive Income (Unaudited) - USD ($) $ in Thousands		3 Months Ended		9 Months Ended
		Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Statement of Comprehensive Income [Abstract]
Net income		$ 84,226	$ 89,299	$ 705,054	$ 630,356
Other comprehensive income (loss):
Unrecognized gain (loss) on available-for-sale securities		0	(3,808)	0	(20,285)
Unrealized gains (losses) on cash flow hedges		0	2	0	2
Foreign currency translation gain (loss)		(3,093)	37,343	(36,890)	70,769
Total other comprehensive income (loss)		(3,093)	33,537	(36,890)	50,486
Total comprehensive income (loss)		81,133	122,836	668,164	680,842
Less: Total comprehensive income (loss) attributable to noncontrolling interests(1)	[1]	10,933	14,732	3,675	29,930
Total comprehensive income (loss) attributable to common stockholders		$ 70,200	$ 108,104	$ 664,489	$ 650,912
[1]	Includes amounts attributable to redeemable noncontrolling interests.

Consolidated Statements of Equi

Consolidated Statements of Equity (Unaudited) - USD ($) $ in Thousands	Total	Preferred Stock	Common Stock	Capital in Excess of Par Value	Treasury Stock	Cumulative Net Income	Cumulative Dividends	Accumulated Other Comprehensive Income (Loss)	Other Equity	Noncontrolling Interests
Balances at beginning of period at Dec. 31, 2016	$ 15,281,472	$ 1,006,250	$ 363,071	$ 16,999,691	$ (54,741)	$ 4,803,575	$ (8,144,981)	$ (169,531)	$ 3,059	$ 475,079
Comprehensive income:
Net income (loss)	632,528					622,621				9,907
Other comprehensive income	50,486							28,291		22,195
Total comprehensive income	683,014
Increase in noncontrolling interests	17,342			9,784						7,558
Amounts related to stock incentive plans, net of forfeitures	7,935		337	17,151	(7,611)				(1,942)
Proceeds from issuance of common stock	530,467		7,513	522,954
Redemption of preferred stock	(287,509)	(287,500)		9,760		(9,769)
Redemption of equity membership units	5,545		91	5,465	(11)
Conversion of preferred stock	(247)	(247)
Option compensation expense	10								10
Cash dividends paid:
Common stock dividends	(955,631)						(955,631)
Preferred stock dividends	(37,734)						(37,734)
Balances at end of period at Sep. 30, 2017	15,244,664	718,503	371,012	17,564,805	(62,363)	5,416,427	(9,138,346)	(141,240)	1,127	514,739
Balances at beginning of period at Dec. 31, 2017	14,925,452	718,503	372,449	17,662,681	(64,559)	5,316,580	(9,471,712)	(111,465)	670	502,305
Comprehensive income:
Net income (loss)	706,908					691,515				15,393
Other comprehensive income	(36,890)							(27,026)		(9,864)
Total comprehensive income	670,018
Increase in noncontrolling interests	419,543									453,682
Decrease in noncontrolling interests				(34,139)
Amounts related to stock incentive plans, net of forfeitures	18,924		172	23,127	(4,194)				(181)
Proceeds from issuance of common stock	241,572		3,732	237,840
Conversion of preferred stock	0	(5)		5
Cash dividends paid:
Common stock dividends	(971,280)						(971,280)
Preferred stock dividends	(35,028)						(35,028)
Balances at end of period at Sep. 30, 2018	$ 15,269,201	$ 718,498	$ 376,353	$ 17,889,514	$ (68,753)	$ 6,008,095	$ (10,478,020)	$ (138,491)	$ 489	$ 961,516

Consolidated Statements of Cash

Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2018		Sep. 30, 2017
Operating activities:
Net income	$ 705,054		$ 630,356
Adjustments to reconcile net income to net cash provided from (used in) operating activities:
Depreciation and amortization	707,625		683,262
Other amortization expenses	12,110		12,095
Impairment of assets	39,557		24,662
Stock-based compensation expense	22,800		16,459
Loss (gain) on derivatives and financial instruments, net	(5,642)		2,284
Loss (gain) on extinguishment of debt, net	16,044		36,870
Loss (income) from unconsolidated entities	836		23,676
Rental income less than (in excess of) cash received	(7,830)		(64,865)
Amortization related to above (below) market leases, net	1,984		180
Loss (gain) on real estate dispositions, net	(373,662)		(287,869)
Distributions by unconsolidated entities	21		116
Increase (decrease) in accrued expenses and other liabilities	103,474		171,713
Decrease (increase) in receivables and other assets	(11,223)		(86,475)
Net cash provided from (used in) operating activities	1,211,148		1,162,464
Investing activities:
Cash disbursed for acquisitions	(3,190,534)		(574,002)
Cash disbursed for capital improvements to existing properties	(173,635)		(159,142)
Cash disbursed for construction in progress	(88,146)		(198,068)
Capitalized interest	(6,357)		(10,033)
Investment in real estate loans receivable	(67,136)		(70,051)
Principal collected on real estate loans receivable	149,592		82,263
Other investments, net of payments	(49,572)		50,877
Contributions to unconsolidated entities	(42,697)		(73,802)
Distributions by unconsolidated entities	61,253		58,754
Proceeds from (payments on) derivatives	65,438		55,771
Proceeds from sales of real property	1,208,501		1,237,851
Net cash provided from (used in) investing activities	(2,133,293)		400,418
Financing activities:
Net increase (decrease) under unsecured credit facilities	593,000		(225,000)
Proceeds from issuance of senior unsecured notes	2,825,898		7,500
Payments to extinguish senior unsecured notes	(1,450,000)		(5,000)
Net proceeds from the issuance of secured debt	44,606		190,459
Payments on secured debt	(238,867)		(1,050,879)
Net proceeds from the issuance of common stock	242,411		530,992
Redemption of preferred stock	0		(287,500)
Payments for deferred financing costs and prepayment penalties	(29,701)		(54,027)
Contributions by noncontrolling interests(1)	11,238	[1]	47,209
Distributions to noncontrolling interests(1)	(86,462)	[1]	(51,824)
Cash distributions to stockholders	(1,006,274)		(992,621)
Other financing activities	(6,290)		(8,416)
Net cash provided from (used in) financing activities	899,559		(1,899,107)
Effect of foreign currency translation on cash, cash equivalents and restricted cash	(5,432)		24,316
Increase (decrease) in cash, cash equivalents and restricted cash	(28,018)		(311,909)
Cash, cash equivalents and restricted cash at beginning of period	309,303		607,220
Cash, cash equivalents and restricted cash at end of period	281,285		295,311
Supplemental cash flow information:
Interest paid	312,452		312,896
Income taxes paid (received), net	$ 3,195		$ 5,606
[1]	Includes amounts attributable to redeemable noncontrolling interests.

Business

Business	9 Months Ended
	Sep. 30, 2018
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Business	Business Welltower Inc., an S&P 500 company headquartered in Toledo, Ohio, is driving the transformation of health care infrastructure. The company invests with leading seniors housing operators, post-acute providers and health systems to fund the real estate and infrastructure needed to scale innovative care delivery models and improve people’s wellness and overall health care experience. Welltower™, a real estate investment trust (“REIT”), owns interests in properties concentrated in major, high-growth markets in the United States, Canada and the United Kingdom, consisting of seniors housing and post-acute communities and outpatient medical properties.

Accounting Policies and Related

Accounting Policies and Related Matters	9 Months Ended
	Sep. 30, 2018
Accounting Policies [Abstract]
Accounting Policies and Related Matters	Accounting Policies and Related Matters Basis of Presentation The accompanying unaudited consolidated financial statements have been prepared in accordance with U.S. generally accepted accounting principles (“U.S. GAAP”) for interim financial information and with instructions to Quarterly Report on Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all of the information and footnotes required by U.S. GAAP for complete financial statements. In the opinion of management, all adjustments (such as normal recurring accruals) considered necessary for a fair presentation have been included. Operating results for the nine months ended September 30, 2018 are not necessarily an indication of the results that may be expected for the year ending December 31, 2018. For further information, refer to the financial statements and notes thereto included in our Annual Report on Form 10-K for the year ended December 31, 2017. New Accounting Standards We adopted the following accounting standards, each of which did not have a material impact on our consolidated financial statements: • In 2014, the Financial Accounting Standards Board (the “FASB”) issued Accounting Standards Update (“ASU”) No. 2014-09, “Revenue from Contracts with Customers (ASC 606),” which is a comprehensive new revenue recognition model that requires revenue to be recognized in a manner to depict the transfer of goods or services to a customer at an amount that reflects the consideration expected to be received in exchange for those goods or services. We adopted ASC 606 on January 1, 2018 using the modified retrospective method of adoption. This guidance did not have a significant impact on our consolidated financial statements. We have evaluated our various revenue streams to identify whether they would be subject to the provisions of ASC 606 and any differences in timing, measurement or presentation of revenue recognition. A significant source of our revenue is generated through leasing arrangements, which are specifically excluded from ASC 606. Management contracts are present in our seniors housing operating and outpatient medical segments and represent agreements to provide asset and property management, leasing, marketing and other services. Under ASC 606, the pattern and timing of recognition of income from these contracts is consistent with the prior accounting model. • In 2017, the FASB issued ASU No. 2017-05, “Other Income – Gains and Losses from the Derecognition of Nonfinancial Assets (Subtopic 610-20): Clarifying the Scope of Asset Derecognition Guidance and Accounting for Partial Sales of Nonfinancial Assets.” The standard clarifies that a financial asset is within the scope of Subtopic 610-20 if it meets the definition of an in substance nonfinancial asset. The standard also defines the term “in substance nonfinancial asset” and clarifies that an entity should identify each distinct nonfinancial asset or in substance nonfinancial asset promised to a counterparty and derecognize each asset when a counterparty obtains control over it. We adopted Subtopic 610-20 using a modified retrospective approach on January 1, 2018 and it did not have a material impact on our consolidated financial statements. • In 2016, the FASB issued ASU No. 2016-01, “Financial Instruments – Overall: Recognition and Measurement of Financial Assets and Financial Liabilities,” which requires entities to measure their investments at fair value and recognize any changes in fair value in net income unless the investments qualify for the new practicability exception. The practicability exception is available for equity investments that do not have readily determinable fair values. This standard requires us to recognize gains and losses from changes in the fair value of our available-for-sale equity securities through the consolidated statement of comprehensive income rather than through accumulated other comprehensive income. During the nine months ended September 30, 2018 , we recognized a gain of $5,642,000 in loss (gain) on derivatives and financial instruments, net on the Consolidated Statement of Comprehensive Income. There was no adjustment to accumulated other comprehensive income upon adoption at January 1, 2018 as accumulated losses were recognized as other-than-temporary impairment during the year ended December 31, 2017. • As of December 31, 2017, we adopted ASU No. 2016-18, “Restricted Cash,” and ASU No. 2016-15, “Classification of Certain Cash Receipts and Cash Payments.” ASU No. 2016-18 requires an entity to reconcile and explain the period over period change in total cash, cash equivalents and restricted cash within its consolidated statement of cash flows and ASU 2016-15 provides guidance clarifying how certain cash receipts and cash payments should be classified. We adopted these accounting standards retrospectively and, accordingly, certain line items in the consolidated statement of cash flows have been reclassified to conform to the current presentation. The following table summarizes the change in cash flows as reported and as previously reported prior to the adoption of these standards for the nine months ended September 30, 2017 (in thousands): As Reported As Previously Reported Cash disbursed for acquisitions $ (574,002 ) $ (575,694 ) Decrease (increase) in restricted cash — 130,470 Net cash provided from (used in) investing activities 400,418 529,196 Increase (decrease) in balance (1) (311,909 ) (183,131 ) Balance at beginning of period (1) 607,220 419,378 Balance at end of period (1) 295,311 236,247 (1) Amounts in As Reported column include cash and cash equivalents and restricted cash as required. Amounts in the As Previously Reported column reflect only cash and cash equivalents. • In August 2017, the FASB issued ASU 2017-12, “Derivatives and Hedging: Targeted Improvements to Accounting for Hedging Activities,” which expands and refines hedge accounting for both nonfinancial and financial risk components and aligns the recognition and presentation of the effects of the hedging instrument and the hedged item in the financial statements. It also includes certain targeted improvements to simplify the application of current guidance related to hedge accounting. The early adoption of this standard on April 1, 2018, did not result in a cumulative effect adjustment and all applicable changes for the company were prospectively made. Please refer to Note 11 of the consolidated financial statements for additional detail on this adoption. The following ASUs have been issued but not yet adopted: • In 2016, the FASB issued ASU No. 2016-02, “Leases (Topic 842),” which requires lessees to recognize assets and liabilities on their consolidated balance sheet related to the rights and obligations created by most leases, while continuing to recognize expenses on their consolidated statements of comprehensive income over the lease term. It will also require disclosures designed to give financial statement users information regarding amount, timing, and uncertainty of cash flows arising from leases. The FASB issued ASU 2018-11, "Leases (Topic 842) Targeted Improvements" in July 2018, which provides lessors with a practical expedient, by class of underlying assets, to not separate non-lease components from the related lease components, and, instead, to account for those components as a single lease component, if certain criteria are met. ASU 2016-02 is effective for us beginning January 1, 2019, with early adoption permitted. Entities are required to use a modified retrospective approach for leases that exist or are entered into after the beginning of the earliest comparative period in the consolidated financial statements. ASU 2018-11 also provides a practical expedient that allows companies to use an optional transition method. Under the optional transition method, a cumulative adjustment to retained earnings during the period of adoption is recorded and prior periods would not require restatement. We are currently evaluating the impact of this guidance on our consolidated financial statements from both the lessee and lessor perspective. We believe that adoption will likely have a material impact to our consolidated financial statements for the recognition of certain operating leases as right-of-use assets and lease liabilities and related amortization. We expect to utilize the practical expedients in ASU 2018-11 as part of our adoption of this guidance. • In 2016, the FASB issued ASU No. 2016-13, “Measurement of Credit Losses on Financial Instruments.” This standard requires a new forward-looking “expected loss” model to be used for receivables, held-to-maturity debt, loans, and other instruments. ASU 2016-13 is effective for fiscal years, and interim periods within those years, beginning after December 15, 2019, and early adoption is permitted for fiscal years beginning after December 15, 2018. We are currently evaluating the impact that the standard will have on our consolidated financial statements.

Real Property Acquisitions and

Real Property Acquisitions and Development	9 Months Ended
	Sep. 30, 2018
Real Estate Liabilities Associated with Assets Held for Development and Sale [Abstract]
Real Property Acquisitions and Development	Real Property Acquisitions and Development The total purchase price for all properties acquired has been allocated to the tangible and identifiable intangible assets, liabilities and noncontrolling interests based upon their relative fair values in accordance with our accounting policies. The results of operations for these acquisitions have been included in our consolidated results of operations since the date of acquisition and are a component of the appropriate segments. Transaction costs primarily represent costs incurred with acquisitions, including due diligence costs, fees for legal and valuation services and termination of pre-existing relationships computed based on the fair value of the assets acquired, lease termination fees and other acquisition-related costs. Transaction costs related to asset acquisitions are capitalized as a component of purchase price and all other non-capitalizable costs are reflected in “Other expenses” on our Consolidated Statements of Comprehensive Income. Certain of our subsidiaries’ functional currencies are the local currencies of their respective countries. Acquisition of Quality Care Properties On July 26, 2018, we completed the acquisition of Quality Care Properties Inc. ("QCP"), with QCP shareholders receiving $20.75 of cash for each share of QCP common stock and all existing QCP debt was repaid upon closing. Prior to the acquisition, ProMedica Health System ("ProMedica") completed the acquisition of HCR ManorCare. Immediately following the acquisition of QCP, we formed an 80 / 20 joint venture with ProMedica to own the real estate associated with the 218 seniors housing properties leased to ProMedica under a lease agreement with the following key terms: (i) 15 -year absolute triple-net master lease with three five -year renewal options; (ii) initial annual cash rent of $179 million with a year one escalator of 1.375% and 2.75% annual escalators thereafter; and (iii) full corporate guarantee of ProMedica. Additionally, we acquired 59 seniors housing properties classified as held for sale and leased to ProMedica under a non-yielding lease, 12 seniors housing properties and one surgery center classified as held for sale and leased to operators under existing triple-net leases, 14 seniors housing properties leased to operators under existing triple-net leases and one multi-tenant medical office building leased to various tenants. We drew on a $1.0 billion term loan facility to fund a portion of the acquisition cash consideration and other related expenses. The term loan facility matures two years from the closing. In addition to the term loan facility draw, we drew on our unsecured credit facility described in Note 9, in order to fund the acquisition. The aggregate consideration to acquire the QCP shares and repay outstanding QCP debt was approximately $3.5 billion. We concluded that the QCP acquisition met the definition of an asset acquisition under ASU No. 2017-01, "Clarifying the Definition of a Business". The following table presents the purchase price calculation and the allocation to assets acquired and liabilities assumed based upon their relative fair value: (In thousands) Land and land improvements $ 417,983 Buildings and improvements 2,249,803 Acquired lease intangibles 15,512 Real property held for sale 418,297 Cash and cash equivalents 381,913 Restricted cash 4,981 Receivables and other assets 1,322 Total assets acquired 3,489,811 Accrued expenses and other liabilities (13,199 ) Total liabilities assumed (13,199 ) Noncontrolling interests (512,741 ) Net assets acquired $ 2,963,871 Net assets acquired in the QCP acquisition detailed above are included in the respective segment tables below. Triple-net Activity Nine Months Ended (In thousands) September 30, 2018 September 30, 2017 Land and land improvements $ 413,588 $ 31,948 Buildings and improvements 2,239,422 206,910 Acquired lease intangibles 12,383 — Real property held for sale 396,265 — Receivables and other assets 1,322 — Total assets acquired (1) 3,062,980 238,858 Accrued expenses and other liabilities (13,199 ) (21,236 ) Total liabilities assumed (13,199 ) (21,236 ) Noncontrolling interests (512,741 ) (7,275 ) Non-cash acquisition related activity (2) — (54,901 ) Cash disbursed for acquisitions 2,537,040 155,446 Construction in progress additions 49,619 106,186 Less: Capitalized interest (1,932 ) (3,886 ) Foreign currency translation 180 (656 ) Cash disbursed for construction in progress 47,867 101,644 Capital improvements to existing properties 6,766 17,873 Total cash invested in real property, net of cash acquired $ 2,591,673 $ 274,963 (1) Excludes $386,894,000 of unrestricted and restricted cash acquired during the nine months ended September 30, 2018 . (2) For the nine months ended September 30, 2017 , $ 54,901,000 is related to the acquisition of assets previously financed as a real estate loan receivable. Seniors Housing Operating Activity Nine Months Ended (In thousands) September 30, 2018 September 30, 2017 Land and land improvements $ 47,865 $ 31,006 Building and improvements 535,436 384,522 Acquired lease intangibles 68,084 48,197 Receivables and other assets 1,255 3,164 Total assets acquired (1) 652,640 466,889 Secured debt (89,973 ) — Accrued expenses and other liabilities (14,686 ) (43,364 ) Total liabilities assumed (104,659 ) (43,364 ) Noncontrolling interests (9,818 ) (4,701 ) Non-cash acquisition related activity (2) — (59,065 ) Cash disbursed for acquisitions 538,163 359,759 Construction in progress additions 28,222 65,282 Less: Capitalized interest (2,608 ) (5,996 ) Foreign currency translation 2,151 (6,218 ) Cash disbursed for construction in progress 27,765 53,068 Capital improvements to existing properties 127,274 110,372 Total cash invested in real property, net of cash acquired $ 693,202 $ 523,199 (1) Excludes $2,442,000 and $6,273,000 of unrestricted and restricted cash acquired during the nine months ended September 30, 2018 and 2017 , respectively. (2) Includes $6,349,000 related to the acquisition of assets previously financed as real estate loans receivable and $51,097,000 previously financed as an investment in an unconsolidated entity during the nine months ended September 30, 2017 . Outpatient Medical Activity Nine Months Ended (In thousands) September 30, 2018 September 30, 2017 Land and land improvements $ 18,496 $ 25,060 Buildings and improvements 79,205 62,336 Acquired lease intangibles 11,271 8,397 Real property held for sale 22,032 — Receivables and other assets 6 3 Total assets acquired (1) 131,010 95,796 Secured debt (14,769 ) (25,709 ) Accrued expenses and other liabilities (910 ) (2,210 ) Total liabilities assumed (15,679 ) (27,919 ) Noncontrolling interests — (9,080 ) Cash disbursed for acquisitions 115,331 58,797 Construction in progress additions 16,733 33,495 Less: Capitalized interest (1,817 ) (1,847 ) Accruals (2) (2,402 ) 11,708 Cash disbursed for construction in progress 12,514 43,356 Capital improvements to existing properties 39,595 30,897 Total cash invested in real property $ 167,440 $ 133,050 (1) Excludes $2,244,000 and $ 0 of unrestricted and restricted cash acquired during the nine months ended September 30, 2018 and 2017 , respectively. (2) Represents non-cash accruals for amounts to be paid in future periods for properties that converted, off-set by amounts paid in the current period. Construction Activity The following is a summary of the construction projects that were placed into service and began generating revenues during the periods presented (in thousands): Nine Months Ended September 30, 2018 September 30, 2017 Development projects: Triple-net $ 90,055 $ 283,472 Seniors housing operating 86,931 3,634 Outpatient medical 11,358 63,036 Total development projects 188,344 350,142 Expansion projects 8,879 10,336 Total construction in progress conversions $ 197,223 $ 360,478

