Welltower (WELL) 10-Q 6 Aug 20 2020 Q2 Quarterly report Financial data

Cover Page

Cover Page - shares	6 Months Ended
	Jun. 30, 2020	Jul. 31, 2020
Document Information [Line Items]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Jun. 30, 2020
Document Transition Report	false
Entity File Number	1-8923
Entity Registrant Name	WELLTOWER INC.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	34-1096634
Entity Address, Address Line One	4500 Dorr Street
Entity Address, City or Town	Toledo,
Entity Address, State or Province	OH
Entity Address, Postal Zip Code	43615
City Area Code	(419)
Local Phone Number	247-2800
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock Shares Outstanding		417,300,700
Entity Central Index Key	0000766704
Amendment Flag	false
Document Fiscal Year Focus	2020
Document Fiscal Period Focus	Q2
Current Fiscal Year End Date	--12-31
Common stock, $1.00 par value per share
Document Information [Line Items]
Title of 12(b) Security	Common stock, $1.00 par value per share
Trading Symbol	WELL
Security Exchange Name	NYSE
4.800% Notes due 2028
Document Information [Line Items]
Title of 12(b) Security	4.800% Notes due 2028
Trading Symbol	WELL28
Security Exchange Name	NYSE
4.500% Notes due 2034
Document Information [Line Items]
Title of 12(b) Security	4.500% Notes due 2034
Trading Symbol	WELL34
Security Exchange Name	NYSE

CONSOLIDATED BALANCE SHEETS

CONSOLIDATED BALANCE SHEETS - USD ($)		Jun. 30, 2020	Dec. 31, 2019
Real property owned:
Land and land improvements		$ 3,479,369,000	$ 3,486,620,000	[1]
Buildings and improvements		28,589,269,000	29,163,305,000	[1]
Acquired lease intangibles		1,565,978,000	1,617,051,000	[1]
Real property held for sale, net of accumulated depreciation		382,580,000	1,253,008,000	[1]
Construction in progress		411,700,000	507,931,000	[1]
Less accumulated depreciation and amortization		(6,001,177,000)	(5,715,459,000)	[1]
Net real property owned		28,427,719,000	30,312,456,000	[1]
Right of use assets, net		502,604,000	536,433,000	[1]
Real estate loans receivable, net of credit allowance		224,871,000	270,382,000	[1]
Net real estate investments		29,155,194,000	31,119,271,000	[1]
Other assets:
Investments in unconsolidated entities		786,921,000	583,423,000	[1]
Goodwill		68,321,000	68,321,000	[1]
Cash and cash equivalents	[1]		284,917,000
Restricted cash	[1]		100,849,000
Straight-line rent receivable		464,716,000	466,222,000	[1]
Receivables and other assets		861,257,000	757,748,000	[1]
Total other assets		4,007,458,000	2,261,480,000	[1]
Total Assets		33,162,652,000	33,380,751,000	[1]
Liabilities:
Unsecured credit facility and commercial paper		0	1,587,597,000	[1]
Senior unsecured notes	[1]		10,336,513,000
Secured debt	[1]		2,990,962,000
Lease liabilities		447,424,000	473,693,000	[1]
Accrued expenses and other liabilities		1,015,906,000	1,009,482,000	[1]
Total liabilities		15,898,980,000	16,398,247,000	[1]
Redeemable noncontrolling interests		327,145,000	475,877,000	[1]
Equity:
Common stock		418,343,000	411,005,000	[1]
Capital in excess of par value		20,836,545,000	20,190,107,000	[1]
Treasury stock		(93,799,000)	(78,955,000)	[1]
Cumulative net income		7,838,284,000	7,353,966,000	[1]
Cumulative dividends		(12,834,381,000)	(12,223,534,000)	[1]
Accumulated other comprehensive income (loss)		(116,856,000)	(112,157,000)	[1]
Other equity		4,000	12,000	[1]
Total Welltower Inc. stockholders’ equity		16,048,140,000	15,540,444,000	[1]
Noncontrolling interests		888,387,000	966,183,000	[1]
Total equity		16,936,527,000	16,506,627,000	[1]
Total liabilities and equity		33,162,652,000	33,380,751,000	[1]
Carrying Amount
Other assets:
Cash and cash equivalents		1,678,770,000	284,917,000
Restricted cash		147,473,000	100,849,000
Liabilities:
Unsecured credit facility and commercial paper		0	1,587,597,000
Senior unsecured notes		11,815,972,000	10,336,513,000
Secured debt		$ 2,619,678,000	$ 2,990,962,000
[1]	The consolidated balance sheet at December 31, 2019 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by U.S. generally accepted accounting principles for complete financial statements.