Real Estate Intangibles

Real Estate Intangibles	9 Months Ended
	Sep. 30, 2018
Intangible Assets, Net (Excluding Goodwill) [Abstract]
Real Estate Intangibles	Real Estate Intangibles The following is a summary of our real estate intangibles, excluding those classified as held for sale, as of the dates indicated (dollars in thousands): September 30, 2018 December 31, 2017 Assets: In place lease intangibles $ 1,398,850 $ 1,352,139 Above market tenant leases 59,011 58,443 Below market ground leases 65,022 58,784 Lease commissions 39,767 33,105 Gross historical cost 1,562,650 1,502,471 Accumulated amortization (1,190,035 ) (1,125,437 ) Net book value $ 372,615 $ 377,034 Weighted-average amortization period in years 16.0 15.1 Liabilities: Below market tenant leases $ 71,566 $ 60,430 Above market ground leases 8,540 8,540 Gross historical cost 80,106 68,970 Accumulated amortization (42,834 ) (39,629 ) Net book value $ 37,272 $ 29,341 Weighted-average amortization period in years 16.1 20.1 The following is a summary of real estate intangible amortization for the periods presented (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2018 2017 2018 2017 Rental income related to above/below market tenant leases, net $ (294 ) $ 173 $ (978 ) $ 745 Property operating expenses related to above/below market ground leases, net (327 ) (306 ) (1,006 ) (925 ) Depreciation and amortization related to in place lease intangibles and lease commissions (31,455 ) (34,270 ) (97,479 ) (109,011 ) The future estimated aggregate amortization of intangible assets and liabilities is as follows for the periods presented (in thousands): Assets Liabilities 2018 $ 32,456 $ 1,433 2019 87,011 5,437 2020 57,221 4,938 2021 24,300 4,444 2022 19,325 3,971 Thereafter 152,302 17,049 Total $ 372,615 $ 37,272

Dispositions and Assets Held fo

Dispositions and Assets Held for Sale	9 Months Ended
	Sep. 30, 2018
Discontinued Operations and Disposal Groups [Abstract]
Dispositions and Assets Held for Sale	Dispositions and Assets Held for Sale We periodically sell properties for various reasons, including favorable market conditions, the exercise of tenant purchase options or reduction of concentrations (e.g., property type, relationship or geography). At September 30, 2018 , 60 triple-net, 16 seniors housing operating and three outpatient medical properties with an aggregate real estate balance of $ 619,141,000 were classified as held for sale. During the nine months ended September 30, 2018 , we recorded impairment charges of $ 39,557,000 on certain held for sale properties for which the carrying values exceeded the fair values, less estimated costs to sell if applicable. The following is a summary of our real property disposition activity for the periods presented (in thousands): Nine Months Ended September 30, 2018 September 30, 2017 Real estate dispositions: Triple-net $ 604,480 $ 899,104 Seniors housing operating 2,200 16,206 Outpatient medical 223,069 12,202 Total dispositions 829,749 927,512 Gain (loss) on real estate dispositions, net 373,662 287,869 Net other assets/liabilities disposed 5,090 22,470 Proceeds from real estate dispositions $ 1,208,501 $ 1,237,851 Dispositions and Assets Held for Sale Pursuant to our adoption of ASU No. 2014-08, “Presentation of Financial Statements (Topic 205) and Property, Plant and Equipment (Topic 360): Reporting Discontinued Operations and Disclosures of Disposals of Components of an Entity”, operating results attributable to properties sold subsequent to or classified as held for sale after January 1, 2014 and which do not meet the definition of discontinued operations are no longer reclassified on our Consolidated Statements of Comprehensive Income. The following represents the activity related to these properties for the periods presented (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2018 2017 2018 2017 Revenues: Total revenues $ 29,035 $ 52,584 $ 92,447 $ 175,934 Expenses: Interest expense 18 1,243 261 5,514 Property operating expenses 21,312 19,147 59,640 58,525 Provision for depreciation 801 10,999 6,605 33,806 Total expenses 22,131 31,389 66,506 97,845 Income (loss) from real estate dispositions, net $ 6,904 $ 21,195 $ 25,941 $ 78,089

Real Estate Loans Receivable

Real Estate Loans Receivable	9 Months Ended
	Sep. 30, 2018
Mortgage Loans on Real Estate, Commercial and Consumer, Net, (Investment Based Operations Presentation) [Abstract]
Real Estate Loans Receivable	Real Estate Loans Receivable Please see Note 2 to the financial statements included in our Annual Report on Form 10-K for the year ended December 31, 2017 for discussion of our accounting policies for real estate loans receivable and related interest income. The following is a summary of our real estate loan activity for the periods presented (in thousands): Nine Months Ended September 30, 2018 September 30, 2017 Triple-net Seniors Housing Operating Outpatient Totals Triple-net Outpatient Totals Advances on real estate loans receivable: Investments in new loans $ 10,628 $ 11,806 $ 14,993 $ 37,427 $ 11,315 $ — $ 11,315 Draws on existing loans 29,709 — — 29,709 58,736 — 58,736 Net cash advances on real estate loans 40,337 11,806 14,993 67,136 70,051 — 70,051 Receipts on real estate loans receivable: Loan payoffs 116,161 — — 116,161 142,392 60,500 202,892 Principal payments on loans 33,431 — — 33,431 1,121 — 1,121 Sub-total 149,592 — — 149,592 143,513 60,500 204,013 Less: Non-cash activity (1) — — — — (61,250 ) (60,500 ) (121,750 ) Net cash receipts on real estate loans 149,592 — — 149,592 82,263 — 82,263 Net cash advances (receipts) on real estate loans $ (109,255 ) $ 11,806 $ 14,993 $ (82,456 ) $ (12,212 ) $ — $ (12,212 ) (1) Triple-net represents acquisitions of assets previously financed as real estate loans. Please see Note 3 for additional information. Outpatient medical represents a deed in lieu of foreclosure on a previously financed first mortgage property. In 2016, we restructured real estate loans with Genesis HealthCare and recorded a loan loss charge in the amount of $ 6,935,000 on one of the loans as the present value of expected future cash flows was less than the carrying value of the loan. In 2017, we recorded an additional loan loss charge of $ 62,966,000 relating to real estate loans with Genesis HealthCare based on an estimation of expected future cash flows discounted at the effective interest rate of the loans. At September 30, 2018 , the allowance for loan losses totals $ 68,372,000 and is deemed to be sufficient to absorb expected losses related to these loans. At September 30, 2018 , we had one real estate loan with an outstanding balance of $ 2,598,000 on non-accrual status and recorded no provision for loan losses during the nine months ended September 30, 2018 . The following is a summary of our impaired loans (in thousands): Nine Months Ended September 30, 2018 September 30, 2017 Balance of impaired loans at end of period $ 201,971 $ 282,929 Allowance for loan losses 68,372 5,406 Balance of impaired loans not reserved $ 133,599 $ 277,523 Average impaired loans for the period $ 230,645 $ 324,255 Interest recognized on impaired loans (1) 13,361 23,957 (1) Represents cash interest recognized in the period since loans were identified as impaired.

Investments in Unconsolidated E

Investments in Unconsolidated Entities	9 Months Ended
	Sep. 30, 2018
Real Estate Investments, Net [Abstract]
Investments in Unconsolidated Entities	Investments in Unconsolidated Entities We participate in a number of joint ventures, which generally invest in seniors housing and health care real estate. The results of operations for these entities have been included in our consolidated results of operations from the date of acquisition by the joint ventures and are reflected in our Consolidated Statements of Comprehensive Income as income or loss from unconsolidated entities. The following is a summary of our investments in unconsolidated entities (dollars in thousands): Percentage Ownership (1) September 30, 2018 December 31, 2017 Triple-net 10% to 49% $ 21,004 $ 22,856 Seniors housing operating 10% to 50% 310,175 352,430 Outpatient medical 43% 92,013 70,299 Total $ 423,192 $ 445,585 (1) Excludes in-substance real estate investments. At September 30, 2018 , the aggregate unamortized basis difference of our joint venture investments of $ 106,625,000 is primarily attributable to the difference between the amount for which we purchase our interest in the entity, including transaction costs, and the historical carrying value of the net assets of the joint venture. This difference is being amortized over the remaining useful life of the related properties and included in the reported amount of income from unconsolidated entities.

Credit Concentration

Credit Concentration	9 Months Ended
	Sep. 30, 2018
Concentration Risks, Types, No Concentration Percentage [Abstract]
Credit Concentration	Credit Concentration We use consolidated net operating income (“NOI”) as our credit concentration metric. See Note 17 for additional information and reconciliation. The following table summarizes certain information about our credit concentration for the nine months ended September 30, 2018 , excluding our share of NOI in unconsolidated entities (dollars in thousands): Number of Total Percent of Concentration by relationship: (1) Properties NOI NOI (2) Sunrise Senior Living (3) 161 $ 252,111 15% Brookdale Senior Living 137 117,367 7% Revera (3) 98 116,158 7% Genesis HealthCare 88 102,015 6% Benchmark Senior Living 48 75,435 4% Remaining portfolio 997 1,013,797 61% Totals 1,529 $ 1,676,883 100% (1) Genesis Healthcare is in our triple-net segment. Sunrise Senior Living and Revera are in our seniors housing operating segment. Benchmark Senior Living and Brookdale Senior Living are in both our triple-net and seniors housing operating segments. (2) NOI with our top five relationships comprised 41% of total NOI for the year ended December 31, 2017. (3) Revera owns a controlling interest in Sunrise Senior Living.

Borrowings Under Credit Facilit

Borrowings Under Credit Facilities and Related Items	9 Months Ended
	Sep. 30, 2018
Line of Credit Facility [Abstract]
Borrowings Under Credit Facilities and Related Items	Borrowings Under Credit Facilities and Related Items At September 30, 2018 , we had a primary unsecured credit facility with a consortium of 31 banks that includes a $ 3,000,000,000 unsecured revolving credit facility, a $ 500,000,000 unsecured term credit facility and a $ 250,000,000 Canadian-denominated unsecured term credit facility. We have an option, through an accordion feature, to upsize the unsecured revolving credit facility and the $ 500,000,000 unsecured term credit facility by up to an additional $ 1,000,000,000 , in the aggregate, and the $ 250,000,000 Canadian-denominated unsecured term credit facility by up to an additional $ 250,000,000 . The primary unsecured credit facility also allows us to borrow up to $ 1,000,000,000 in alternate currencies (none outstanding at September 30, 2018 ). Borrowings under the unsecured revolving credit facility are subject to interest payable at the applicable margin over LIBOR interest rate ( 3.09% at September 30, 2018 ). The applicable margin is based on our debt ratings and was 0.825% at September 30, 2018 . In addition, we pay a facility fee quarterly to each bank based on the bank’s commitment amount. The facility fee depends on our debt ratings and was 0.15% at September 30, 2018 . The term credit facilities mature on July 19, 2023 . The revolving credit facility is scheduled to mature on July 19, 2022 and can be extended for two successive terms of six months each at our option. The following information relates to aggregate borrowings under the primary unsecured revolving credit facility for the periods presented (dollars in thousands): Three Months Ended Nine Months Ended September 30, September 30, 2018 2017 2018 2017 Balance outstanding at quarter end $ 1,312,000 $ 420,000 $ 1,312,000 $ 420,000 Maximum amount outstanding at any month end $ 2,148,000 $ 645,000 $ 2,148,000 $ 1,010,000 Average amount outstanding (total of daily principal balances divided by days in period) $ 1,519,000 $ 450,130 $ 819,516 $ 601,346 Weighted average interest rate (actual interest expense divided by average borrowings outstanding) 3.00 % 2.19 % 2.95 % 1.95 %

Senior Unsecured Notes and Secu

Senior Unsecured Notes and Secured Debt	9 Months Ended
	Sep. 30, 2018
Long-term Debt, by Current and Noncurrent [Abstract]
Senior Unsecured Notes and Secured Debt	Senior Unsecured Notes and Secured Debt We may repurchase, redeem or refinance senior unsecured notes from time to time, taking advantage of favorable market conditions when available. We may purchase senior notes for cash through open market purchases, privately negotiated transactions, a tender offer or, in some cases, through the early redemption of such securities pursuant to their terms. The senior unsecured notes are redeemable at our option, at any time in whole or from time to time in part, at a redemption price equal to the sum of (1) the principal amount of the notes (or portion of such notes) being redeemed plus accrued and unpaid interest thereon up to the redemption date and (2) any “make-whole” amount due under the terms of the notes in connection with early redemptions. Redemptions and repurchases of debt, if any, will depend on prevailing market conditions, our liquidity requirements, contractual restrictions and other factors. At September 30, 2018 , the annual principal payments due on these debt obligations were as follows (in thousands): Senior Unsecured Notes (1,2) Secured Debt (1,3) Totals 2018 $ — $ 170,742 $ 170,742 2019 600,000 489,166 1,089,166 2020 (4) 689,662 138,938 828,600 2021 450,000 347,280 797,280 2022 600,000 225,832 825,832 Thereafter (5,6,7,8) 7,414,034 1,107,797 8,521,831 Totals $ 9,753,696 $ 2,479,755 $ 12,233,451 (1) Amounts represent principal amounts due and do not include unamortized premiums/discounts, debt issuance costs, or other fair value adjustments as reflected on the balance sheet. (2) Annual interest rates range from 2.73% to 6.50% . (3) Annual interest rates range from 1.69% to 7.93% . Carrying value of the properties securing the debt totaled $5,303,414,000 at September 30, 2018 . (4) Includes a $300,000,000 Canadian-denominated 3.35% senior unsecured notes due 2020 (approximately $232,162,000 based on the Canadian/U.S. Dollar exchange rate on September 30, 2018 ). (5) Includes a $250,000,000 Canadian-denominated unsecured term credit facility (approximately $193,469,000 based on the Canadian/U.S. Dollar exchange rate on September 30, 2018 ). The loan matures on July 19, 2023 and bears interest at the Canadian Dealer Offered Rate plus 0.9% ( 2.73% at September 30, 2018 ). (6) Includes a $500,000,000 unsecured term credit facility. The loan matures on July 19, 2023 and bears interest at LIBOR plus 0.9% ( 3.07% at September 30, 2018 ). (7) Includes a £550,000,000 4.80% senior unsecured notes due 2028 (approximately $717,915,000 based on the Sterling/U.S. Dollar exchange rate in effect on September 30, 2018 ). (8) Includes a £500,000,000 4.50% senior unsecured notes due 2034 (approximately $652,650,000 based on the Sterling/U.S. Dollar exchange rate in effect on September 30, 2018 ). The following is a summary of our senior unsecured notes principal activity during the periods presented (dollars in thousands): Nine Months Ended September 30, 2018 September 30, 2017 Weighted Avg. Weighted Avg. Amount Interest Rate Amount Interest Rate Beginning balance $ 8,417,447 4.31% $ 8,260,038 4.25% Debt issued 2,850,000 4.57% 7,500 1.94% Debt extinguished (1,450,000 ) 3.46% (5,000 ) 1.83% Foreign currency (63,751 ) 4.30% 141,855 4.24% Ending balance $ 9,753,696 4.45% $ 8,404,393 4.29% The following is a summary of our secured debt principal activity for the periods presented (dollars in thousands): Nine Months Ended September 30, 2018 September 30, 2017 Weighted Avg. Weighted Avg. Amount Interest Rate Amount Interest Rate Beginning balance $ 2,618,408 3.76% $ 3,465,066 4.09% Debt issued 44,606 3.38% 190,459 2.73% Debt assumed 99,552 4.30% 23,094 6.67% Debt extinguished (196,573 ) 5.66% (1,003,372 ) 5.32% Principal payments (42,294 ) 3.91% (47,507 ) 4.34% Foreign currency (43,944 ) 3.29% 92,262 3.20% Ending balance $ 2,479,755 3.79% $ 2,720,002 3.74% Our debt agreements contain various covenants, restrictions and events of default. Certain agreements require us to maintain certain financial ratios and minimum net worth and impose certain limits on our ability to incur indebtedness, create liens and make investments or acquisitions. As of September 30, 2018 , we were in compliance with all of the covenants under our debt agreements.

Derivative Instruments

Derivative Instruments	9 Months Ended
	Sep. 30, 2018
Summary of Derivative Instruments [Abstract]
Derivative Instruments	Derivative Instruments We are exposed to, among other risks, the impact of changes in foreign currency exchange rates as a result of our non-U.S. investments. Our risk management program is designed to manage the exposure and volatility arising from these risks, and utilizes derivative financial instruments and debt issued in foreign currencies to offset a portion of these risks. Foreign Currency Forward Contracts Designated as Cash Flow Hedges For instruments that are designated and qualify as a cash flow hedge, the effective portion of the gain or loss on the derivative is deferred as a component of other comprehensive income (“OCI”), and reclassified into earnings in the same period or periods, during which the hedged transaction affects earnings. Gains and losses on the derivative representing either hedge ineffectiveness or hedge components excluded from the assessment of effectiveness are recognized in earnings. Foreign Currency Forward Contracts and Cross Currency Swap Contracts Designated as Net Investment Hedges We use foreign currency forward and cross currency forward swap contracts to hedge a portion of the net investment in foreign subsidiaries against fluctuations in foreign exchange rates. For instruments that are designated and qualify as net investment hedges, the variability in the foreign currency to U.S. Dollar of the instrument is recorded as a cumulative translation adjustment component of OCI. In the second quarter of 2018, we redesignated these derivative financial instruments that qualify as hedges of net investments in foreign operations using the spot method in order to more closely align the underlying economics of the hedged transactions. The changes in fair values and the excluded components of derivative instruments designated as net investment hedges are recognized as a cumulative translation adjustment component of OCI. The cross currency basis spread is recognized in interest expense on the Consolidated Statement of Comprehensive Income using the swap accrual process. Prior to the adoption of ASU 2017-12, all settlements and changes in fair values of these derivative instruments were recognized as a cumulative transaction adjustment component of OCI and there had been no ineffectiveness on these hedging relationships. During the nine months ended September 30, 2018 and 2017 , we settled certain net investment hedges generating cash proceeds of $ 70,937,000 and $ 55,771,000 , respectively. The balance of the cumulative translation adjustment will be reclassified to earnings if the hedged investment is sold or substantially liquidated. Derivative Contracts Undesignated We use foreign currency exchange contracts to manage existing exposures to foreign currency exchange risk. Gains and losses resulting from the changes in fair value of these instruments are recorded in interest expense on the consolidated statement of comprehensive income, and are substantially offset by net revaluation impacts on foreign currency denominated balance sheet exposures. In addition, we have several interest rate cap contracts related to variable rate secured debt agreements. Gains and losses resulting from the changes in fair values of these instruments are also recorded in interest expense. The following presents the notional amount of derivatives and other financial instruments as of the dates indicated (in thousands): September 30, 2018 December 31, 2017 Derivatives designated as net investment hedges: Denominated in Canadian Dollars $ 575,000 $ 575,000 Denominated in Pounds Sterling £ 890,708 £ 550,000 Financial instruments designated as net investment hedges: Denominated in Canadian Dollars $ 250,000 $ 250,000 Denominated in Pounds Sterling £ 1,050,000 £ 1,050,000 Derivatives designated as cash flow hedges: Denominated in Canadian Dollars $ — $ 36,000 Derivative instruments not designated: Denominated in U.S. Dollars $ 405,819 $ 408,007 Forward purchase contracts denominated in Canadian Dollars $ (500,000 ) $ — Forward sales contracts denominated in Canadian Dollars $ 580,000 $ 80,000 Forward purchase contracts denominated in Pounds Sterling £ (350,000 ) £ — Forward sales contracts denominated in Pounds Sterling £ 350,000 £ — The following presents the impact of derivative instruments on the Consolidated Statements of Comprehensive Income for the periods presented (in thousands): Three Months Ended September 30, Nine Months Ended September 30, Location 2018 2017 2018 2017 Gain (loss) on derivative instruments designated as hedges recognized in income Interest expense $ 4,185 $ (576 ) $ 8,008 $ 3,613 Gain (loss) on derivative instruments not designated as hedges recognized in income Interest expense $ (203 ) $ (294 ) $ 2,250 $ (1,228 ) Gain (loss) on foreign exchange contracts and term loans designated as net investment hedge recognized in OCI OCI $ 12,200 $ (98,003 ) $ 100,205 $ (239,884 )

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
	Sep. 30, 2018
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies At September 30, 2018 , we had 13 outstanding letter of credit obligations totaling $ 51,684,000 and expiring between 2018 and 2024 . At September 30, 2018 , we had outstanding construction in progress of $ 135,343,000 and were committed to providing additional funds of approximately $ 332,834,000 to complete construction. At September 30, 2018 , we had contingent purchase obligations totaling $ 10,245,000 . These contingent purchase obligations relate to unfunded capital improvement obligations and contingent obligations on acquisitions. Rents due from the tenant are increased to reflect the additional investment in the property. We evaluate our leases for operating versus capital lease treatment in accordance with ASC Topic 840 “Leases.” A lease is classified as a capital lease if it provides for transfer of ownership of the leased asset at the end of the lease term, contains a bargain purchase option, has a lease term greater than 75% of the economic life of the leased asset, or if the net present value of the future minimum lease payments are in excess of 90% of the fair value of the leased asset. Certain leases contain bargain purchase options and have been classified as capital leases. At September 30, 2018 , we had operating lease obligations of $ 1,107,336,000 relating to certain ground leases and company office space and capital lease obligations of $ 85,308,000 relating primarily to certain investment properties. Regarding ground leases, we have sublease agreements with certain of our operators that require the operators to reimburse us for our monthly operating lease obligations. At September 30, 2018 , aggregate future minimum rentals to be received under these noncancelable subleases totaled $ 73,771,000 .