CONSOLIDATED STATEMENTS OF COMP

CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (UNAUDITED) - USD ($) shares in Thousands, $ in Thousands		3 Months Ended		6 Months Ended
		Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Revenues:
Rental income		$ 396,305	$ 385,586	$ 786,265	$ 766,670
Total revenues		1,188,475	1,320,106	2,447,077	2,592,351
Expenses:
Property operating expenses		660,764	701,127	1,342,545	1,371,934
Depreciation and amortization		265,371	248,052	540,172	491,984
Interest expense		126,357	141,336	268,364	286,568
General and administrative expenses		34,062	33,741	69,543	69,023
Loss (gain) on derivatives and financial instruments, net		1,434	1,913	9,085	(574)
Loss (gain) on extinguishment of debt, net		249	0	249	15,719
Provision for loan losses		1,422	0	8,494	18,690
Impairment of assets		75,151	9,939	102,978	9,939
Other expenses		19,411	21,628	25,703	30,384
Total expenses		1,184,221	1,157,736	2,367,133	2,293,667
Income (loss) from continuing operations before income taxes and other items		4,254	162,370	79,944	298,684
Income tax (expense) benefit		(2,233)	(1,599)	(7,675)	(3,821)
Income (loss) from unconsolidated entities		1,332	(9,049)	(2,360)	(18,248)
Gain (loss) on real estate dispositions, net		155,863	(1,682)	418,687	165,727
Income (loss) from continuing operations		159,216	150,040	488,596	442,342
Net income (loss)		159,216	150,040	488,596	442,342
Less: Net income (loss) attributable to noncontrolling interests	[1]	(20,030)	12,278	(934)	24,110
Net income (loss) attributable to common stockholders		$ 179,246	$ 137,762	$ 489,530	$ 418,232
Average number of common shares outstanding:
Basic (in shares)		417,084	404,607	413,696	398,073
Diluted (in shares)		419,121	406,673	415,775	400,096
Basic:
Income (loss) from continuing operations (in USD per share)		$ 0.38	$ 0.37	$ 1.18	$ 1.11
Net income (loss) attributable to common stockholders (in dollars per share)		0.43	0.34	1.18	1.05
Diluted:
Income (loss) from continuing operations (in USD per share)		0.38	0.37	1.18	1.11
Net income (loss) attributable to common stockholders (in dollars per share)	[2]	0.42	0.34	1.17	1.05
Dividends declared and paid per common share (in dollars per share)		$ 0.61	$ 0.87	$ 1.48	$ 1.74
Net income		$ 159,216	$ 150,040	$ 488,596	$ 442,342
Other comprehensive income (loss):
Foreign currency translation gain (loss)		13,015	(54,024)	(252,562)	24,596
Gain (loss) on derivative and financial instruments designated as hedges recognized in OCI		(27,171)	100,407	231,941	12,725
Total other comprehensive income (loss)		(14,156)	46,383	(20,621)	37,321
Total comprehensive income (loss)		145,060	196,423	467,975	479,663
Less: Total comprehensive income (loss) attributable to noncontrolling interests	[1]	(13,543)	14,665	(16,856)	32,284
Total comprehensive income (loss) attributable to common stockholders		158,603	181,758	484,831	447,379
Resident fees and services
Revenues:
Revenue from contract with customer		769,560	914,085	1,619,532	1,782,370
Interest income
Revenues:
Revenue from contract with customer		16,069	17,356	31,310	32,475
Other income
Revenues:
Revenue from contract with customer		$ 6,541	$ 3,079	$ 9,970	$ 10,836
[1]	Includes amounts attributable to redeemable noncontrolling interests.
[2]	Includes adjustment to the numerator for income (loss) attributable to OP unitholders.