Stockholders' Equity

Stockholders' Equity	9 Months Ended
	Sep. 30, 2018
Stockholders' Equity Note [Abstract]
Stockholders' Equity	Stockholders’ Equity The following is a summary of our stockholders’ equity capital accounts as of the dates indicated: September 30, 2018 December 31, 2017 Preferred Stock: Authorized shares 50,000,000 50,000,000 Issued shares 14,375,000 14,375,000 Outstanding shares 14,369,965 14,370,060 Common Stock, $1.00 par value: Authorized shares 700,000,000 700,000,000 Issued shares 376,759,924 372,852,311 Outstanding shares 375,576,579 371,731,551 Preferred Stock. The following is a summary of our preferred stock activity during the periods indicated: Nine Months Ended September 30, 2018 September 30, 2017 Weighted Avg. Weighted Avg. Shares Dividend Rate Shares Dividend Rate Beginning balance 14,370,060 6.50% 25,875,000 6.50% Shares redeemed — 0.00% (11,500,000 ) 6.50% Shares converted (95 ) 6.50% (4,935 ) 6.50% Ending balance 14,369,965 6.50% 14,370,065 6.50% During the nine months ended September 30, 2017 , we recognized a charge of $ 9,769,000 in connection with the redemption of the Series J preferred stock. Common Stock. The following is a summary of our common stock issuances during the nine months ended September 30, 2018 and 2017 (dollars in thousands, except average price amounts): Shares Issued Average Price Gross Proceeds Net Proceeds 2017 Dividend reinvestment plan issuances 4,312,447 $71.14 $ 306,785 $ 305,996 2017 Option exercises 209,192 50.62 10,590 10,590 2017 Equity shelf program issuances 2,986,574 72.30 215,917 214,406 2017 Preferred stock conversions 4,296 — — 2017 Redemption of equity membership units 91,180 — — 2017 Stock incentive plans, net of forfeitures 135,773 — — 2017 Totals 7,739,462 $ 533,292 $ 530,992 2018 Dividend reinvestment plan issuances 1,755,446 $64.24 $ 112,770 $ 112,294 2018 Option exercises 32,120 39.94 1,283 1,283 2018 Equity shelf program issuances 1,944,511 66.72 129,744 128,834 2018 Preferred stock conversions 83 — — 2018 Stock incentive plans, net of forfeitures 112,868 — — 2018 Totals 3,845,028 $ 243,797 $ 242,411 Dividends . The increase in dividends is primarily attributable to increases in our common shares outstanding as described above. The following is a summary of our dividend payments (in thousands, except per share amounts): Nine Months Ended September 30, 2018 September 30, 2017 Per Share Amount Per Share Amount Common Stock $ 2.6100 $ 971,280 $ 2.6100 $ 955,631 Series I Preferred Stock 2.4375 35,028 2.4375 35,035 Series J Preferred Stock — — 0.2347 2,699 Totals $ 1,006,308 $ 993,365 Accumulated Other Comprehensive Income . The following is a summary of accumulated other comprehensive income (loss) for the periods presented (in thousands): Unrecognized gains (losses) related to: Foreign Currency Translation Available for Sale Securities Actuarial Losses Cash Flow Hedges Total Balance at December 31, 2017 $ (110,581 ) $ — $ (884 ) $ — $ (111,465 ) Other comprehensive income before reclassification adjustments (27,026 ) — — — (27,026 ) Net current-period other comprehensive income (27,026 ) — — — (27,026 ) Balance at September 30, 2018 $ (137,607 ) $ — $ (884 ) $ — $ (138,491 ) Balance at December 31, 2016 $ (173,496 ) $ 5,120 $ (1,153 ) $ (2 ) $ (169,531 ) Other comprehensive income before reclassification adjustments 48,574 (20,285 ) — 2 28,291 Net current-period other comprehensive income 48,574 (20,285 ) — 2 28,291 Balance at September 30, 2017 $ (124,922 ) $ (15,165 ) $ (1,153 ) $ — $ (141,240 )

Stock Incentive Plans

Stock Incentive Plans	9 Months Ended
	Sep. 30, 2018
Employee Stock Ownership Plan (ESOP), Shares in ESOP [Abstract]
Stock Incentive Plans	Stock Incentive Plans Our 2016 Long-Term Incentive Plan (“2016 Plan”) authorizes up to 10,000,000 shares of common stock to be issued at the discretion of the Compensation Committee of the Board of Directors. Our non-employee directors, officers and key employees are eligible to participate in the 2016 Plan. The 2016 Plan allows for the issuance of, among other things, stock options, stock appreciation rights, restricted stock, deferred stock units, performance units and dividend equivalent rights. Vesting periods for options, deferred stock units and restricted shares generally range from three to five years . Options expire ten years from the date of grant. Stock-based compensation expense totaled $6,075,000 and $ 22,800,000 for the three and nine months ended September 30, 2018 , respectively, and $ 6,790,000 and $ 16,459,000 for the same periods in 2017 .

Earnings Per Share

Earnings Per Share	9 Months Ended
	Sep. 30, 2018
Earnings Per Share [Abstract]
Earnings Per Share	Earnings Per Share The following table sets forth the computation of basic and diluted earnings per share (in thousands, except per share data): Three Months Ended Nine Months Ended September 30, September 30, 2018 2017 2018 2017 Numerator for basic and diluted earnings per share - net income (loss) attributable to common stockholders $ 64,384 $ 74,043 $ 656,487 $ 575,118 Denominator for basic earnings per share - weighted average shares 373,023 369,089 372,052 366,096 Effect of dilutive securities: Employee stock options 6 40 12 53 Non-vested restricted shares 348 515 464 464 Redeemable shares 1,096 1,096 1,096 1,281 Employee stock purchase program 14 — 14 — Dilutive potential common shares 1,464 1,651 1,586 1,798 Denominator for diluted earnings per share - adjusted weighted average shares 374,487 370,740 373,638 367,894 Basic earnings per share $ 0.17 $ 0.20 $ 1.76 $ 1.57 Diluted earnings per share $ 0.17 $ 0.20 $ 1.76 $ 1.56 The Series I Cumulative Convertible Perpetual Preferred Stock was not included in the calculations as the effect of conversions into common stock was anti-dilutive.

Disclosure about Fair Value of

Disclosure about Fair Value of Financial Instruments	9 Months Ended
	Sep. 30, 2018
Fair Value Disclosures [Abstract]
Disclosure about Fair Value of Financial Instruments	Disclosure about Fair Value of Financial Instruments U.S. GAAP provides authoritative guidance for measuring and disclosing fair value measurements of assets and liabilities. The guidance defines fair value as the exchange price that would be received for an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market for the asset or liability in an orderly transaction between market participants on the measurement date. The guidance also establishes a fair value hierarchy which requires an entity to maximize the use of observable inputs and minimize the use of unobservable inputs when measuring fair value. Please see Note 2 to the financial statements included in our Annual Report on Form 10-K for the year ended December 31, 2017 for additional information. The guidance describes three levels of inputs that may be used to measure fair value: Level 1 - Quoted prices in active markets for identical assets or liabilities. Level 2 - Observable inputs other than Level 1 prices such as quoted prices for similar assets or liabilities, quoted prices in markets that are not active, or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities. Level 3 - Unobservable inputs that are supported by little or no market activity and that are significant to the fair value of the assets or liabilities. The following methods and assumptions were used to estimate the fair value of each class of financial instruments for which it is practicable to estimate that value. Mortgage Loans and Other Real Estate Loans Receivable — The fair value of mortgage loans and other real estate loans receivable is generally estimated by using Level 2 and Level 3 inputs such as discounting the estimated future cash flows using the current rates at which similar loans would be made to borrowers with similar credit ratings and for the same remaining maturities. Cash and Cash Equivalents and Restricted Cash — The carrying amount approximates fair value. Equity Securities — Equity securities are recorded at their fair value based on Level 1 publicly available trading prices. Borrowings Under Primary Unsecured Credit Facility — The carrying amount of the primary unsecured credit facility approximates fair value because the borrowings are interest rate adjustable. Senior Unsecured Notes — The fair value of the senior unsecured notes payable was estimated based on Level 1 publicly available trading prices. The carrying amount of the variable rate senior unsecured notes approximates fair value because they are interest rate adjustable. Secured Debt — The fair value of fixed rate secured debt is estimated using Level 2 inputs by discounting the estimated future cash flows using the current rates at which similar loans would be made with similar credit ratings and for the same remaining maturities. The carrying amount of variable rate secured debt approximates fair value because the borrowings are interest rate adjustable. Foreign Currency Forward Contracts and Cross Currency Swaps — Foreign currency forward contracts and cross currency swaps are recorded in other assets or other liabilities on the balance sheet at fair market value. Fair market value is determined using Level 2 inputs by estimating the future value of the currency pair based on existing exchange rates, comprised of current spot and traded forward points, and calculating a present value of the net amount using a discount factor based on observable traded interest rates. Redeemable OP Unitholder Interests — Our redeemable unitholder interests are recorded on the balance sheet at fair value using Level 2 inputs. The fair value is measured using the closing price of our common stock, as units may be redeemed at the election of the holder for cash or, at our option, one share of our common stock per unit, subject to adjustment in certain circumstances. The carrying amounts and estimated fair values of our financial instruments are as follows (in thousands): September 30, 2018 December 31, 2017 Carrying Amount Fair Value Carrying Amount Fair Value Financial assets: Mortgage loans receivable $ 266,286 $ 273,620 $ 306,120 $ 332,508 Other real estate loans receivable 74,538 75,091 121,379 125,480 Equity securities 12,912 12,912 7,269 7,269 Cash and cash equivalents 191,199 191,199 243,777 243,777 Restricted cash 90,086 90,086 65,526 65,526 Foreign currency forward contracts and cross currency swaps 34,902 34,902 15,604 15,604 Financial liabilities: Borrowings under unsecured credit facilities $ 1,312,000 $ 1,312,000 $ 719,000 $ 719,000 Senior unsecured notes 9,655,022 10,169,806 8,331,722 9,168,432 Secured debt 2,465,661 2,464,635 2,608,976 2,641,997 Foreign currency forward contracts and cross currency swaps 78,566 78,566 38,654 38,654 Redeemable OP unitholder interests $ 97,476 $ 97,476 $ 97,476 $ 97,476 Items Measured at Fair Value on a Recurring Basis The market approach is utilized to measure fair value for our financial assets and liabilities reported at fair value on a recurring basis. The market approach uses prices and other relevant information generated by market transactions involving identical or comparable assets or liabilities. The following summarizes items measured at fair value on a recurring basis (in thousands): Fair Value Measurements as of September 30, 2018 Total Level 1 Level 2 Level 3 Equity securities $ 12,912 $ 12,912 $ — $ — Foreign currency forward contracts and cross currency swaps, net asset (liability) (1) (43,664 ) — (43,664 ) — Redeemable OP unitholder interests 97,476 — 97,476 — Totals $ 66,724 $ 12,912 $ 53,812 $ — (1) Please see Note 11 for additional information. Items Measured at Fair Value on a Nonrecurring Basis In addition to items that are measured at fair value on a recurring basis, we also have assets and liabilities in our balance sheet that are measured at fair value on a nonrecurring basis. As these assets and liabilities are not measured at fair value on a recurring basis, they are not included in the tables above. Assets, liabilities and noncontrolling interests that are measured at fair value on a nonrecurring basis include those acquired/assumed. Asset impairments (if applicable, see Note 5 for impairments of real property and Note 6 for impairments of loans receivable) are also measured at fair value on a nonrecurring basis. We have determined that the fair value measurements included in each of these assets and liabilities rely primarily on company-specific inputs and our assumptions about the use of the assets and settlement of liabilities, as observable inputs are not available. As such, we have determined that each of these fair value measurements generally resides within Level 3 of the fair value hierarchy. We estimate the fair value of real estate and related intangibles using the income approach and unobservable data such as net operating income and estimated capitalization and discount rates. We also consider local and national industry market data including comparable sales, and commonly engage an external real estate appraiser to assist us in our estimation of fair value. We estimate the fair value of assets held for sale based on current sales price expectations or, in the absence of such price expectations, Level 3 inputs described above. We estimate the fair value of loans receivable using projected payoff valuations based on the expected future cash flows and/or the estimated fair value of collateral, net of sales costs, if the repayment of the loan is expected to be provided solely by the collateral. We estimate the fair value of secured debt assumed in business combinations and asset acquisitions using current interest rates at which similar borrowings could be obtained on the transaction date.

Segment Reporting

Segment Reporting	9 Months Ended
	Sep. 30, 2018
Segment Reporting [Abstract]
Segment Reporting	Segment Reporting We invest in seniors housing and health care real estate. We evaluate our business and make resource allocations on our three operating segments: triple-net, seniors housing operating and outpatient medical. Our triple-net properties include long-term/post-acute care facilities, assisted living facilities, independent living/continuing care retirement communities, care homes (United Kingdom), independent supportive living facilities (Canada), care homes with nursing (United Kingdom) and combinations thereof. Under the triple-net segment, we invest in seniors housing and health care real estate through acquisition and financing of primarily single tenant properties. Properties acquired are primarily leased under triple-net leases and we are not involved in the management of the property. Our seniors housing operating properties include the seniors housing communities referenced above that are owned and/or operated through RIDEA structures (see Note 18). Our outpatient medical properties are typically leased to multiple tenants and generally require a certain level of property management. We evaluate performance based upon consolidated net operating income (“NOI”) of each segment. We define NOI as total revenues, including tenant reimbursements, less property operating expenses. We believe NOI provides investors relevant and useful information as it measures the operating performance of our properties at the property level on an unleveraged basis. We use NOI to make decisions about resource allocations and to assess the property level performance of our properties. Non-segment revenue consists mainly of interest income on certain non-real estate investments and other income. Non-segment assets consist of corporate assets including cash, deferred loan expenses and corporate offices and equipment among others. Non-property specific revenues and expenses are not allocated to individual segments in determining NOI. The accounting policies of the segments are the same as those described in the summary of significant accounting policies (see Note 2 to the financial statements included in our Annual Report on Form 10-K for the year ended December 31, 2017 ). The results of operations for all acquisitions described in Note 3 are included in our consolidated results of operations from the acquisition dates and are components of the appropriate segments. There are no intersegment sales or transfers. Summary information for the reportable segments (which excludes unconsolidated entities) is as follows (in thousands): Three Months Ended September 30, 2018: Triple-net Seniors Housing Operating Outpatient Medical Non-segment / Corporate Total Rental income $ 203,039 $ — $ 139,848 $ — $ 342,887 Resident fees and services — 875,171 — — 875,171 Interest income 14,378 159 85 — 14,622 Other income 1,693 1,175 136 695 3,699 Total revenues 219,110 876,505 140,069 695 1,236,379 Property operating expenses 426 610,659 46,072 — 657,157 Consolidated net operating income 218,684 265,846 93,997 695 579,222 Interest expense 3,500 17,319 1,643 115,570 138,032 Loss (gain) on derivatives and financial instruments, net 8,991 — — — 8,991 Depreciation and amortization 60,383 136,532 46,234 — 243,149 General and administrative — — — 28,746 28,746 Loss (gain) on extinguishment of debt, net — — — 4,038 4,038 Impairment of assets 6,178 562 — — 6,740 Other expenses 87,076 (1) (811 ) 1,055 1,306 88,626 Income (loss) from continuing operations before income taxes and income from unconsolidated entities 52,556 112,244 45,065 (148,965 ) 60,900 Income tax (expense) benefit 1,116 211 239 (3,307 ) (1,741 ) Income (loss) from unconsolidated entities 5,377 (6,705 ) 1,672 — 344 Income (loss) from continuing operations 59,049 105,750 46,976 (152,272 ) 59,503 Gain (loss) on real estate dispositions, net 24,782 (1 ) (58 ) — 24,723 Net income (loss) $ 83,831 $ 105,749 $ 46,918 $ (152,272 ) $ 84,226 Total assets $ 10,163,867 $ 14,989,442 $ 4,953,277 $ 142,533 $ 30,249,119 Three Months Ended September 30, 2017: Triple-net Seniors Housing Operating Outpatient Medical Non-segment / Corporate Total Rental income $ 221,555 $ — $ 141,325 $ — $ 362,880 Resident fees and services — 702,380 — — 702,380 Interest income 20,187 — — — 20,187 Other income 3,174 1,497 667 698 6,036 Total revenues 244,916 703,877 141,992 698 1,091,483 Property operating expenses — 478,777 45,220 — 523,997 Consolidated net operating income 244,916 225,100 96,772 698 567,486 Interest expense 3,622 16,369 2,929 99,658 122,578 Loss (gain) on derivatives and financial instruments, net 324 — — — 324 Depreciation and amortization 62,891 119,089 48,158 — 230,138 General and administrative — — — 29,913 29,913 Other expenses 89,236 (1) 5,157 530 4,672 99,595 Income (loss) from continuing operations before income taxes and income from unconsolidated entities 88,843 84,485 45,155 (133,545 ) 84,938 Income tax (expense) benefit (816 ) (1,519 ) (366 ) 2,032 (669 ) Income (loss) from unconsolidated entities 5,478 (2,886 ) 816 — 3,408 Income (loss) from continuing operations 93,505 80,080 45,605 (131,513 ) 87,677 Gain (loss) on real estate dispositions, net (185 ) (197 ) 2,004 — 1,622 Net income (loss) $ 93,320 $ 79,883 $ 47,609 $ (131,513 ) $ 89,299 (1) Represents non-capitalizable transaction costs primarily related to a joint venture transaction with an existing seniors housing operator including the conversion of properties from triple-net to seniors housing operating, an exchange of PropCo/OpCo interests, and termination/restructuring of pre-existing relationships. Nine Months Ended September 30, 2018 Triple-net Seniors Housing Operating Outpatient Medical Non-segment / Corporate Total Rental income $ 607,831 $ — $ 412,026 $ — $ 1,019,857 Resident fees and services — 2,374,450 — — 2,374,450 Interest income 42,176 416 140 — 42,732 Other income 16,282 3,973 401 1,561 22,217 Total revenues 666,289 2,378,839 412,567 1,561 3,459,256 Property operating expenses 583 1,648,262 133,528 — 1,782,373 Consolidated net operating income 665,706 730,577 279,039 1,561 1,676,883 Interest expense 10,742 51,225 4,975 315,281 382,223 Loss (gain) on derivatives and financial instruments, net (5,642 ) — — — (5,642 ) Depreciation and amortization 171,724 397,080 138,821 — 707,625 General and administrative — — — 95,282 95,282 Loss (gain) on extinguishment of debt, net (32 ) 110 11,928 4,038 16,044 Impairment of assets 34,482 5,075 — — 39,557 Other expenses 89,153 5,168 3,748 4,327 102,396 Income (loss) from continuing operations before income taxes and income from unconsolidated entities 365,279 271,919 119,567 (417,367 ) 339,398 Income tax (expense) benefit (708 ) (2,244 ) (567 ) (3,651 ) (7,170 ) Income (loss) from unconsolidated entities 16,260 (21,389 ) 4,293 — (836 ) Income (loss) from continuing operations 380,831 248,286 123,293 (421,018 ) 331,392 Gain (loss) on real estate dispositions, net 158,938 3 214,721 — 373,662 Net income (loss) $ 539,769 $ 248,289 $ 338,014 $ (421,018 ) $ 705,054 Nine Months Ended September 30, 2017 Triple-net Seniors Housing Operating Outpatient Medical Non-segment / Corporate Total Rental income $ 666,735 $ — $ 418,886 $ — $ 1,085,621 Resident fees and services — 2,049,757 — — 2,049,757 Interest income 61,767 69 — — 61,836 Other income 7,496 4,005 2,497 1,171 15,169 Total revenues 735,998 2,053,831 421,383 1,171 3,212,383 Property operating expenses — 1,400,313 135,708 — 1,536,021 Consolidated net operating income 735,998 653,518 285,675 1,171 1,676,362 Interest expense 11,647 47,587 7,342 290,829 357,405 Loss (gain) on derivatives and financial instruments, net 2,284 — — — 2,284 Depreciation and amortization 182,672 356,023 144,567 — 683,262 General and administrative — — — 93,643 93,643 Loss (gain) on extinguishment of debt, net 29,083 3,414 4,373 — 36,870 Impairment of assets 4,846 14,191 5,625 — 24,662 Other expenses 96,425 8,100 2,201 10,882 117,608 Income (loss) from continuing operations before income taxes and income from unconsolidated entities 409,041 224,203 121,567 (394,183 ) 360,628 Income tax (expense) benefit (2,070 ) 9,133 (655 ) (873 ) 5,535 Income (loss) from unconsolidated entities 14,983 (40,527 ) 1,868 — (23,676 ) Income (loss) from continuing operations 421,954 192,809 122,780 (395,056 ) 342,487 Gain (loss) on real estate dispositions, net 273,051 12,814 2,004 — 287,869 Net income (loss) $ 695,005 $ 205,623 $ 124,784 $ (395,056 ) $ 630,356 Our portfolio of properties and other investments are located in the United States, the United Kingdom and Canada. Revenues and assets are attributed to the country in which the property is physically located. The following is a summary of geographic information for the periods presented (dollars in thousands): Three Months Ended Nine Months Ended September 30, 2018 September 30, 2017 September 30, 2018 September 30, 2017 Revenues: Amount % Amount % Amount % Amount % United States $ 1,007,203 81.5 % $ 871,431 79.9 % $ 2,766,726 80.0 % $ 2,582,042 80.4 % United Kingdom 111,503 9.0 % 105,028 9.6 % 340,059 9.8 % 298,618 9.3 % Canada 117,673 9.5 % 115,024 10.5 % 352,471 10.2 % 331,723 10.3 % Total $ 1,236,379 100.0 % $ 1,091,483 100.0 % $ 3,459,256 100.0 % $ 3,212,383 100.0 % As of September 30, 2018 December 31, 2017 Assets: Amount % Amount % United States $ 24,616,066 81.4 % $ 22,274,443 79.7 % United Kingdom 3,150,305 10.4 % 3,239,039 11.6 % Canada 2,482,748 8.2 % 2,430,963 8.7 % Total $ 30,249,119 100.0 % $ 27,944,445 100.0 %