CONSOLIDATED STATEMENTS OF EQUI

CONSOLIDATED STATEMENTS OF EQUITY (UNAUDITED) - USD ($) $ in Thousands	Total		Cumulative effect, period of adoption, adjustment	Cumulative effect, period of adoption, adjusted balance	Preferred Stock	Common Stock	Common StockCumulative effect, period of adoption, adjusted balance	Capital in Excess of Par Value	Capital in Excess of Par ValueCumulative effect, period of adoption, adjusted balance	Treasury Stock	Treasury StockCumulative effect, period of adoption, adjusted balance	Cumulative Net Income	Cumulative Net IncomeCumulative effect, period of adoption, adjustment	Cumulative Net IncomeCumulative effect, period of adoption, adjusted balance	Cumulative Dividends	Cumulative DividendsCumulative effect, period of adoption, adjusted balance	Accumulated Other Comprehensive Income (Loss)	Accumulated Other Comprehensive Income (Loss)Cumulative effect, period of adoption, adjusted balance	Other Equity	Other EquityCumulative effect, period of adoption, adjusted balance	Noncontrolling Interests	Noncontrolling InterestsCumulative effect, period of adoption, adjusted balance
Balances at beginning of period at Dec. 31, 2018	$ 15,586,599				$ 718,498	$ 384,465		$ 18,424,368		$ (68,499)		$ 6,121,534			$ (10,818,557)		$ (129,769)		$ 294		$ 954,265
Comprehensive income:
Net income (loss)	291,255											280,470									10,785
Other comprehensive income (loss)	(9,062)																(14,849)				5,787
Total comprehensive income	282,193
Net change in noncontrolling interests	(10,342)							(8,845)													(1,497)
Amounts related to stock incentive plans, net of forfeitures	1,521					120		7,420		(5,993)									(26)
Net proceeds from issuance of common stock	532,620					7,212		525,408
Conversion of preferred stock	0				(718,498)	12,712		705,786
Dividends paid:
Common stock dividends	(344,760)														(344,760)
Balances at end of period at Mar. 31, 2019	16,047,831				0	404,509		19,654,137		(74,492)		6,402,004			(11,163,317)		(144,618)		268		969,340
Balances at beginning of period at Dec. 31, 2018	15,586,599				718,498	384,465		18,424,368		(68,499)		6,121,534			(10,818,557)		(129,769)		294		954,265
Comprehensive income:
Other comprehensive income (loss)	37,321
Balances at end of period at Jun. 30, 2019	15,969,572				0	406,014		19,740,145		(74,042)		6,539,766			(11,516,994)		(100,622)		188		975,117
Balances at beginning of period at Mar. 31, 2019	16,047,831				0	404,509		19,654,137		(74,492)		6,402,004			(11,163,317)		(144,618)		268		969,340
Comprehensive income:
Net income (loss)	149,111											137,762									11,349
Other comprehensive income (loss)	46,383																43,996				2,387
Total comprehensive income	195,494
Net change in noncontrolling interests	(31,631)							(23,672)													(7,959)
Amounts related to stock incentive plans, net of forfeitures	8,347					18		7,959		450									(80)
Net proceeds from issuance of common stock	103,208					1,487		101,721
Dividends paid:
Common stock dividends	(353,677)														(353,677)
Balances at end of period at Jun. 30, 2019	15,969,572				$ 0	406,014		19,740,145		(74,042)		6,539,766			(11,516,994)		(100,622)		188		975,117
Balances at beginning of period at Dec. 31, 2019	16,506,627	[1]	$ (5,212)	$ 16,501,415		411,005	$ 411,005	20,190,107	$ 20,190,107	(78,955)	$ (78,955)	7,353,966	$ (5,212)	$ 7,348,754	(12,223,534)	$ (12,223,534)	(112,157)	$ (112,157)	12	$ 12	966,183	$ 966,183
Comprehensive income:
Net income (loss)	329,272											310,284									18,988
Other comprehensive income (loss)	(6,011)																15,944				(21,955)
Total comprehensive income	323,261
Net change in noncontrolling interests	7,963							37,625													(29,662)
Amounts related to stock incentive plans, net of forfeitures	(1,166)					246		6,608		(8,020)
Net proceeds from issuance of common stock	590,865					6,975		583,890
Dividends paid:
Common stock dividends	(356,001)														(356,001)
Balances at end of period at Mar. 31, 2020	17,066,337					418,226		20,818,230		(86,975)		7,659,038			(12,579,535)		(96,213)		12		933,554
Balances at beginning of period at Dec. 31, 2019	16,506,627	[1]	$ (5,212)	$ 16,501,415		411,005	$ 411,005	20,190,107	$ 20,190,107	(78,955)	$ (78,955)	7,353,966	$ (5,212)	$ 7,348,754	(12,223,534)	$ (12,223,534)	(112,157)	$ (112,157)	12	$ 12	966,183	$ 966,183
Comprehensive income:
Other comprehensive income (loss)	(20,621)
Balances at end of period at Jun. 30, 2020	16,936,527					418,343		20,836,545		(93,799)		7,838,284			(12,834,381)		(116,856)		4		888,387
Balances at beginning of period at Mar. 31, 2020	17,066,337					418,226		20,818,230		(86,975)		7,659,038			(12,579,535)		(96,213)		12		933,554
Comprehensive income:
Net income (loss)	197,905											179,246									18,659
Other comprehensive income (loss)	(14,345)																(20,643)				6,298
Other comprehensive income (loss)	(14,156)
Total comprehensive income	183,560
Net change in noncontrolling interests	(62,825)							7,299													(70,124)
Amounts related to stock incentive plans, net of forfeitures	8,264					28		7,412		832									(8)
Net proceeds from issuance of common stock	3,693					89		3,604
Repurchase of common stock	(7,656)									(7,656)
Dividends paid:
Common stock dividends	(254,846)														(254,846)
Balances at end of period at Jun. 30, 2020	$ 16,936,527					$ 418,343		$ 20,836,545		$ (93,799)		$ 7,838,284			$ (12,834,381)		$ (116,856)		$ 4		$ 888,387
[1]	The consolidated balance sheet at December 31, 2019 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by U.S. generally accepted accounting principles for complete financial statements.