Income Taxes and Distributions

Income Taxes and Distributions	9 Months Ended
	Sep. 30, 2018
Income Tax Disclosure [Abstract]
Income Taxes And Distributions	Income Taxes and Distributions We elected to be taxed as a REIT commencing with our first taxable year. To qualify as a REIT for federal income tax purposes, at least 90% of taxable income (excluding 100% of net capital gains) must be distributed to stockholders. REITs that do not distribute a certain amount of current year taxable income in the current year are also subject to a 4% federal excise tax. The main differences between undistributed net income for federal income tax purposes and financial statement purposes are the recognition of straight-line rent for reporting purposes, basis differences in acquisitions, recording of impairments, differing useful lives and depreciation and amortization methods for real property and the provision for loan losses for reporting purposes versus bad debt expense for tax purposes. Under the provisions of the REIT Investment Diversification and Empowerment Act of 2007 (“RIDEA”), for taxable years beginning after July 30, 2008, a REIT may lease “qualified health care properties” on an arm’s-length basis to a taxable REIT subsidiary (“TRS”) if the property is operated on behalf of such TRS by a person who qualifies as an “eligible independent contractor.” Generally, the rent received from the TRS will meet the related party rent exception and will be treated as “rents from real property.” A “qualified health care property” includes real property and any personal property that is, or is necessary or incidental to the use of, a hospital, nursing facility, assisted living facility, congregate care facility, qualified continuing care facility, or other licensed facility which extends medical or nursing or ancillary services to patients. We have entered into various joint ventures that were structured under RIDEA. Resident level rents and related operating expenses for these facilities are reported in the unaudited consolidated financial statements and are subject to federal and state income taxes as the operations of such facilities are included in TRS entities. Certain net operating loss carryforwards could be utilized to offset taxable income in future years. Income taxes reflected in the financial statements primarily represents U.S. federal, state and local income taxes as well as non-U.S. income based or withholding taxes on certain investments located in jurisdictions outside the U.S. The provision for income taxes for the nine months ended September 30, 2018 and 2017 , was primarily due to operating income or losses, offset by certain discrete items at our TRS entities. In 2014, we established certain wholly-owned direct and indirect subsidiaries in Luxembourg and Jersey and transferred interests in certain foreign investments into this holding company structure. The structure includes a property holding company that is tax resident in the United Kingdom. No material adverse current tax consequences in Luxembourg, Jersey or the United Kingdom resulted from the creation of this holding company structure and most of the subsidiary entities in the structure are treated as disregarded entities of the company for U.S. federal income tax purposes. The company reflects current and deferred tax liabilities for any such withholding taxes incurred as a result of this holding company structure in its consolidated financial statements. Generally, given current statutes of limitations, we are subject to audit by the Internal Revenue Service (“IRS”) for the year ended December 31, 2014 and subsequent years and by state taxing authorities for the year ended December 31, 2013 and subsequent years. The company and its subsidiaries are also subject to audit by the Canada Revenue Agency and provincial authorities generally for periods subsequent to our initial investments in Canada in May 2012, by HM Revenue & Customs for periods subsequent to our initial investments in the United Kingdom in August 2012 and by Luxembourg taxing authorities generally for periods subsequent to our establishment of certain Luxembourg-based subsidiaries during 2014.

Variable Interest Entity Disclo

Variable Interest Entity Disclosure	9 Months Ended
	Sep. 30, 2018
Variable Interest Entity, Consolidated, Carrying Amount, Assets and Liabilities, Net [Abstract]
Variable Interest Entities	Variable Interest Entities We have entered into joint ventures to own certain seniors housing and outpatient medical assets which are deemed to be variable interest entities (“VIE”). We have concluded that we are the primary beneficiary of these VIEs based on a combination of operational control of the joint venture and the rights to receive residual returns or the obligation to absorb losses arising from the joint ventures. Except for capital contributions associated with the initial joint venture formations, the joint ventures have been and are expected to be funded from the ongoing operations of the underlying properties. Accordingly, such joint ventures have been consolidated, and the table below summarizes the balance sheets of consolidated VIEs in the aggregate (in thousands): September 30, 2018 December 31, 2017 Assets Net real property owned $ 977,252 $ 1,002,137 Cash and cash equivalents 15,059 12,308 Receivables and other assets 17,922 16,330 Total assets (1) $ 1,010,233 $ 1,030,775 Liabilities and equity Secured debt $ 466,772 $ 471,103 Accrued expenses and other liabilities 18,144 14,832 Total equity 525,317 544,840 Total liabilities and equity $ 1,010,233 $ 1,030,775 (1) Note that assets of the consolidated VIEs can only be used to settle obligations relating to such VIEs. Liabilities of the consolidated VIEs represent claims against the specific assets of the VIEs.

Accounting Policies and Relat_2

Accounting Policies and Related Matters (Policies)	9 Months Ended
	Sep. 30, 2018
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation The accompanying unaudited consolidated financial statements have been prepared in accordance with U.S. generally accepted accounting principles (“U.S. GAAP”) for interim financial information and with instructions to Quarterly Report on Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all of the information and footnotes required by U.S. GAAP for complete financial statements. In the opinion of management, all adjustments (such as normal recurring accruals) considered necessary for a fair presentation have been included. Operating results for the nine months ended September 30, 2018 are not necessarily an indication of the results that may be expected for the year ending December 31, 2018. For further information, refer to the financial statements and notes thereto included in our Annual Report on Form 10-K for the year ended December 31, 2017.
New Accounting Standards	New Accounting Standards We adopted the following accounting standards, each of which did not have a material impact on our consolidated financial statements: • In 2014, the Financial Accounting Standards Board (the “FASB”) issued Accounting Standards Update (“ASU”) No. 2014-09, “Revenue from Contracts with Customers (ASC 606),” which is a comprehensive new revenue recognition model that requires revenue to be recognized in a manner to depict the transfer of goods or services to a customer at an amount that reflects the consideration expected to be received in exchange for those goods or services. We adopted ASC 606 on January 1, 2018 using the modified retrospective method of adoption. This guidance did not have a significant impact on our consolidated financial statements. We have evaluated our various revenue streams to identify whether they would be subject to the provisions of ASC 606 and any differences in timing, measurement or presentation of revenue recognition. A significant source of our revenue is generated through leasing arrangements, which are specifically excluded from ASC 606. Management contracts are present in our seniors housing operating and outpatient medical segments and represent agreements to provide asset and property management, leasing, marketing and other services. Under ASC 606, the pattern and timing of recognition of income from these contracts is consistent with the prior accounting model. • In 2017, the FASB issued ASU No. 2017-05, “Other Income – Gains and Losses from the Derecognition of Nonfinancial Assets (Subtopic 610-20): Clarifying the Scope of Asset Derecognition Guidance and Accounting for Partial Sales of Nonfinancial Assets.” The standard clarifies that a financial asset is within the scope of Subtopic 610-20 if it meets the definition of an in substance nonfinancial asset. The standard also defines the term “in substance nonfinancial asset” and clarifies that an entity should identify each distinct nonfinancial asset or in substance nonfinancial asset promised to a counterparty and derecognize each asset when a counterparty obtains control over it. We adopted Subtopic 610-20 using a modified retrospective approach on January 1, 2018 and it did not have a material impact on our consolidated financial statements. • In 2016, the FASB issued ASU No. 2016-01, “Financial Instruments – Overall: Recognition and Measurement of Financial Assets and Financial Liabilities,” which requires entities to measure their investments at fair value and recognize any changes in fair value in net income unless the investments qualify for the new practicability exception. The practicability exception is available for equity investments that do not have readily determinable fair values. This standard requires us to recognize gains and losses from changes in the fair value of our available-for-sale equity securities through the consolidated statement of comprehensive income rather than through accumulated other comprehensive income. During the nine months ended September 30, 2018 , we recognized a gain of $5,642,000 in loss (gain) on derivatives and financial instruments, net on the Consolidated Statement of Comprehensive Income. There was no adjustment to accumulated other comprehensive income upon adoption at January 1, 2018 as accumulated losses were recognized as other-than-temporary impairment during the year ended December 31, 2017. • As of December 31, 2017, we adopted ASU No. 2016-18, “Restricted Cash,” and ASU No. 2016-15, “Classification of Certain Cash Receipts and Cash Payments.” ASU No. 2016-18 requires an entity to reconcile and explain the period over period change in total cash, cash equivalents and restricted cash within its consolidated statement of cash flows and ASU 2016-15 provides guidance clarifying how certain cash receipts and cash payments should be classified. We adopted these accounting standards retrospectively and, accordingly, certain line items in the consolidated statement of cash flows have been reclassified to conform to the current presentation. The following table summarizes the change in cash flows as reported and as previously reported prior to the adoption of these standards for the nine months ended September 30, 2017 (in thousands): As Reported As Previously Reported Cash disbursed for acquisitions $ (574,002 ) $ (575,694 ) Decrease (increase) in restricted cash — 130,470 Net cash provided from (used in) investing activities 400,418 529,196 Increase (decrease) in balance (1) (311,909 ) (183,131 ) Balance at beginning of period (1) 607,220 419,378 Balance at end of period (1) 295,311 236,247 (1) Amounts in As Reported column include cash and cash equivalents and restricted cash as required. Amounts in the As Previously Reported column reflect only cash and cash equivalents. • In August 2017, the FASB issued ASU 2017-12, “Derivatives and Hedging: Targeted Improvements to Accounting for Hedging Activities,” which expands and refines hedge accounting for both nonfinancial and financial risk components and aligns the recognition and presentation of the effects of the hedging instrument and the hedged item in the financial statements. It also includes certain targeted improvements to simplify the application of current guidance related to hedge accounting. The early adoption of this standard on April 1, 2018, did not result in a cumulative effect adjustment and all applicable changes for the company were prospectively made. Please refer to Note 11 of the consolidated financial statements for additional detail on this adoption. The following ASUs have been issued but not yet adopted: • In 2016, the FASB issued ASU No. 2016-02, “Leases (Topic 842),” which requires lessees to recognize assets and liabilities on their consolidated balance sheet related to the rights and obligations created by most leases, while continuing to recognize expenses on their consolidated statements of comprehensive income over the lease term. It will also require disclosures designed to give financial statement users information regarding amount, timing, and uncertainty of cash flows arising from leases. The FASB issued ASU 2018-11, "Leases (Topic 842) Targeted Improvements" in July 2018, which provides lessors with a practical expedient, by class of underlying assets, to not separate non-lease components from the related lease components, and, instead, to account for those components as a single lease component, if certain criteria are met. ASU 2016-02 is effective for us beginning January 1, 2019, with early adoption permitted. Entities are required to use a modified retrospective approach for leases that exist or are entered into after the beginning of the earliest comparative period in the consolidated financial statements. ASU 2018-11 also provides a practical expedient that allows companies to use an optional transition method. Under the optional transition method, a cumulative adjustment to retained earnings during the period of adoption is recorded and prior periods would not require restatement. We are currently evaluating the impact of this guidance on our consolidated financial statements from both the lessee and lessor perspective. We believe that adoption will likely have a material impact to our consolidated financial statements for the recognition of certain operating leases as right-of-use assets and lease liabilities and related amortization. We expect to utilize the practical expedients in ASU 2018-11 as part of our adoption of this guidance. • In 2016, the FASB issued ASU No. 2016-13, “Measurement of Credit Losses on Financial Instruments.” This standard requires a new forward-looking “expected loss” model to be used for receivables, held-to-maturity debt, loans, and other instruments. ASU 2016-13 is effective for fiscal years, and interim periods within those years, beginning after December 15, 2019, and early adoption is permitted for fiscal years beginning after December 15, 2018. We are currently evaluating the impact that the standard will have on our consolidated financial statements.

Accounting Policies and Relat_3

Accounting Policies and Related Matters (Tables)	9 Months Ended
	Sep. 30, 2018
Accounting Policies [Abstract]
Cash and Cash Equivalents, Restricted Cash and Cash Equivalents, Policy	The following table summarizes the change in cash flows as reported and as previously reported prior to the adoption of these standards for the nine months ended September 30, 2017 (in thousands): As Reported As Previously Reported Cash disbursed for acquisitions $ (574,002 ) $ (575,694 ) Decrease (increase) in restricted cash — 130,470 Net cash provided from (used in) investing activities 400,418 529,196 Increase (decrease) in balance (1) (311,909 ) (183,131 ) Balance at beginning of period (1) 607,220 419,378 Balance at end of period (1) 295,311 236,247 (1) Amounts in As Reported column include cash and cash equivalents and restricted cash as required. Amounts in the As Previously Reported column reflect only cash and cash equivalents.

Real Property Acquisitions an_2

Real Property Acquisitions and Development (Tables)	9 Months Ended
	Sep. 30, 2018
Real Estate Liabilities Associated with Assets Held for Development and Sale [Abstract]
Schedule of Acquired Assets and Liabilities	The following table presents the purchase price calculation and the allocation to assets acquired and liabilities assumed based upon their relative fair value: (In thousands) Land and land improvements $ 417,983 Buildings and improvements 2,249,803 Acquired lease intangibles 15,512 Real property held for sale 418,297 Cash and cash equivalents 381,913 Restricted cash 4,981 Receivables and other assets 1,322 Total assets acquired 3,489,811 Accrued expenses and other liabilities (13,199 ) Total liabilities assumed (13,199 ) Noncontrolling interests (512,741 ) Net assets acquired $ 2,963,871
Estimated Fair Value of Allocated Purchase Price of Asset and Liabilities	Triple-net Activity Nine Months Ended (In thousands) September 30, 2018 September 30, 2017 Land and land improvements $ 413,588 $ 31,948 Buildings and improvements 2,239,422 206,910 Acquired lease intangibles 12,383 — Real property held for sale 396,265 — Receivables and other assets 1,322 — Total assets acquired (1) 3,062,980 238,858 Accrued expenses and other liabilities (13,199 ) (21,236 ) Total liabilities assumed (13,199 ) (21,236 ) Noncontrolling interests (512,741 ) (7,275 ) Non-cash acquisition related activity (2) — (54,901 ) Cash disbursed for acquisitions 2,537,040 155,446 Construction in progress additions 49,619 106,186 Less: Capitalized interest (1,932 ) (3,886 ) Foreign currency translation 180 (656 ) Cash disbursed for construction in progress 47,867 101,644 Capital improvements to existing properties 6,766 17,873 Total cash invested in real property, net of cash acquired $ 2,591,673 $ 274,963 (1) Excludes $386,894,000 of unrestricted and restricted cash acquired during the nine months ended September 30, 2018 . (2) For the nine months ended September 30, 2017 , $ 54,901,000 is related to the acquisition of assets previously financed as a real estate loan receivable. Seniors Housing Operating Activity Nine Months Ended (In thousands) September 30, 2018 September 30, 2017 Land and land improvements $ 47,865 $ 31,006 Building and improvements 535,436 384,522 Acquired lease intangibles 68,084 48,197 Receivables and other assets 1,255 3,164 Total assets acquired (1) 652,640 466,889 Secured debt (89,973 ) — Accrued expenses and other liabilities (14,686 ) (43,364 ) Total liabilities assumed (104,659 ) (43,364 ) Noncontrolling interests (9,818 ) (4,701 ) Non-cash acquisition related activity (2) — (59,065 ) Cash disbursed for acquisitions 538,163 359,759 Construction in progress additions 28,222 65,282 Less: Capitalized interest (2,608 ) (5,996 ) Foreign currency translation 2,151 (6,218 ) Cash disbursed for construction in progress 27,765 53,068 Capital improvements to existing properties 127,274 110,372 Total cash invested in real property, net of cash acquired $ 693,202 $ 523,199 (1) Excludes $2,442,000 and $6,273,000 of unrestricted and restricted cash acquired during the nine months ended September 30, 2018 and 2017 , respectively. (2) Includes $6,349,000 related to the acquisition of assets previously financed as real estate loans receivable and $51,097,000 previously financed as an investment in an unconsolidated entity during the nine months ended September 30, 2017 . Outpatient Medical Activity Nine Months Ended (In thousands) September 30, 2018 September 30, 2017 Land and land improvements $ 18,496 $ 25,060 Buildings and improvements 79,205 62,336 Acquired lease intangibles 11,271 8,397 Real property held for sale 22,032 — Receivables and other assets 6 3 Total assets acquired (1) 131,010 95,796 Secured debt (14,769 ) (25,709 ) Accrued expenses and other liabilities (910 ) (2,210 ) Total liabilities assumed (15,679 ) (27,919 ) Noncontrolling interests — (9,080 ) Cash disbursed for acquisitions 115,331 58,797 Construction in progress additions 16,733 33,495 Less: Capitalized interest (1,817 ) (1,847 ) Accruals (2) (2,402 ) 11,708 Cash disbursed for construction in progress 12,514 43,356 Capital improvements to existing properties 39,595 30,897 Total cash invested in real property $ 167,440 $ 133,050 (1) Excludes $2,244,000 and $ 0 of unrestricted and restricted cash acquired during the nine months ended September 30, 2018 and 2017 , respectively. (2) Represents non-cash accruals for amounts to be paid in future periods for properties that converted, off-set by amounts paid in the current period. Construction Activity The following is a summary of the construction projects that were placed into service and began generating revenues during the periods presented (in thousands): Nine Months Ended September 30, 2018 September 30, 2017 Development projects: Triple-net $ 90,055 $ 283,472 Seniors housing operating 86,931 3,634 Outpatient medical 11,358 63,036 Total development projects 188,344 350,142 Expansion projects 8,879 10,336 Total construction in progress conversions $ 197,223 $ 360,478

Real Estate Intangibles (Tables

Real Estate Intangibles (Tables)	9 Months Ended
	Sep. 30, 2018
Intangible Assets, Net (Excluding Goodwill) [Abstract]
Summary of real estate intangibles excluding those classified as held for sale	The following is a summary of our real estate intangibles, excluding those classified as held for sale, as of the dates indicated (dollars in thousands): September 30, 2018 December 31, 2017 Assets: In place lease intangibles $ 1,398,850 $ 1,352,139 Above market tenant leases 59,011 58,443 Below market ground leases 65,022 58,784 Lease commissions 39,767 33,105 Gross historical cost 1,562,650 1,502,471 Accumulated amortization (1,190,035 ) (1,125,437 ) Net book value $ 372,615 $ 377,034 Weighted-average amortization period in years 16.0 15.1 Liabilities: Below market tenant leases $ 71,566 $ 60,430 Above market ground leases 8,540 8,540 Gross historical cost 80,106 68,970 Accumulated amortization (42,834 ) (39,629 ) Net book value $ 37,272 $ 29,341 Weighted-average amortization period in years 16.1 20.1
Schedule of Real Estate Intangible Amortization	The following is a summary of real estate intangible amortization for the periods presented (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2018 2017 2018 2017 Rental income related to above/below market tenant leases, net $ (294 ) $ 173 $ (978 ) $ 745 Property operating expenses related to above/below market ground leases, net (327 ) (306 ) (1,006 ) (925 ) Depreciation and amortization related to in place lease intangibles and lease commissions (31,455 ) (34,270 ) (97,479 ) (109,011 )
Schedule of future amortization expense	The future estimated aggregate amortization of intangible assets and liabilities is as follows for the periods presented (in thousands): Assets Liabilities 2018 $ 32,456 $ 1,433 2019 87,011 5,437 2020 57,221 4,938 2021 24,300 4,444 2022 19,325 3,971 Thereafter 152,302 17,049 Total $ 372,615 $ 37,272

Dispositions, Assets Held for S

Dispositions, Assets Held for Sale and Discontinued Operations (Tables)	9 Months Ended
	Sep. 30, 2018
Discontinued Operations and Disposal Groups [Abstract]
Summary of real property disposition activity	The following represents the activity related to these properties for the periods presented (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2018 2017 2018 2017 Revenues: Total revenues $ 29,035 $ 52,584 $ 92,447 $ 175,934 Expenses: Interest expense 18 1,243 261 5,514 Property operating expenses 21,312 19,147 59,640 58,525 Provision for depreciation 801 10,999 6,605 33,806 Total expenses 22,131 31,389 66,506 97,845 Income (loss) from real estate dispositions, net $ 6,904 $ 21,195 $ 25,941 $ 78,089 The following is a summary of our real property disposition activity for the periods presented (in thousands): Nine Months Ended September 30, 2018 September 30, 2017 Real estate dispositions: Triple-net $ 604,480 $ 899,104 Seniors housing operating 2,200 16,206 Outpatient medical 223,069 12,202 Total dispositions 829,749 927,512 Gain (loss) on real estate dispositions, net 373,662 287,869 Net other assets/liabilities disposed 5,090 22,470 Proceeds from real estate dispositions $ 1,208,501 $ 1,237,851

Real Estate Loans Receivable (T

Real Estate Loans Receivable (Tables)	9 Months Ended
	Sep. 30, 2018
Mortgage Loans on Real Estate, Commercial and Consumer, Net, (Investment Based Operations Presentation) [Abstract]
Summary of real estate loan activity	The following is a summary of our real estate loan activity for the periods presented (in thousands): Nine Months Ended September 30, 2018 September 30, 2017 Triple-net Seniors Housing Operating Outpatient Totals Triple-net Outpatient Totals Advances on real estate loans receivable: Investments in new loans $ 10,628 $ 11,806 $ 14,993 $ 37,427 $ 11,315 $ — $ 11,315 Draws on existing loans 29,709 — — 29,709 58,736 — 58,736 Net cash advances on real estate loans 40,337 11,806 14,993 67,136 70,051 — 70,051 Receipts on real estate loans receivable: Loan payoffs 116,161 — — 116,161 142,392 60,500 202,892 Principal payments on loans 33,431 — — 33,431 1,121 — 1,121 Sub-total 149,592 — — 149,592 143,513 60,500 204,013 Less: Non-cash activity (1) — — — — (61,250 ) (60,500 ) (121,750 ) Net cash receipts on real estate loans 149,592 — — 149,592 82,263 — 82,263 Net cash advances (receipts) on real estate loans $ (109,255 ) $ 11,806 $ 14,993 $ (82,456 ) $ (12,212 ) $ — $ (12,212 ) (1) Triple-net represents acquisitions of assets previously financed as real estate loans. Please see Note 3 for additional information. Outpatient medical represents a deed in lieu of foreclosure on a previously financed first mortgage property.
Summary of impaired loans	Nine Months Ended September 30, 2018 September 30, 2017 Balance of impaired loans at end of period $ 201,971 $ 282,929 Allowance for loan losses 68,372 5,406 Balance of impaired loans not reserved $ 133,599 $ 277,523 Average impaired loans for the period $ 230,645 $ 324,255 Interest recognized on impaired loans (1) 13,361 23,957 (1) Represents cash interest recognized in the period since loans were identified as impaired.

Investments in Unconsolidated_2

Investments in Unconsolidated Entities (Tables)	9 Months Ended
	Sep. 30, 2018
Real Estate Investments, Net [Abstract]
Real Estate Investment Financial Statements, Disclosure	The following is a summary of our investments in unconsolidated entities (dollars in thousands): Percentage Ownership (1) September 30, 2018 December 31, 2017 Triple-net 10% to 49% $ 21,004 $ 22,856 Seniors housing operating 10% to 50% 310,175 352,430 Outpatient medical 43% 92,013 70,299 Total $ 423,192 $ 445,585 (1) Excludes in-substance real estate investments.

Credit Concentration (Tables)

Credit Concentration (Tables)	9 Months Ended
	Sep. 30, 2018
Concentration Risks, Types, No Concentration Percentage [Abstract]
Summary of credit concentration	The following table summarizes certain information about our credit concentration for the nine months ended September 30, 2018 , excluding our share of NOI in unconsolidated entities (dollars in thousands): Number of Total Percent of Concentration by relationship: (1) Properties NOI NOI (2) Sunrise Senior Living (3) 161 $ 252,111 15% Brookdale Senior Living 137 117,367 7% Revera (3) 98 116,158 7% Genesis HealthCare 88 102,015 6% Benchmark Senior Living 48 75,435 4% Remaining portfolio 997 1,013,797 61% Totals 1,529 $ 1,676,883 100% (1) Genesis Healthcare is in our triple-net segment. Sunrise Senior Living and Revera are in our seniors housing operating segment. Benchmark Senior Living and Brookdale Senior Living are in both our triple-net and seniors housing operating segments. (2) NOI with our top five relationships comprised 41% of total NOI for the year ended December 31, 2017. (3) Revera owns a controlling interest in Sunrise Senior Living.

Borrowings Under Credit Facil_2

Borrowings Under Credit Facilities and Related Items (Tables)	9 Months Ended
	Sep. 30, 2018
Line of Credit Facility [Abstract]
Aggregate borrowings under the unsecured line of credit arrangements	The following information relates to aggregate borrowings under the primary unsecured revolving credit facility for the periods presented (dollars in thousands): Three Months Ended Nine Months Ended September 30, September 30, 2018 2017 2018 2017 Balance outstanding at quarter end $ 1,312,000 $ 420,000 $ 1,312,000 $ 420,000 Maximum amount outstanding at any month end $ 2,148,000 $ 645,000 $ 2,148,000 $ 1,010,000 Average amount outstanding (total of daily principal balances divided by days in period) $ 1,519,000 $ 450,130 $ 819,516 $ 601,346 Weighted average interest rate (actual interest expense divided by average borrowings outstanding) 3.00 % 2.19 % 2.95 % 1.95 %

Senior Unsecured Notes and Se_2

Senior Unsecured Notes and Secured Debt (Tables)	9 Months Ended
	Sep. 30, 2018
Long-term Debt, by Current and Noncurrent [Abstract]
Schedule of long term debt	At September 30, 2018 , the annual principal payments due on these debt obligations were as follows (in thousands): Senior Unsecured Notes (1,2) Secured Debt (1,3) Totals 2018 $ — $ 170,742 $ 170,742 2019 600,000 489,166 1,089,166 2020 (4) 689,662 138,938 828,600 2021 450,000 347,280 797,280 2022 600,000 225,832 825,832 Thereafter (5,6,7,8) 7,414,034 1,107,797 8,521,831 Totals $ 9,753,696 $ 2,479,755 $ 12,233,451 (1) Amounts represent principal amounts due and do not include unamortized premiums/discounts, debt issuance costs, or other fair value adjustments as reflected on the balance sheet. (2) Annual interest rates range from 2.73% to 6.50% . (3) Annual interest rates range from 1.69% to 7.93% . Carrying value of the properties securing the debt totaled $5,303,414,000 at September 30, 2018 . (4) Includes a $300,000,000 Canadian-denominated 3.35% senior unsecured notes due 2020 (approximately $232,162,000 based on the Canadian/U.S. Dollar exchange rate on September 30, 2018 ). (5) Includes a $250,000,000 Canadian-denominated unsecured term credit facility (approximately $193,469,000 based on the Canadian/U.S. Dollar exchange rate on September 30, 2018 ). The loan matures on July 19, 2023 and bears interest at the Canadian Dealer Offered Rate plus 0.9% ( 2.73% at September 30, 2018 ). (6) Includes a $500,000,000 unsecured term credit facility. The loan matures on July 19, 2023 and bears interest at LIBOR plus 0.9% ( 3.07% at September 30, 2018 ). (7) Includes a £550,000,000 4.80% senior unsecured notes due 2028 (approximately $717,915,000 based on the Sterling/U.S. Dollar exchange rate in effect on September 30, 2018 ). (8) Includes a £500,000,000 4.50% senior unsecured notes due 2034 (approximately $652,650,000 based on the Sterling/U.S. Dollar exchange rate in effect on September 30, 2018 ). The following is a summary of our senior unsecured notes principal activity during the periods presented (dollars in thousands): Nine Months Ended September 30, 2018 September 30, 2017 Weighted Avg. Weighted Avg. Amount Interest Rate Amount Interest Rate Beginning balance $ 8,417,447 4.31% $ 8,260,038 4.25% Debt issued 2,850,000 4.57% 7,500 1.94% Debt extinguished (1,450,000 ) 3.46% (5,000 ) 1.83% Foreign currency (63,751 ) 4.30% 141,855 4.24% Ending balance $ 9,753,696 4.45% $ 8,404,393 4.29% The following is a summary of our secured debt principal activity for the periods presented (dollars in thousands): Nine Months Ended September 30, 2018 September 30, 2017 Weighted Avg. Weighted Avg. Amount Interest Rate Amount Interest Rate Beginning balance $ 2,618,408 3.76% $ 3,465,066 4.09% Debt issued 44,606 3.38% 190,459 2.73% Debt assumed 99,552 4.30% 23,094 6.67% Debt extinguished (196,573 ) 5.66% (1,003,372 ) 5.32% Principal payments (42,294 ) 3.91% (47,507 ) 4.34% Foreign currency (43,944 ) 3.29% 92,262 3.20% Ending balance $ 2,479,755 3.79% $ 2,720,002 3.74%

Derivative Instruments (Tables)

Derivative Instruments (Tables)	9 Months Ended
	Sep. 30, 2018
Summary of Derivative Instruments [Abstract]
Impact of derivative instruments on the statement of operations and OCI	We use foreign currency exchange contracts to manage existing exposures to foreign currency exchange risk. Gains and losses resulting from the changes in fair value of these instruments are recorded in interest expense on the consolidated statement of comprehensive income, and are substantially offset by net revaluation impacts on foreign currency denominated balance sheet exposures. In addition, we have several interest rate cap contracts related to variable rate secured debt agreements. Gains and losses resulting from the changes in fair values of these instruments are also recorded in interest expense. The following presents the notional amount of derivatives and other financial instruments as of the dates indicated (in thousands): September 30, 2018 December 31, 2017 Derivatives designated as net investment hedges: Denominated in Canadian Dollars $ 575,000 $ 575,000 Denominated in Pounds Sterling £ 890,708 £ 550,000 Financial instruments designated as net investment hedges: Denominated in Canadian Dollars $ 250,000 $ 250,000 Denominated in Pounds Sterling £ 1,050,000 £ 1,050,000 Derivatives designated as cash flow hedges: Denominated in Canadian Dollars $ — $ 36,000 Derivative instruments not designated: Denominated in U.S. Dollars $ 405,819 $ 408,007 Forward purchase contracts denominated in Canadian Dollars $ (500,000 ) $ — Forward sales contracts denominated in Canadian Dollars $ 580,000 $ 80,000 Forward purchase contracts denominated in Pounds Sterling £ (350,000 ) £ — Forward sales contracts denominated in Pounds Sterling £ 350,000 £ — The following presents the impact of derivative instruments on the Consolidated Statements of Comprehensive Income for the periods presented (in thousands): Three Months Ended September 30, Nine Months Ended September 30, Location 2018 2017 2018 2017 Gain (loss) on derivative instruments designated as hedges recognized in income Interest expense $ 4,185 $ (576 ) $ 8,008 $ 3,613 Gain (loss) on derivative instruments not designated as hedges recognized in income Interest expense $ (203 ) $ (294 ) $ 2,250 $ (1,228 ) Gain (loss) on foreign exchange contracts and term loans designated as net investment hedge recognized in OCI OCI $ 12,200 $ (98,003 ) $ 100,205 $ (239,884 )

Stockholders' Equity (Tables)

Stockholders' Equity (Tables)	9 Months Ended
	Sep. 30, 2018
Stockholders' Equity Note [Abstract]
Schedule of stockholder's equity capital accounts	Common Stock. The following is a summary of our common stock issuances during the nine months ended September 30, 2018 and 2017 (dollars in thousands, except average price amounts): Shares Issued Average Price Gross Proceeds Net Proceeds 2017 Dividend reinvestment plan issuances 4,312,447 $71.14 $ 306,785 $ 305,996 2017 Option exercises 209,192 50.62 10,590 10,590 2017 Equity shelf program issuances 2,986,574 72.30 215,917 214,406 2017 Preferred stock conversions 4,296 — — 2017 Redemption of equity membership units 91,180 — — 2017 Stock incentive plans, net of forfeitures 135,773 — — 2017 Totals 7,739,462 $ 533,292 $ 530,992 2018 Dividend reinvestment plan issuances 1,755,446 $64.24 $ 112,770 $ 112,294 2018 Option exercises 32,120 39.94 1,283 1,283 2018 Equity shelf program issuances 1,944,511 66.72 129,744 128,834 2018 Preferred stock conversions 83 — — 2018 Stock incentive plans, net of forfeitures 112,868 — — 2018 Totals 3,845,028 $ 243,797 $ 242,411 The following is a summary of our stockholders’ equity capital accounts as of the dates indicated: September 30, 2018 December 31, 2017 Preferred Stock: Authorized shares 50,000,000 50,000,000 Issued shares 14,375,000 14,375,000 Outstanding shares 14,369,965 14,370,060 Common Stock, $1.00 par value: Authorized shares 700,000,000 700,000,000 Issued shares 376,759,924 372,852,311 Outstanding shares 375,576,579 371,731,551 Preferred Stock. The following is a summary of our preferred stock activity during the periods indicated: Nine Months Ended September 30, 2018 September 30, 2017 Weighted Avg. Weighted Avg. Shares Dividend Rate Shares Dividend Rate Beginning balance 14,370,060 6.50% 25,875,000 6.50% Shares redeemed — 0.00% (11,500,000 ) 6.50% Shares converted (95 ) 6.50% (4,935 ) 6.50% Ending balance 14,369,965 6.50% 14,370,065 6.50%
Schedule of dividend payments	The following is a summary of our dividend payments (in thousands, except per share amounts): Nine Months Ended September 30, 2018 September 30, 2017 Per Share Amount Per Share Amount Common Stock $ 2.6100 $ 971,280 $ 2.6100 $ 955,631 Series I Preferred Stock 2.4375 35,028 2.4375 35,035 Series J Preferred Stock — — 0.2347 2,699 Totals $ 1,006,308 $ 993,365
Schedule of accumulated other comprehensive income/(loss)	Accumulated Other Comprehensive Income . The following is a summary of accumulated other comprehensive income (loss) for the periods presented (in thousands): Unrecognized gains (losses) related to: Foreign Currency Translation Available for Sale Securities Actuarial Losses Cash Flow Hedges Total Balance at December 31, 2017 $ (110,581 ) $ — $ (884 ) $ — $ (111,465 ) Other comprehensive income before reclassification adjustments (27,026 ) — — — (27,026 ) Net current-period other comprehensive income (27,026 ) — — — (27,026 ) Balance at September 30, 2018 $ (137,607 ) $ — $ (884 ) $ — $ (138,491 ) Balance at December 31, 2016 $ (173,496 ) $ 5,120 $ (1,153 ) $ (2 ) $ (169,531 ) Other comprehensive income before reclassification adjustments 48,574 (20,285 ) — 2 28,291 Net current-period other comprehensive income 48,574 (20,285 ) — 2 28,291 Balance at September 30, 2017 $ (124,922 ) $ (15,165 ) $ (1,153 ) $ — $ (141,240 )

Earnings Per Share (Tables)

Earnings Per Share (Tables)	9 Months Ended
	Sep. 30, 2018
Earnings Per Share [Abstract]
Computation of basic and diluted earnings per share	The following table sets forth the computation of basic and diluted earnings per share (in thousands, except per share data): Three Months Ended Nine Months Ended September 30, September 30, 2018 2017 2018 2017 Numerator for basic and diluted earnings per share - net income (loss) attributable to common stockholders $ 64,384 $ 74,043 $ 656,487 $ 575,118 Denominator for basic earnings per share - weighted average shares 373,023 369,089 372,052 366,096 Effect of dilutive securities: Employee stock options 6 40 12 53 Non-vested restricted shares 348 515 464 464 Redeemable shares 1,096 1,096 1,096 1,281 Employee stock purchase program 14 — 14 — Dilutive potential common shares 1,464 1,651 1,586 1,798 Denominator for diluted earnings per share - adjusted weighted average shares 374,487 370,740 373,638 367,894 Basic earnings per share $ 0.17 $ 0.20 $ 1.76 $ 1.57 Diluted earnings per share $ 0.17 $ 0.20 $ 1.76 $ 1.56

Disclosure about Fair Value o_2

Disclosure about Fair Value of Financial Instruments (Tables)	9 Months Ended
	Sep. 30, 2018
Fair Value Disclosures [Abstract]
Carrying amounts and estimated fair values of financial instruments	The carrying amounts and estimated fair values of our financial instruments are as follows (in thousands): September 30, 2018 December 31, 2017 Carrying Amount Fair Value Carrying Amount Fair Value Financial assets: Mortgage loans receivable $ 266,286 $ 273,620 $ 306,120 $ 332,508 Other real estate loans receivable 74,538 75,091 121,379 125,480 Equity securities 12,912 12,912 7,269 7,269 Cash and cash equivalents 191,199 191,199 243,777 243,777 Restricted cash 90,086 90,086 65,526 65,526 Foreign currency forward contracts and cross currency swaps 34,902 34,902 15,604 15,604 Financial liabilities: Borrowings under unsecured credit facilities $ 1,312,000 $ 1,312,000 $ 719,000 $ 719,000 Senior unsecured notes 9,655,022 10,169,806 8,331,722 9,168,432 Secured debt 2,465,661 2,464,635 2,608,976 2,641,997 Foreign currency forward contracts and cross currency swaps 78,566 78,566 38,654 38,654 Redeemable OP unitholder interests $ 97,476 $ 97,476 $ 97,476 $ 97,476
The Market approach utilized to measure fair value of financial assets and liabilities on recurring basis	The following summarizes items measured at fair value on a recurring basis (in thousands): Fair Value Measurements as of September 30, 2018 Total Level 1 Level 2 Level 3 Equity securities $ 12,912 $ 12,912 $ — $ — Foreign currency forward contracts and cross currency swaps, net asset (liability) (1) (43,664 ) — (43,664 ) — Redeemable OP unitholder interests 97,476 — 97,476 — Totals $ 66,724 $ 12,912 $ 53,812 $ — (1) Please see Note 11 for additional information.