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS (UNAUDITED) - USD ($) $ in Thousands		6 Months Ended
		Jun. 30, 2020	Jun. 30, 2019
Operating activities:
Net income		$ 488,596	$ 442,342
Adjustments to reconcile net income to net cash provided from (used in) operating activities:
Depreciation and amortization		540,172	491,984
Other amortization expenses		6,947	9,761
Provision for loan losses		8,494	18,690
Impairment of assets		102,978	9,939
Stock-based compensation expense		14,373	15,192
Loss (gain) on derivatives and financial instruments, net		9,085	(574)
Loss (gain) on extinguishment of debt, net		249	15,719
Loss (income) from unconsolidated entities		2,360	18,248
Rental income less than (in excess of) cash received		(25,959)	(53,234)
Amortization related to above (below) market leases, net		(1,008)	(2)
Loss (gain) on real estate dispositions, net		(418,687)	(165,727)
Distributions by unconsolidated entities		6,795	46
Increase (decrease) in accrued expenses and other liabilities		22,348	55,415
Decrease (increase) in receivables and other assets		54,873	(3,317)
Net cash provided from (used in) operating activities		811,616	854,482
Investing activities:
Cash disbursed for acquisitions, net of cash acquired		(390,802)	(2,718,808)
Cash disbursed for capital improvements to existing properties		(122,103)	(124,176)
Cash disbursed for construction in progress		(93,031)	(155,409)
Capitalized interest		(9,287)	(6,256)
Investment in loans receivable		(19,538)	(65,422)
Principal collected on loans receivable		12,796	8,660
Other investments, net of payments		(3,695)	(16,973)
Contributions to unconsolidated entities		(225,739)	(119,001)
Distributions by unconsolidated entities		8,811	70,844
Proceeds from (payments on) derivatives		(13,319)	(21,643)
Proceeds from sales of real property		1,998,087	616,820
Net cash provided from (used in) investing activities		1,142,180	(2,531,364)
Financing activities:
Net increase (decrease) under unsecured credit facility and commercial paper		(1,587,597)
Net increase (decrease) under unsecured credit facility and commercial paper			722,188
Proceeds from issuance of senior unsecured notes		1,588,549	2,036,964
Payments to extinguish senior unsecured notes		0	(1,050,000)
Net proceeds from the issuance of secured debt		44,921	295,969
Payments on secured debt		(345,340)	(178,700)
Net proceeds from the issuance of common stock		595,313	647,156
Repurchase of common stock		(7,656)	0
Payments for deferred financing costs and prepayment penalties		(4,725)	(24,177)
Contributions by noncontrolling interests	[1]	13,764	39,122
Distributions to noncontrolling interests	[1]	(180,875)	(64,004)
Cash distributions to stockholders		(610,847)	(695,099)
Other financing activities		(9,816)	(8,615)
Net cash provided from (used in) financing activities		(504,309)	1,720,804
Effect of foreign currency translation on cash and cash equivalents and restricted cash		(9,010)	(333)
Increase (decrease) in cash, cash equivalents and restricted cash		1,440,477	43,589
Cash, cash equivalents and restricted cash at beginning of period		385,766	316,129
Cash, cash equivalents and restricted cash at end of period		1,826,243	359,718
Supplemental cash flow information:
Interest paid		227,632	252,714
Income taxes paid (received), net		$ (1,142)	$ 2,040
[1]	(1) Includes amounts attributable to redeemable noncontrolling interests.