Segment Reporting (Tables)

Segment Reporting (Tables)	9 Months Ended
	Sep. 30, 2018
Segment Reporting [Abstract]
Summary of information for reportable segments	The following is a summary of geographic information for the periods presented (dollars in thousands): Three Months Ended Nine Months Ended September 30, 2018 September 30, 2017 September 30, 2018 September 30, 2017 Revenues: Amount % Amount % Amount % Amount % United States $ 1,007,203 81.5 % $ 871,431 79.9 % $ 2,766,726 80.0 % $ 2,582,042 80.4 % United Kingdom 111,503 9.0 % 105,028 9.6 % 340,059 9.8 % 298,618 9.3 % Canada 117,673 9.5 % 115,024 10.5 % 352,471 10.2 % 331,723 10.3 % Total $ 1,236,379 100.0 % $ 1,091,483 100.0 % $ 3,459,256 100.0 % $ 3,212,383 100.0 % As of September 30, 2018 December 31, 2017 Assets: Amount % Amount % United States $ 24,616,066 81.4 % $ 22,274,443 79.7 % United Kingdom 3,150,305 10.4 % 3,239,039 11.6 % Canada 2,482,748 8.2 % 2,430,963 8.7 % Total $ 30,249,119 100.0 % $ 27,944,445 100.0 % Summary information for the reportable segments (which excludes unconsolidated entities) is as follows (in thousands): Three Months Ended September 30, 2018: Triple-net Seniors Housing Operating Outpatient Medical Non-segment / Corporate Total Rental income $ 203,039 $ — $ 139,848 $ — $ 342,887 Resident fees and services — 875,171 — — 875,171 Interest income 14,378 159 85 — 14,622 Other income 1,693 1,175 136 695 3,699 Total revenues 219,110 876,505 140,069 695 1,236,379 Property operating expenses 426 610,659 46,072 — 657,157 Consolidated net operating income 218,684 265,846 93,997 695 579,222 Interest expense 3,500 17,319 1,643 115,570 138,032 Loss (gain) on derivatives and financial instruments, net 8,991 — — — 8,991 Depreciation and amortization 60,383 136,532 46,234 — 243,149 General and administrative — — — 28,746 28,746 Loss (gain) on extinguishment of debt, net — — — 4,038 4,038 Impairment of assets 6,178 562 — — 6,740 Other expenses 87,076 (1) (811 ) 1,055 1,306 88,626 Income (loss) from continuing operations before income taxes and income from unconsolidated entities 52,556 112,244 45,065 (148,965 ) 60,900 Income tax (expense) benefit 1,116 211 239 (3,307 ) (1,741 ) Income (loss) from unconsolidated entities 5,377 (6,705 ) 1,672 — 344 Income (loss) from continuing operations 59,049 105,750 46,976 (152,272 ) 59,503 Gain (loss) on real estate dispositions, net 24,782 (1 ) (58 ) — 24,723 Net income (loss) $ 83,831 $ 105,749 $ 46,918 $ (152,272 ) $ 84,226 Total assets $ 10,163,867 $ 14,989,442 $ 4,953,277 $ 142,533 $ 30,249,119 Three Months Ended September 30, 2017: Triple-net Seniors Housing Operating Outpatient Medical Non-segment / Corporate Total Rental income $ 221,555 $ — $ 141,325 $ — $ 362,880 Resident fees and services — 702,380 — — 702,380 Interest income 20,187 — — — 20,187 Other income 3,174 1,497 667 698 6,036 Total revenues 244,916 703,877 141,992 698 1,091,483 Property operating expenses — 478,777 45,220 — 523,997 Consolidated net operating income 244,916 225,100 96,772 698 567,486 Interest expense 3,622 16,369 2,929 99,658 122,578 Loss (gain) on derivatives and financial instruments, net 324 — — — 324 Depreciation and amortization 62,891 119,089 48,158 — 230,138 General and administrative — — — 29,913 29,913 Other expenses 89,236 (1) 5,157 530 4,672 99,595 Income (loss) from continuing operations before income taxes and income from unconsolidated entities 88,843 84,485 45,155 (133,545 ) 84,938 Income tax (expense) benefit (816 ) (1,519 ) (366 ) 2,032 (669 ) Income (loss) from unconsolidated entities 5,478 (2,886 ) 816 — 3,408 Income (loss) from continuing operations 93,505 80,080 45,605 (131,513 ) 87,677 Gain (loss) on real estate dispositions, net (185 ) (197 ) 2,004 — 1,622 Net income (loss) $ 93,320 $ 79,883 $ 47,609 $ (131,513 ) $ 89,299 (1) Represents non-capitalizable transaction costs primarily related to a joint venture transaction with an existing seniors housing operator including the conversion of properties from triple-net to seniors housing operating, an exchange of PropCo/OpCo interests, and termination/restructuring of pre-existing relationships. Nine Months Ended September 30, 2018 Triple-net Seniors Housing Operating Outpatient Medical Non-segment / Corporate Total Rental income $ 607,831 $ — $ 412,026 $ — $ 1,019,857 Resident fees and services — 2,374,450 — — 2,374,450 Interest income 42,176 416 140 — 42,732 Other income 16,282 3,973 401 1,561 22,217 Total revenues 666,289 2,378,839 412,567 1,561 3,459,256 Property operating expenses 583 1,648,262 133,528 — 1,782,373 Consolidated net operating income 665,706 730,577 279,039 1,561 1,676,883 Interest expense 10,742 51,225 4,975 315,281 382,223 Loss (gain) on derivatives and financial instruments, net (5,642 ) — — — (5,642 ) Depreciation and amortization 171,724 397,080 138,821 — 707,625 General and administrative — — — 95,282 95,282 Loss (gain) on extinguishment of debt, net (32 ) 110 11,928 4,038 16,044 Impairment of assets 34,482 5,075 — — 39,557 Other expenses 89,153 5,168 3,748 4,327 102,396 Income (loss) from continuing operations before income taxes and income from unconsolidated entities 365,279 271,919 119,567 (417,367 ) 339,398 Income tax (expense) benefit (708 ) (2,244 ) (567 ) (3,651 ) (7,170 ) Income (loss) from unconsolidated entities 16,260 (21,389 ) 4,293 — (836 ) Income (loss) from continuing operations 380,831 248,286 123,293 (421,018 ) 331,392 Gain (loss) on real estate dispositions, net 158,938 3 214,721 — 373,662 Net income (loss) $ 539,769 $ 248,289 $ 338,014 $ (421,018 ) $ 705,054 Nine Months Ended September 30, 2017 Triple-net Seniors Housing Operating Outpatient Medical Non-segment / Corporate Total Rental income $ 666,735 $ — $ 418,886 $ — $ 1,085,621 Resident fees and services — 2,049,757 — — 2,049,757 Interest income 61,767 69 — — 61,836 Other income 7,496 4,005 2,497 1,171 15,169 Total revenues 735,998 2,053,831 421,383 1,171 3,212,383 Property operating expenses — 1,400,313 135,708 — 1,536,021 Consolidated net operating income 735,998 653,518 285,675 1,171 1,676,362 Interest expense 11,647 47,587 7,342 290,829 357,405 Loss (gain) on derivatives and financial instruments, net 2,284 — — — 2,284 Depreciation and amortization 182,672 356,023 144,567 — 683,262 General and administrative — — — 93,643 93,643 Loss (gain) on extinguishment of debt, net 29,083 3,414 4,373 — 36,870 Impairment of assets 4,846 14,191 5,625 — 24,662 Other expenses 96,425 8,100 2,201 10,882 117,608 Income (loss) from continuing operations before income taxes and income from unconsolidated entities 409,041 224,203 121,567 (394,183 ) 360,628 Income tax (expense) benefit (2,070 ) 9,133 (655 ) (873 ) 5,535 Income (loss) from unconsolidated entities 14,983 (40,527 ) 1,868 — (23,676 ) Income (loss) from continuing operations 421,954 192,809 122,780 (395,056 ) 342,487 Gain (loss) on real estate dispositions, net 273,051 12,814 2,004 — 287,869 Net income (loss) $ 695,005 $ 205,623 $ 124,784 $ (395,056 ) $ 630,356

Variable Interest Entity Disc_2

Variable Interest Entity Disclosure (Tables)	9 Months Ended
	Sep. 30, 2018
Variable Interest Entity, Consolidated, Carrying Amount, Assets and Liabilities, Net [Abstract]
Schedule of Variable Interest Entities	Accordingly, such joint ventures have been consolidated, and the table below summarizes the balance sheets of consolidated VIEs in the aggregate (in thousands): September 30, 2018 December 31, 2017 Assets Net real property owned $ 977,252 $ 1,002,137 Cash and cash equivalents 15,059 12,308 Receivables and other assets 17,922 16,330 Total assets (1) $ 1,010,233 $ 1,030,775 Liabilities and equity Secured debt $ 466,772 $ 471,103 Accrued expenses and other liabilities 18,144 14,832 Total equity 525,317 544,840 Total liabilities and equity $ 1,010,233 $ 1,030,775 (1) Note that assets of the consolidated VIEs can only be used to settle obligations relating to such VIEs. Liabilities of the consolidated VIEs represent claims against the specific assets of the VIEs.

Accounting Policies and Relat_4

Accounting Policies and Related Matters (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Accounting Policies [Abstract]
Loss (gain) on derivatives and financial instruments, net	$ (8,991)	$ (324)	$ 5,642	$ (2,284)

Accounting Policies and Relat_5

Accounting Policies and Related Matters (Details 2) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Dec. 31, 2017	Dec. 31, 2016
Accounting Policies and Related Matters [Line Items]
Cash disbursed for acquisitions	$ (3,190,534)	$ (574,002)
Decrease (increase) in restricted cash		0
Net cash provided from (used in) investing activities	(2,133,293)	400,418
Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents, Period Increase (Decrease), Including Exchange Rate Effect	(28,018)	(311,909)
Cash and cash equivalents at beginning of period	243,777
Cash and cash equivalents at end of period	191,199
Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents	$ 281,285	295,311	$ 309,303	$ 607,220
Accounting Standards Update 2016-18 [Member] | As Previously Reported
Accounting Policies and Related Matters [Line Items]
Cash disbursed for acquisitions		(575,694)
Decrease (increase) in restricted cash		130,470
Net cash provided from (used in) investing activities		529,196
Increase (decrease) in cash and cash equivalents		(183,131)
Cash and cash equivalents at beginning of period		419,378
Cash and cash equivalents at end of period		$ 236,247

Real Property Acquisitions an_3

Real Property Acquisitions and Development Real Property Acquisitions and Development (Details 1) - USD ($) $ in Thousands	Sep. 30, 2018	Dec. 31, 2017
Business Acquisition [Line Items]
Real estate held-for-sale	$ 619,141	$ 734,147
Cash and cash equivalents	191,199	243,777
Restricted cash	90,086	$ 65,526
Quality Care Properties Inc [Member]
Business Acquisition [Line Items]
Land and land improvements	417,983
Buildings and improvements	2,249,803
Acquired lease intangibles	15,512
Real estate held-for-sale	418,297
Cash and cash equivalents	381,913
Restricted cash	4,981
Receivables and other assets	1,322
Total assets acquired	3,489,811
Accrued expenses and other liabilities	(13,199)
Total liabilities assumed	(13,199)
Noncontrolling interests	(512,741)
Net assets acquired	$ 2,963,871

Real Property Acquisitions an_4

Real Property Acquisitions and Development (Details 2) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Dec. 31, 2017
Estimated Fair Value of Allocated Purchase Price of Asset and Liabilities
Real estate held-for-sale	$ 619,141		$ 734,147
Triple Net
Estimated Fair Value of Allocated Purchase Price of Asset and Liabilities
Land and land improvements	413,588	$ 31,948
Buildings and improvements	2,239,422	206,910
Acquired lease intangibles	12,383	0
Real estate held-for-sale	396,265	0
Receivables and other assets	1,322	0
Total assets acquired	3,062,980	238,858
Accrued expenses and other liabilities	(13,199)	(21,236)
Total liabilities assumed	(13,199)	(21,236)
Noncontrolling interests	(512,741)	(7,275)
Non-cash acquisition related activity	0	(54,901)
Cash disbursed for acquisitions	2,537,040	155,446
Construction in progress additions	49,619	106,186
Less: Capitalized Interest	(1,932)	(3,886)
Less: Foreign currency translation	180	(656)
Cash disbursed for construction in progress	47,867	101,644
Capital improvements to existing properties	6,766	17,873
Total cash invested in real property	2,591,673	274,963
Cash acquired from acquisition	386,894
Non cash acquisition financed as equity investments		54,901
Senior housing - operating
Estimated Fair Value of Allocated Purchase Price of Asset and Liabilities
Land and land improvements	47,865	31,006
Buildings and improvements	535,436	384,522
Acquired lease intangibles	68,084	48,197
Receivables and other assets	1,255	3,164
Total assets acquired	652,640	466,889
Secured debt	(89,973)	0
Accrued expenses and other liabilities	(14,686)	(43,364)
Total liabilities assumed	(104,659)	(43,364)
Noncontrolling interests	(9,818)	(4,701)
Non-cash acquisition related activity	0	(59,065)
Cash disbursed for acquisitions	538,163	359,759
Construction in progress additions	28,222	65,282
Less: Capitalized Interest	(2,608)	(5,996)
Less: Foreign currency translation	2,151	(6,218)
Cash disbursed for construction in progress	27,765	53,068
Capital improvements to existing properties	127,274	110,372
Total cash invested in real property	693,202	523,199
Cash acquired from acquisition	2,442	6,273
Non cash acquisition financed as real estate loan receivable		6,349
Non cash acquisition financed as equity investments		51,097
Outpatient Medical
Estimated Fair Value of Allocated Purchase Price of Asset and Liabilities
Land and land improvements	18,496	25,060
Buildings and improvements	79,205	62,336
Acquired lease intangibles	11,271	8,397
Real estate held-for-sale	22,032	0
Receivables and other assets	6	3
Total assets acquired	131,010	95,796
Secured debt	(14,769)	(25,709)
Accrued expenses and other liabilities	(910)	(2,210)
Total liabilities assumed	(15,679)	(27,919)
Noncontrolling interests	0	(9,080)
Cash disbursed for acquisitions	115,331	58,797
Construction in progress additions	16,733	33,495
Less: Capitalized Interest	(1,817)	(1,847)
Less: Accruals	(2,402)	11,708
Cash disbursed for construction in progress	12,514	43,356
Capital improvements to existing properties	39,595	30,897
Total cash invested in real property	167,440	133,050
Cash acquired from acquisition	$ 2,244	$ 0

Real Property Acquisitions an_5

Real Property Acquisitions and Development (Details 3) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017
Development projects:
Total development projects	$ 188,344	$ 350,142
Expansion Projects	8,879	10,336
Total construction in progress conversions	197,223	360,478
Triple Net
Development projects:
Total development projects	90,055	283,472
Seniors housing operating [Member]
Development projects:
Total development projects	86,931	3,634
Outpatient Medical
Development projects:
Total development projects	$ 11,358	$ 63,036

Real Property Acquisitions an_6

Real Property Acquisitions and Development Real Property Acquisitions and Development (Textual) (Details) $ / shares in Units, $ in Millions	Jul. 26, 2018USD ($)propertiesNumber$ / shares
Business Acquisition [Line Items]
Seniors Housing Properties Leased To Operators Under Existing Triple Net Leases	14
Multi Tenant Medical Office Building Leased To Various Tenants | Number	1
Commitment To Unsecured Credit Facility Maximum Borrowing Capacity | $	$ 1,000
Quality Care Properties Inc [Member]
Business Acquisition [Line Items]
Business Acquisition, Share Price | $ / shares	$ 20.75
Business Combination, Consideration Transferred | $	$ 3,500
Joint Venture With ProMedica
Business Acquisition [Line Items]
Equity Method Investment, Ownership Percentage	80.00%
ProMedica Member
Business Acquisition [Line Items]
Lessor, Operating Lease, Lease Not yet Commenced, Term of Contract	15 years
Lease Agreement Number Of Renewal Options	3
Lessor, Operating Lease, Lease Not yet Commenced, Renewal Term	5 years
Proceeds from Rents Received | $	$ 179
Lease Agreement Escalator In Year One	1.375%
Lease Agreement Annual Escalator Thereafter	2.75%
Total Senior Housing Properties Leased to Promedica	218
ProMedica Member | Joint Venture With ProMedica
Business Acquisition [Line Items]
Equity Method Investment, Ownership Percentage	20.00%
Held For Sale [Member]
Business Acquisition [Line Items]
Seniors Housing Properties Leased To Promedica Under A Non Yielding Lease	59
Seniors Housing Properties Leased To Operators Under Existing Triple Net Leases	12
Surgery Center Leased To Operators Under Existing Triple Net Leases	1

Real Estate Intangibles (Detail

Real Estate Intangibles (Details) - USD ($) $ in Thousands	9 Months Ended	12 Months Ended
	Sep. 30, 2018	Dec. 31, 2017
Finite-Lived Intangible Assets and Liabilities [Line Items]
Assets - gross historical cost	$ 1,562,650	$ 1,502,471
Assets - accumulated amortization	(1,190,035)	(1,125,437)
Net book value	$ 372,615	$ 377,034
Assets - weighted-average amortization period in years	16 years 11 days	15 years 1 month 6 days
Liabilities - gross historical cost	$ 80,106	$ 68,970
Liabilities - accumulated Amortization	(42,834)	(39,629)
Real Estate Intangible Liabilities Net	$ 37,272	$ 29,341
Liabilities - weighted-average amortization period in years	16 years 1 month 16 days	20 years 1 month 6 days
In place lease intangibles [Member]
Finite-Lived Intangible Assets and Liabilities [Line Items]
Assets - gross historical cost	$ 1,398,850	$ 1,352,139
Above market tenant leases [Member]
Finite-Lived Intangible Assets and Liabilities [Line Items]
Assets - gross historical cost	59,011	58,443
Liabilities - gross historical cost	8,540	8,540
Below market ground leases [Member]
Finite-Lived Intangible Assets and Liabilities [Line Items]
Assets - gross historical cost	65,022	58,784
Lease commissions [Member]
Finite-Lived Intangible Assets and Liabilities [Line Items]
Assets - gross historical cost	39,767	33,105
Below market tenant leases [Member]
Finite-Lived Intangible Assets and Liabilities [Line Items]
Liabilities - gross historical cost	$ 71,566	$ 60,430

Real Estate Intangibles (Deta_2

Real Estate Intangibles (Details 1) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Real Estate Intangible Amortization [Abstract]
Rental income related to above/below market tenant leases, net	$ (294)	$ 173	$ (978)	$ 745
Property operating expenses related to above/below market ground leases, net	(327)	(306)	(1,006)	(925)
Depreciation and amortization related to in place lease intangibles and lease commissions	$ (31,455)	$ (34,270)	$ (97,479)	$ (109,011)

Real Estate Intangibles (Real E

Real Estate Intangibles (Real Estate Intangible Maturity Schedule) (Details) - USD ($) $ in Thousands	Sep. 30, 2018	Dec. 31, 2017
Finite-Lived Intangible Assets, Net, Amortization Expense, Fiscal Year Maturity [Abstract]
2018, amortization expense	$ 32,456
2019, amortization expense	87,011
2020, amortization expense	57,221
2021, amortization expense	24,300
2022, amortization expense	19,325
Thereafter, amortization expense	152,302
Net book value	372,615	$ 377,034
Below Market Lease, Net, Amortization Income, Fiscal Year Maturity [Abstract]
2018, amortization income	1,433
2019, amortization income	5,437
2020, amortization income	4,938
2021, amortization income	4,444
2022, amortization income	3,971
Thereafter, amortization income	17,049
Real Estate Intangible Liabilities Net	$ 37,272	$ 29,341

Dispositions, Assets Held for_2

Dispositions, Assets Held for Sale and Discontinued Operations (Details) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018USD ($)properties	Sep. 30, 2017USD ($)	Sep. 30, 2018USD ($)properties	Sep. 30, 2017USD ($)	Dec. 31, 2017USD ($)
Real property dispositions:
Total dispositions			$ 829,749	$ 927,512
Gain (loss) on real estate dispositions, net	$ 24,723	$ 1,622	373,662	287,869
Net other assets/liabilities disposed			5,090	22,470
Proceeds from sales of real property			1,208,501	1,237,851
Real estate held-for-sale	619,141		619,141		$ 734,147
Impairment of assets	$ 6,740	$ 0	39,557	24,662
Triple Net
Real property dispositions:
Total dispositions			$ 604,480	899,104
Number of properties classified as held for sale | properties	60		60
Senior housing - operating
Real property dispositions:
Total dispositions			$ 2,200	16,206
Number of properties classified as held for sale | properties	16		16
Outpatient Medical
Real property dispositions:
Total dispositions			$ 223,069	$ 12,202
Number of properties classified as held for sale | properties	3		3

Dispositions but not discontinu

Dispositions but not discontinued operations (Details) - Disposal Group, Disposed of by Sale, Not Discontinued Operations - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Revenues:
Total revenues	$ 29,035	$ 52,584	$ 92,447	$ 175,934
Expenses:
Interest expense	18	1,243	261	5,514
Property operating expenses	21,312	19,147	59,640	58,525
Provision for depreciation	801	10,999	6,605	33,806
Total expenses	22,131	31,389	66,506	97,845
Income (loss) from real estate dispositions, net	$ 6,904	$ 21,195	$ 25,941	$ 78,089

Real Estate Loans Receivable (D

Real Estate Loans Receivable (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017
Advances on real estate loans receivable:
Investments in new loans	$ 37,427	$ 11,315
Draws on existing loans	29,709	58,736
Net cash advances on real estate loans	67,136	70,051
Receipts on real estate loans receivable:
Loan payoffs	116,161	202,892
Principal payments on loans	33,431	1,121
Sub-total	149,592	204,013
Less : Non-cash activity	0	(121,750)
Total receipts on real estate loans	149,592	82,263
Net advances (receipts) on real estate loans	(82,456)	(12,212)
Triple Net
Advances on real estate loans receivable:
Investments in new loans	10,628	11,315
Draws on existing loans	29,709	58,736
Net cash advances on real estate loans	40,337	70,051
Receipts on real estate loans receivable:
Loan payoffs	116,161	142,392
Principal payments on loans	33,431	1,121
Sub-total	149,592	143,513
Less : Non-cash activity	0	(61,250)
Total receipts on real estate loans	149,592	82,263
Net advances (receipts) on real estate loans	(109,255)	(12,212)
Senior housing - operating
Advances on real estate loans receivable:
Investments in new loans	11,806
Draws on existing loans	0
Net cash advances on real estate loans	11,806
Receipts on real estate loans receivable:
Loan payoffs	0
Principal payments on loans	0
Sub-total	0
Less : Non-cash activity	0
Total receipts on real estate loans	0
Net advances (receipts) on real estate loans	11,806
Outpatient Medical
Advances on real estate loans receivable:
Investments in new loans	14,993	0
Draws on existing loans	0	0
Net cash advances on real estate loans	14,993	0
Receipts on real estate loans receivable:
Loan payoffs	0	60,500
Principal payments on loans	0	0
Sub-total	0	60,500
Less : Non-cash activity	0	(60,500)
Total receipts on real estate loans	0	0
Net advances (receipts) on real estate loans	$ 14,993	$ 0

Real Estate Loans Receivable _2

Real Estate Loans Receivable (Details 1) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Dec. 31, 2017
Summary of loan impairments
Balance of impaired loans at end of period	$ 201,971	$ 282,929
Allowance for loan losses	68,372	5,406	$ 68,372
Balance of impaired loans not reserved	133,599	277,523
Average impaired loans for the period	230,645	324,255
Interest recognized on impaired loans	$ 13,361	$ 23,957

Real Estate Loans Receivable _3

Real Estate Loans Receivable (Textuals) (Details) - USD ($)	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Sep. 30, 2018	Sep. 30, 2017
Financing Receivable, Modifications [Line Items]
Allowance for loan losses	$ 68,372,000		$ 68,372,000	$ 5,406,000
Real estate loans with outstanding balances			$ 2,598,000
Genesis Healthcare Loans [Member] | Triple Net
Financing Receivable, Modifications [Line Items]
Provision For Loan And Lease Losses Real Estate Excluding Write Off	$ 62,966,000	$ 6,935,000

Investments in Unconsolidated_3

Investments in Unconsolidated Entities (Summary of Investments in Unconsolidated Entities) (Details) - USD ($) $ in Thousands	Sep. 30, 2018	Dec. 31, 2017
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated entities	$ 423,192	$ 445,585
Triple Net
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated entities	$ 21,004	$ 22,856
Triple Net | Minimum
Schedule of Equity Method Investments [Line Items]
Equity Method Investment, Ownership Percentage	10.00%	10.00%
Triple Net | Maximum
Schedule of Equity Method Investments [Line Items]
Equity Method Investment, Ownership Percentage	49.00%	49.00%
Seniors Housing Facilities Operating [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated entities	$ 310,175	$ 352,430
Seniors Housing Facilities Operating [Member] | Minimum
Schedule of Equity Method Investments [Line Items]
Equity Method Investment, Ownership Percentage	10.00%	10.00%
Seniors Housing Facilities Operating [Member] | Maximum
Schedule of Equity Method Investments [Line Items]
Equity Method Investment, Ownership Percentage	50.00%	50.00%
Outpatient Medical
Schedule of Equity Method Investments [Line Items]
Equity Method Investment, Ownership Percentage	43.00%	43.00%
Investments in unconsolidated entities	$ 92,013	$ 70,299

Investments in Unconsolidated_4

Investments in Unconsolidated Entities (Details) $ in Thousands	Sep. 30, 2018USD ($)
Schedule of Equity Method Investments [Line Items]
Unamortized Investment In Joint Venture Primarily Attributable To Real Estate And Related Intangible Assets	$ 106,625

Credit Concentration (Details)

Credit Concentration (Details) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018USD ($)properties	Sep. 30, 2017USD ($)	Sep. 30, 2018USD ($)properties	Sep. 30, 2017USD ($)	Dec. 31, 2017
Concentration by investment:
Number of properties in diversified portfolio | properties	1,529		1,529
Net Operating Income	$ 579,222	$ 567,486	$ 1,676,883	$ 1,676,362
Credit Concentration (Textual) [Abstract]
Percentage total investments with top five customers					41.00%
Net Operating Income [Member]
Concentration by investment:
Percent of NOI			100.00%
Net Operating Income			$ 1,676,883
Sunrise Senior Living Inc. [Member]
Concentration by investment:
Number of properties in diversified portfolio | properties	161		161
Sunrise Senior Living Inc. [Member] | Net Operating Income [Member]
Concentration by investment:
Percent of NOI			15.00%
Net Operating Income			$ 252,111
Brookdale [Member]
Concentration by investment:
Number of properties in diversified portfolio | properties	137		137
Brookdale [Member] | Net Operating Income [Member]
Concentration by investment:
Percent of NOI			7.00%
Net Operating Income			$ 117,367
Revera [Member]
Concentration by investment:
Number of properties in diversified portfolio | properties	98		98
Revera [Member] | Net Operating Income [Member]
Concentration by investment:
Percent of NOI			7.00%
Net Operating Income			$ 116,158
Genesis HealthCare [Member]
Concentration by investment:
Number of properties in diversified portfolio | properties	88		88
Genesis HealthCare [Member] | Net Operating Income [Member]
Concentration by investment:
Percent of NOI			6.00%
Net Operating Income			$ 102,015
Benchmark Senior Living [Member]
Concentration by investment:
Number of properties in diversified portfolio | properties	48		48
Benchmark Senior Living [Member] | Net Operating Income [Member]
Concentration by investment:
Percent of NOI			4.00%
Net Operating Income			$ 75,435
Remaining Portfolio [Member]
Concentration by investment:
Number of properties in diversified portfolio | properties	997		997
Remaining Portfolio [Member] | Net Operating Income [Member]
Concentration by investment:
Percent of NOI			61.00%
Net Operating Income			$ 1,013,797

Borrowings Under Credit Facil_3

Borrowings Under Credit Facilities and Related Items (Details Textual)	9 Months Ended
	Sep. 30, 2018USD ($)properties
Line of Credit Facility [Line Items]
Number of banks in consortium | properties	31
Available to borrow in alternate currencies	$ 1,000,000,000
Debt instrument, basis spread on variable rate	0.825%
Line of credit facility, commitment fee percentage	0.15%
Revolving Credit Facility
Line of Credit Facility [Line Items]
Unsecured line of credit arrangement	$ 3,000,000,000
Term Credit Facility
Line of Credit Facility [Line Items]
Unsecured line of credit arrangement	500,000,000
Term Credit Facility, CAD Denominated
Line of Credit Facility [Line Items]
Unsecured line of credit arrangement	$ 250,000,000
London Interbank Offered Rate (LIBOR) | Revolving Credit Facility
Line of Credit Facility [Line Items]
Debt instrument, interest rate during period	3.09%
Accordion Feature [Member]
Line of Credit Facility [Line Items]
Unsecured line of credit arrangement	$ 1,000,000,000
Accordion Feature [Member] | Term Credit Facility, CAD Denominated
Line of Credit Facility [Line Items]
Unsecured line of credit arrangement	$ 250,000,000

Borrowings Under Credit Facil_4

Borrowings Under Credit Facilities and Related Items (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017	Dec. 31, 2017
Line of Credit Facility [Abstract]
Balance outstanding at quarter end	$ 1,312,000	$ 420,000	$ 1,312,000	$ 420,000	$ 719,000
Maximum amount outstanding at any month end	2,148,000	645,000	2,148,000	1,010,000
Average amount outstanding (total of daily principal balances divided by days in period)	$ 1,519,000	$ 450,130	$ 819,516	$ 601,346
Weighted average interest rate (actual interest expense divided by average borrowings outstanding)	3.00%	2.19%	2.95%	1.95%

Senior Unsecured Notes and Se_3

Senior Unsecured Notes and Secured Debt (Details) £ in Thousands, $ in Thousands, $ in Thousands	9 Months Ended
	Sep. 30, 2018USD ($)	Sep. 30, 2018GBP (£)	Sep. 30, 2018CAD ($)	Dec. 31, 2017USD ($)	Sep. 30, 2017USD ($)	Dec. 31, 2016USD ($)
Principal payments due on debt obligations
2,018	$ 170,742
2,019	1,089,166
2,020	828,600
2,021	797,280
2,022	825,832
Thereafter	8,521,831
Totals	12,233,451
Senior Unsecured Notes and Secured Debt (Textual) [Abstract]
Senior unsecured notes	$ 9,655,022			$ 8,331,722
Debt instrument, basis spread on variable rate	0.825%
Unsecured term credit facility
Senior Unsecured Notes and Secured Debt (Textual) [Abstract]
Senior unsecured notes	$ 500,000
Unsecured term credit facility | London Interbank Offered Rate (LIBOR)
Senior Unsecured Notes and Secured Debt (Textual) [Abstract]
Interest rate	3.07%	3.07%	3.07%
Debt instrument, basis spread on variable rate	0.90%
Senior Unsecured Notes
Principal payments due on debt obligations
2,018	$ 0
2,019	600,000
2,020	689,662
2,021	450,000
2,022	600,000
Thereafter	7,414,034
Totals	$ 9,753,696			8,417,447	$ 8,404,393	$ 8,260,038
Senior Unsecured Notes | Maximum
Senior Unsecured Notes and Secured Debt (Textual) [Abstract]
Interest rate	6.50%	6.50%	6.50%
Senior Unsecured Notes | Minimum
Senior Unsecured Notes and Secured Debt (Textual) [Abstract]
Interest rate	2.73%	2.73%	2.73%
Secured Debt
Principal payments due on debt obligations
2,018	$ 170,742
2,019	489,166
2,020	138,938
2,021	347,280
2,022	225,832
Thereafter	1,107,797
Totals	2,479,755			$ 2,618,408	$ 2,720,002	$ 3,465,066
Senior Unsecured Notes and Secured Debt (Textual) [Abstract]
Carrying values of properties securing the debt	$ 5,303,414
Secured Debt | Maximum
Senior Unsecured Notes and Secured Debt (Textual) [Abstract]
Interest rate	7.93%	7.93%	7.93%
Secured Debt | Minimum
Senior Unsecured Notes and Secured Debt (Textual) [Abstract]
Interest rate	1.69%	1.69%	1.69%
3.35% senior unsecured note due 2020
Senior Unsecured Notes and Secured Debt (Textual) [Abstract]
Guarantees	$ 232,162		$ 300,000
Canadian Denominated Unsecured Term Loan
Senior Unsecured Notes and Secured Debt (Textual) [Abstract]
Senior unsecured notes	$ 193,469		$ 250,000
Canadian Denominated Unsecured Term Loan | London Interbank Offered Rate (LIBOR)
Senior Unsecured Notes and Secured Debt (Textual) [Abstract]
Debt instrument, basis spread on variable rate	0.90%
Canadian Denominated Unsecured Term Loan | Canadian Denominated Unsecured Term Loan
Senior Unsecured Notes and Secured Debt (Textual) [Abstract]
Interest rate	2.73%	2.73%	2.73%
UK Debt Due 2028
Senior Unsecured Notes and Secured Debt (Textual) [Abstract]
Interest rate	4.80%	4.80%	4.80%
Senior unsecured notes issued amount	$ 717,915	£ 550,000
UK Debt Due 2034
Senior Unsecured Notes and Secured Debt (Textual) [Abstract]
Interest rate	4.50%	4.50%	4.50%
Senior unsecured notes issued amount	$ 652,650	£ 500,000

Senior Unsecured Notes and Se_4

Senior Unsecured Notes and Secured Debt (Details 1) $ in Thousands	9 Months Ended
	Sep. 30, 2018USD ($)	Sep. 30, 2017USD ($)
Debt Instrument [Line Items]
Debt issued, unsecured	$ 2,825,898	$ 7,500
Debt issued, secured	44,606	190,459
Long-term Debt, ending balance	12,233,451
Senior Unsecured Notes
Debt Instrument [Line Items]
Long-term Debt, beginning balance	8,417,447	8,260,038
Debt issued, unsecured	2,850,000	7,500
Debt extinguished	(1,450,000)	(5,000)
Foreign currency	(63,751)	141,855
Long-term Debt, ending balance	$ 9,753,696	$ 8,404,393
Weighted average interest rate
Rate of debt, beginning balance	4.31%	4.25%
Rate on debt issued	0.0457	0.0194
Rate on notes extinguished	0.0346	0.0183
Rate on notes foreign currency	0.0430	0.0424
Rate of debt, ending balance	4.45%	4.29%
Secured Debt
Debt Instrument [Line Items]
Long-term Debt, beginning balance	$ 2,618,408	$ 3,465,066
Debt issued, secured	44,606	190,459
Debt assumed	99,552	23,094
Debt extinguished	(196,573)	(1,003,372)
Principal payments	(42,294)	(47,507)
Foreign currency	(43,944)	92,262
Long-term Debt, ending balance	$ 2,479,755	$ 2,720,002
Weighted average interest rate
Rate of debt, beginning balance	3.76%	4.09%
Rate on debt issued	0.0338	0.0273
Rate on secured debt assumed	0.0430	0.0667
Rate on notes extinguished	0.0566	0.0532
Rate on secured debt principal payment	0.0391	0.0434
Rate on notes foreign currency	0.0329	0.0320
Rate of debt, ending balance	3.79%	3.74%

Derivative Instruments (Textual

Derivative Instruments (Textual) (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017
Summary of Derivative Instruments [Abstract]
Payments for (proceeds from) hedge, investing activities	$ 70,937	$ 55,771

Derivative Instrument (Notional

Derivative Instrument (Notional Table) (Details) £ in Thousands, $ in Thousands, $ in Thousands	9 Months Ended		12 Months Ended
	Sep. 30, 2018GBP (£)	Sep. 30, 2018CAD ($)	Dec. 31, 2017GBP (£)	Dec. 31, 2017CAD ($)	Sep. 30, 2018USD ($)	Sep. 30, 2018GBP (£)	Sep. 30, 2018CAD ($)	Dec. 31, 2017USD ($)	Dec. 31, 2017GBP (£)	Dec. 31, 2017CAD ($)
Canada, Dollars | Designated as Hedging Instrument | Cash Flow Hedging
Derivatives, Fair Value [Line Items]
Derivative, notional amount							$ 0			$ 36,000
Canada, Dollars | Designated as Hedging Instrument | Net Investment Hedging
Derivatives, Fair Value [Line Items]
Derivative, notional amount							575,000	$ 575,000
Notional amount of non-derivative instruments		$ 250,000		$ 250,000
United States of America, Dollars | Not Designated as Hedging Instrument
Derivatives, Fair Value [Line Items]
Derivative, notional amount					$ 405,819			408,007
United Kingdom, Pounds | Designated as Hedging Instrument | Net Investment Hedging
Derivatives, Fair Value [Line Items]
Derivative, notional amount | £						£ 890,708			£ 550,000
Notional amount of non-derivative instruments | £	£ 1,050,000		£ 1,050,000
Short | Canada, Dollars | Not Designated as Hedging Instrument
Derivatives, Fair Value [Line Items]
Derivative, notional amount							500,000			0
Short | United Kingdom, Pounds | Not Designated as Hedging Instrument
Derivatives, Fair Value [Line Items]
Derivative, notional amount					350,000			0
Long | Canada, Dollars | Not Designated as Hedging Instrument
Derivatives, Fair Value [Line Items]
Derivative, notional amount							$ 580,000			$ 80,000
Long | United Kingdom, Pounds | Not Designated as Hedging Instrument
Derivatives, Fair Value [Line Items]
Derivative, notional amount					$ 350,000			$ 0

Derivative Instruments (Details

Derivative Instruments (Details 1) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Designated as Hedging Instrument
Derivative [Line Items]
Gain (loss) on derivative instruments	$ 4,185	$ (576)	$ 8,008	$ 3,613
Not Designated as Hedging Instrument
Derivative [Line Items]
Gain (loss) on derivative instruments	(203)	(294)	2,250	(1,228)
Foreign Exchange Contract
Derivative [Line Items]
Gain (loss) on foreign exchange contracts designated as net investment hedge	$ 12,200	$ (98,003)	$ 100,205	$ (239,884)

Commitments and Contingencies (

Commitments and Contingencies (Details Textual)	9 Months Ended
	Sep. 30, 2018USD ($)obligation	Dec. 31, 2017USD ($)
Commitments and Contingencies Disclosure [Abstract]
Number of outstanding credit obligations | obligation	13
Letter of credit obligation	$ 51,684,000
Outstanding construction financings for leased properties	135,343,000	$ 237,746,000
Additional financing to complete construction	332,834,000
Total contingent purchase obligations	$ 10,245,000
Minimum part of economic life of the leased asset to be classified as capital lease	75.00%
Minimum net present value of the future minimum lease payments to be classified as capital lease.	90.00%
Operating lease obligations relating to certain ground leases	$ 1,107,336,000
Capital leases, future minimum payments due	85,308,000
Operating leases, future minimum payments due, future minimum sublease rentals	$ 73,771,000

Stockholder's Equity (Details 1

Stockholder's Equity (Details 1) - shares	Sep. 30, 2018	Dec. 31, 2017	Sep. 30, 2017	Dec. 31, 2016
Preferred Stock:
Authorized shares (in shares)	50,000,000	50,000,000
Issued shares (in shares)	14,375,000	14,375,000
Outstanding shares (in shares)	14,369,965	14,370,060	14,370,065	25,875,000
Common Stock, $1.00 par value:
Authorized shares (in shares)	700,000,000	700,000,000
Issued shares (in shares)	376,759,924	372,852,311
Outstanding shares (in shares)	375,576,579	371,731,551

Stockholder's Equity (Details 2

Stockholder's Equity (Details 2) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017	Dec. 31, 2017	Dec. 31, 2016
Stockholders' Equity Note [Abstract]
Preferred stock, shares outstanding, beginning balance (in shares)			14,370,060	25,875,000	25,875,000
Shares redeemed (in shares)			0	(11,500,000)
Preferred stock conversions (in shares)			(95)	(4,935)
Preferred stock, shares outstanding, ending balance (in shares)	14,369,965	14,370,065	14,369,965	14,370,065	14,370,060	25,875,000
Preferred stock, dividend rate, percentage			6.50%	6.50%	6.50%	6.50%
Preferred stock, dividend rate, shares redeemed			0.00%	6.50%
Preferred stock, dividend rate, shares converted			6.50%	6.50%
Preferred stock redemption charge	$ 0	$ 0	$ 0	$ 9,769

Stockholder's Equity (Details 3

Stockholder's Equity (Details 3) $ in Thousands	9 Months Ended
	Sep. 30, 2018USD ($)$ / sharesshares	Sep. 30, 2017USD ($)$ / sharesshares
Class of Stock [Line Items]
Dividend reinvestment plan issuances (in shares) | shares	1,755,446	4,312,447
Dividend reinvestment plan issuances, average price (USD per share) | $ / shares	64.24	71.14
Dividend reinvestment plan issuances, Gross Proceeds | $	$ 112,770	$ 306,785
Proceeds from dividend reinvestment plan | $	$ 112,294	$ 305,996
Option exercises, shares (in shares) | shares	32,120	209,192
Option exercises, average price (USD per share) | $ / shares	39.94	50.62
Option exercises, Gross Proceeds | $	$ 1,283	$ 10,590
Option exercises, Net Proceeds | $	$ 1,283	$ 10,590
Equity shelf plan issuances, shares issued (in shares) | shares	1,944,511	2,986,574
Equity shelf plan issuances, average price (USD per share) | $ / shares	66.72	72.30
Equity Shelf Plan Issuances Gross Proceeds | $	$ 129,744	$ 215,917
Equity Shelf Plan Issuances Net Proceeds | $	$ 128,834	$ 214,406
Shared issued for redemption of units (in shares) | shares		91,180
Preferred stock conversions (in shares) | shares	95	4,935
Stock incentive plans, net of forfeitures, shares issued (in shares) | shares	112,868	135,773
Issuance of Common Stock (in shares) | shares	3,845,028	7,739,462
Gross Proceeds From Issuance of Common Stock | $	$ 243,797	$ 533,292
Net proceeds from the issuance of common stock | $	$ 242,411	$ 530,992
Convertible Preferred Stock [Member]
Class of Stock [Line Items]
Preferred stock conversions (in shares) | shares	83	4,296

Stockholder's Equity (Details 4

Stockholder's Equity (Details 4) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Class of Stock [Line Items]
Dividends declared and paid per common share (in USD per share)	$ 0.87	$ 0.87	$ 2.6100	$ 2.6100
Common stock cash dividends			$ 971,280	$ 955,631
Total dividends paid			$ 1,006,308	$ 993,365
Series I Preferred Stock
Class of Stock [Line Items]
Dividends declared and paid per preferred share (in USD per share)			$ 2.4375	$ 2.4375
Preferred stock cash dividends			$ 35,028	$ 35,035
Series J Preferred Stock
Class of Stock [Line Items]
Dividends declared and paid per preferred share (in USD per share)			$ 0	$ 0.2347
Preferred stock cash dividends			$ 0	$ 2,699

Stockholder's Equity (Details 5

Stockholder's Equity (Details 5) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017
Summary of accumulated other comprehensive income/(loss) [Line Items]
Balances at beginning of period	$ 14,925,452	$ 15,281,472
OCI, before reclassifications, net of tax	(27,026)	28,291
Balances at end of period	15,269,201	15,244,664
Accumulated Foreign Currency Adjustment Attributable to Parent
Summary of accumulated other comprehensive income/(loss) [Line Items]
Balances at beginning of period	(110,581)	(173,496)
OCI, before reclassifications, net of tax	(27,026)	48,574
Balances at end of period	(137,607)	(124,922)
Accumulated Net Investment Gain (Loss) Attributable to Parent
Summary of accumulated other comprehensive income/(loss) [Line Items]
Balances at beginning of period	0	5,120
OCI, before reclassifications, net of tax	0	(20,285)
Balances at end of period	0	(15,165)
Accumulated Defined Benefit Plans Adjustment, Net Gain (Loss) Attributable to Parent
Summary of accumulated other comprehensive income/(loss) [Line Items]
Balances at beginning of period	(884)	(1,153)
OCI, before reclassifications, net of tax	0	0
Balances at end of period	(884)	(1,153)
Accumulated Net Gain (Loss) from Cash Flow Hedges Attributable to Parent
Summary of accumulated other comprehensive income/(loss) [Line Items]
Balances at beginning of period	0	(2)
OCI, before reclassifications, net of tax	0	2
Balances at end of period	0	0
Accumulated Other Comprehensive Income (Loss)
Summary of accumulated other comprehensive income/(loss) [Line Items]
Balances at beginning of period	(111,465)	(169,531)
Balances at end of period	$ (138,491)	$ (141,240)

Stock Incentive Plans (Details

Stock Incentive Plans (Details Textual) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of common stock authorized for 2016 LTIP	10,000		10,000
Option expiration period			10 years
Stock-based compensation expense	$ 6,075	$ 6,790	$ 22,800	$ 16,459
Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period			5 years
Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period			3 years

Earnings Per Share (Details)

Earnings Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Computation of basic and diluted earnings per share
Numerator for basic and diluted earnings per share - net income (loss) attributable to common stockholders	$ 64,384	$ 74,043	$ 656,487	$ 575,118
Denominator for basic earnings per share - weighted average shares (in shares)	373,023,000	369,089,000	372,052,000	366,096,000
Effect of dilutive securities:
Employee stock options (in shares)	6,000	40,000	12,000	53,000
Non-vested restricted shares (in shares)	348,000	515,000	464,000	464,000
Redeemable shares (in shares)	1,096,000	1,096,000	1,096,000	1,281,000
Employee stock purchase program (in shares)	14,000	0	14,000	0
Dilutive potential common shares (in shares)	1,464,000	1,651,000	1,586,000	1,798,000
Denominator for diluted earnings per share - adjusted weighted average shares (in shares)	374,487,000	370,740,000	373,638,000	367,894,000
Basic earnings per share (USD per share)	$ 0.17	$ 0.20	$ 1.76	$ 1.57
Diluted earnings per share (USD per share)	$ 0.17	$ 0.20	$ 1.76	$ 1.56

Disclosure about Fair Value o_3

Disclosure about Fair Value of Financial Instruments (Details) - USD ($) $ in Thousands	Sep. 30, 2018	Dec. 31, 2017	Sep. 30, 2017
Financial Assets:
Loans receivable, Carrying Amount	$ 409,196	$ 495,871
Equity securities, carrying amount	12,912	7,269
Equity securities, fair value disclosure	12,912	7,269
Cash and Cash Equivalents, at Carrying Value	191,199	243,777
Cash and cash equivalents, Fair Value	191,199	243,777
Restricted cash, carrying amount	90,086	65,526
Restricted Cash, Fair Value Disclosure	90,086	65,526
Foreign Currency Forward Contracts Carrying Value	34,902	15,604
Foreign Currency Forward Contracts Fair Value	34,902	15,604
Financial Liabilities:
Borrowings under primary unsecured credit facility, Carrying Value	1,312,000	719,000	$ 420,000
Borrowings under primary unsecured credit facilities, Fair Value	1,312,000	719,000
Senior unsecured notes, Carrying Amount	9,655,022	8,331,722
Senior unsecured notes, Fair Value	10,169,806	9,168,432
Secured debt, Carrying Amount	2,465,661	2,608,976
Secured debt, Fair Value	2,464,635	2,641,997
Foreign Currency Forward Contracts Carrying Value	78,566	38,654
Foreign Currency Forward Contracts, Fair Value	78,566	38,654
Redeemable OP unitholder interests carrying value	97,476	97,476
Redeemable OP unitholder interests fair value	97,476	97,476
Mortgage Loans on Real Estate
Financial Assets:
Loans receivable, Carrying Amount	266,286	306,120
Loans receivable, Fair value	273,620	332,508
Other Real Estate Loans Receivable
Financial Assets:
Loans receivable, Carrying Amount	74,538	121,379
Loans receivable, Fair value	$ 75,091	$ 125,480

Disclosure about Fair Value o_4

Disclosure about Fair Value of Financial Instruments (Details 1) - USD ($) $ in Thousands	Sep. 30, 2018	Dec. 31, 2017
The Market approach utilized to measure fair value of financial assets and liabilities on recurring basis
Equity securities, carrying amount	$ 12,912	$ 7,269
Foreign currency forward contracts	(43,664)
Redeemable OP unitholder interests	97,476
Totals	66,724
Level 1
The Market approach utilized to measure fair value of financial assets and liabilities on recurring basis
Equity securities, carrying amount	12,912
Foreign currency forward contracts	0
Redeemable OP unitholder interests	0
Totals	12,912
Level 2
The Market approach utilized to measure fair value of financial assets and liabilities on recurring basis
Equity securities, carrying amount	0
Foreign currency forward contracts	(43,664)
Redeemable OP unitholder interests	97,476
Totals	53,812
Level 3
The Market approach utilized to measure fair value of financial assets and liabilities on recurring basis
Equity securities, carrying amount	0
Foreign currency forward contracts	0
Redeemable OP unitholder interests	0
Totals	$ 0

Segment Reporting (Details)

Segment Reporting (Details)	3 Months Ended		9 Months Ended
	Sep. 30, 2018USD ($)	Sep. 30, 2017USD ($)	Sep. 30, 2018USD ($)	Sep. 30, 2017USD ($)	Dec. 31, 2017USD ($)
Segment Reporting Information [Line Items]
Total revenues	$ 1,236,379,000	$ 1,091,483,000	$ 3,459,256,000	$ 3,212,383,000
Property operating expenses	657,157,000	523,997,000	1,782,373,000	1,536,021,000
Net Operating Income from Continuing Operations	579,222,000	567,486,000	1,676,883,000	1,676,362,000
Interest expense	138,032,000	122,578,000	382,223,000	357,405,000
Loss (gain) on derivatives and financial instruments, net	8,991,000	324,000	(5,642,000)	2,284,000
Depreciation and amortization	243,149,000	230,138,000	707,625,000	683,262,000
General and administrative	28,746,000	29,913,000	95,282,000	93,643,000
Loss (gain) on extinguishment of debt, net	4,038,000	0	16,044,000	36,870,000
Impairment of assets	6,740,000	0	39,557,000	24,662,000
Other expenses	88,626,000	99,595,000	102,396,000	117,608,000
Income (loss) from continuing operations before income taxes and income from unconsolidated entities	60,900,000	84,938,000	339,398,000	360,628,000
Income tax expense	(1,741,000)	(669,000)	(7,170,000)	5,535,000
(Loss) income from unconsolidated entities	344,000	3,408,000	(836,000)	(23,676,000)
Income from continuing operations	59,503,000	87,677,000	331,392,000	342,487,000
Gain (loss) on real estate dispositions, net	24,723,000	1,622,000	373,662,000	287,869,000
Net income	84,226,000	$ 89,299,000	705,054,000	$ 630,356,000
Total assets	$ 30,249,119,000		$ 30,249,119,000		$ 27,944,445,000
Percent Of Assets	1		1		1
Percent Of Revenues	1	1	1	1
United States
Segment Reporting Information [Line Items]
Total revenues	$ 1,007,203,000	$ 871,431,000	$ 2,766,726,000	$ 2,582,042,000
Total assets	$ 24,616,066,000		$ 24,616,066,000		$ 22,274,443,000
Percent Of Assets	0.814		0.814		0.797
Percent Of Revenues	0.815	0.799	0.800	0.804
United Kingdom
Segment Reporting Information [Line Items]
Total revenues	$ 111,503,000	$ 105,028,000	$ 340,059,000	$ 298,618,000
Total assets	$ 3,150,305,000		$ 3,150,305,000		$ 3,239,039,000
Percent Of Assets	0.104		0.104		0.116
Percent Of Revenues	0.090	0.096	0.098	0.093
Canada
Segment Reporting Information [Line Items]
Total revenues	$ 117,673,000	$ 115,024,000	$ 352,471,000	$ 331,723,000
Total assets	$ 2,482,748,000		$ 2,482,748,000		$ 2,430,963,000
Percent Of Assets	0.082		0.082		0.087
Percent Of Revenues	0.095	0.105	0.102	0.103
Triple Net
Segment Reporting Information [Line Items]
Lease termination fee income	$ 10,805,000
Operating Segments | Triple Net
Segment Reporting Information [Line Items]
Total revenues	219,110,000	$ 244,916,000	$ 666,289,000	$ 735,998,000
Property operating expenses	426,000	0	583,000	0
Net Operating Income from Continuing Operations	218,684,000	244,916,000	665,706,000	735,998,000
Interest expense	3,500,000	3,622,000	10,742,000	11,647,000
Loss (gain) on derivatives and financial instruments, net	8,991,000	324,000	(5,642,000)	2,284,000
Depreciation and amortization	60,383,000	62,891,000	171,724,000	182,672,000
General and administrative	0	0	0	0
Loss (gain) on extinguishment of debt, net	0		(32,000)	29,083,000
Impairment of assets	6,178,000		34,482,000	4,846,000
Other expenses	87,076,000	89,236,000	89,153,000	96,425,000
Income (loss) from continuing operations before income taxes and income from unconsolidated entities	52,556,000	88,843,000	365,279,000	409,041,000
Income tax expense	1,116,000	(816,000)	(708,000)	(2,070,000)
(Loss) income from unconsolidated entities	5,377,000	5,478,000	16,260,000	14,983,000
Income from continuing operations	59,049,000	93,505,000	380,831,000	421,954,000
Gain (loss) on real estate dispositions, net	24,782,000	(185,000)	158,938,000	273,051,000
Net income	83,831,000	93,320,000	539,769,000	695,005,000
Total assets	10,163,867,000		10,163,867,000
Operating Segments | Senior housing - operating
Segment Reporting Information [Line Items]
Total revenues	876,505,000	703,877,000	2,378,839,000	2,053,831,000
Property operating expenses	610,659,000	478,777,000	1,648,262,000	1,400,313,000
Net Operating Income from Continuing Operations	265,846,000	225,100,000	730,577,000	653,518,000
Interest expense	17,319,000	16,369,000	51,225,000	47,587,000
Loss (gain) on derivatives and financial instruments, net	0	0	0	0
Depreciation and amortization	136,532,000	119,089,000	397,080,000	356,023,000
General and administrative	0	0	0	0
Loss (gain) on extinguishment of debt, net	0		110,000	3,414,000
Impairment of assets	562,000		5,075,000	14,191,000
Other expenses	(811,000)	5,157,000	5,168,000	8,100,000
Income (loss) from continuing operations before income taxes and income from unconsolidated entities	112,244,000	84,485,000	271,919,000	224,203,000
Income tax expense	211,000	(1,519,000)	(2,244,000)	9,133,000
(Loss) income from unconsolidated entities	(6,705,000)	(2,886,000)	(21,389,000)	(40,527,000)
Income from continuing operations	105,750,000	80,080,000	248,286,000	192,809,000
Gain (loss) on real estate dispositions, net	(1,000)	(197,000)	3,000	12,814,000
Net income	105,749,000	79,883,000	248,289,000	205,623,000
Total assets	14,989,442,000		14,989,442,000
Operating Segments | Outpatient Medical
Segment Reporting Information [Line Items]
Total revenues	140,069,000	141,992,000	412,567,000	421,383,000
Property operating expenses	46,072,000	45,220,000	133,528,000	135,708,000
Net Operating Income from Continuing Operations	93,997,000	96,772,000	279,039,000	285,675,000
Interest expense	1,643,000	2,929,000	4,975,000	7,342,000
Loss (gain) on derivatives and financial instruments, net	0	0	0	0
Depreciation and amortization	46,234,000	48,158,000	138,821,000	144,567,000
General and administrative	0	0	0	0
Loss (gain) on extinguishment of debt, net	0		11,928,000	4,373,000
Impairment of assets	0		0	5,625,000
Other expenses	1,055,000	530,000	3,748,000	2,201,000
Income (loss) from continuing operations before income taxes and income from unconsolidated entities	45,065,000	45,155,000	119,567,000	121,567,000
Income tax expense	239,000	(366,000)	(567,000)	(655,000)
(Loss) income from unconsolidated entities	1,672,000	816,000	4,293,000	1,868,000
Income from continuing operations	46,976,000	45,605,000	123,293,000	122,780,000
Gain (loss) on real estate dispositions, net	(58,000)	2,004,000	214,721,000	2,004,000
Net income	46,918,000	47,609,000	338,014,000	124,784,000
Total assets	4,953,277,000		4,953,277,000
Corporate, Non-Segment
Segment Reporting Information [Line Items]
Total revenues	695,000	698,000	1,561,000	1,171,000
Property operating expenses	0	0	0	0
Net Operating Income from Continuing Operations	695,000	698,000	1,561,000	1,171,000
Interest expense	115,570,000	99,658,000	315,281,000	290,829,000
Loss (gain) on derivatives and financial instruments, net	0	0	0	0
Depreciation and amortization	0	0	0	0
General and administrative	28,746,000	29,913,000	95,282,000	93,643,000
Loss (gain) on extinguishment of debt, net	4,038,000		4,038,000	0
Impairment of assets	0		0	0
Other expenses	1,306,000	4,672,000	4,327,000	10,882,000
Income (loss) from continuing operations before income taxes and income from unconsolidated entities	(148,965,000)	(133,545,000)	(417,367,000)	(394,183,000)
Income tax expense	(3,307,000)	2,032,000	(3,651,000)	(873,000)
(Loss) income from unconsolidated entities	0	0	0	0
Income from continuing operations	(152,272,000)	(131,513,000)	(421,018,000)	(395,056,000)
Gain (loss) on real estate dispositions, net	0	0	0	0
Net income	(152,272,000)	(131,513,000)	(421,018,000)	(395,056,000)
Total assets	142,533,000		142,533,000
Rental income
Segment Reporting Information [Line Items]
Total revenues	342,887,000	362,880,000	1,019,857,000	1,085,621,000
Rental income | Operating Segments | Triple Net
Segment Reporting Information [Line Items]
Total revenues	203,039,000	221,555,000	607,831,000	666,735,000
Rental income | Operating Segments | Senior housing - operating
Segment Reporting Information [Line Items]
Total revenues	0	0	0	0
Rental income | Operating Segments | Outpatient Medical
Segment Reporting Information [Line Items]
Total revenues	139,848,000	141,325,000	412,026,000	418,886,000
Rental income | Corporate, Non-Segment
Segment Reporting Information [Line Items]
Total revenues	0	0	0	0
Resident fees and services
Segment Reporting Information [Line Items]
Total revenues	875,171,000	702,380,000	2,374,450,000	2,049,757,000
Resident fees and services | Operating Segments | Triple Net
Segment Reporting Information [Line Items]
Total revenues	0	0	0	0
Resident fees and services | Operating Segments | Senior housing - operating
Segment Reporting Information [Line Items]
Total revenues	875,171,000	702,380,000	2,374,450,000	2,049,757,000
Resident fees and services | Operating Segments | Outpatient Medical
Segment Reporting Information [Line Items]
Total revenues	0	0	0	0
Resident fees and services | Corporate, Non-Segment
Segment Reporting Information [Line Items]
Total revenues	0	0	0	0
Interest income
Segment Reporting Information [Line Items]
Total revenues	14,622,000	20,187,000	42,732,000	61,836,000
Interest income | Operating Segments | Triple Net
Segment Reporting Information [Line Items]
Total revenues	14,378,000	20,187,000	42,176,000	61,767,000
Interest income | Operating Segments | Senior housing - operating
Segment Reporting Information [Line Items]
Total revenues	159,000	0	416,000	69,000
Interest income | Operating Segments | Outpatient Medical
Segment Reporting Information [Line Items]
Total revenues	85,000	0	140,000	0
Interest income | Corporate, Non-Segment
Segment Reporting Information [Line Items]
Total revenues	0	0	0	0
Other income
Segment Reporting Information [Line Items]
Total revenues	3,699,000	6,036,000	22,217,000	15,169,000
Other income | Operating Segments | Triple Net
Segment Reporting Information [Line Items]
Total revenues	1,693,000	3,174,000	16,282,000	7,496,000
Other income | Operating Segments | Senior housing - operating
Segment Reporting Information [Line Items]
Total revenues	1,175,000	1,497,000	3,973,000	4,005,000
Other income | Operating Segments | Outpatient Medical
Segment Reporting Information [Line Items]
Total revenues	136,000	667,000	401,000	2,497,000
Other income | Corporate, Non-Segment
Segment Reporting Information [Line Items]
Total revenues	$ 695,000	$ 698,000	$ 1,561,000	$ 1,171,000

Variable Interest Entity Disc_3

Variable Interest Entity Disclosure (Details) - USD ($) $ in Thousands	Sep. 30, 2018	Dec. 31, 2017
Variable Interest Entity [Line Items]
Total assets	$ 1,010,233	$ 1,030,775
Total equity	525,317	544,840
Total liabilities and equity	1,010,233	1,030,775
Net real property owned
Variable Interest Entity [Line Items]
Total assets	977,252	1,002,137
Cash and cash equivalents
Variable Interest Entity [Line Items]
Total assets	15,059	12,308
Receivables and other assets
Variable Interest Entity [Line Items]
Total assets	17,922	16,330
Secured Debt
Variable Interest Entity [Line Items]
Liabilities	466,772	471,103
Accrued expenses and other liabilities
Variable Interest Entity [Line Items]
Liabilities	$ 18,144	$ 14,832