Business

Business	6 Months Ended
	Jun. 30, 2020
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Business	Business Welltower Inc. (the "Company"), 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 (“U.S.”), Canada and the United Kingdom (“U.K.”), consisting of seniors housing and post-acute communities and outpatient medical properties.

Accounting Policies and Related

Accounting Policies and Related Matters	6 Months Ended
	Jun. 30, 2020
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 six months ended June 30, 2020 are not necessarily an indication of the results that may be expected for the year ending December 31, 2020. 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, 2019. Impact of COVID-19 Pandemic The extent to which the COVID-19 pandemic impacts our operations and those of our operators and tenants will depend on future developments, which are highly uncertain and cannot be predicted with confidence, including the scope, severity and duration of the pandemic, the actions taken to contain the pandemic or mitigate its impact and the direct and indirect economic effects of the pandemic and containment measures, among others. The COVID-19 pandemic could have material and adverse effects on our financial condition, results of operations and cash flows in the future, including but not limited to, the following: • Our Seniors Housing Operating revenues are dependent on occupancy. Declines in occupancy are expected due to heightened move-in criteria and screening, as well as increased mortality rates among seniors. Occupancy within our total Seniors Housing Operating portfolio has declined as follows: February March April May June July Spot occupancy (1) 85.8 % 85.0 % 82.8 % 81.0 % 80.1 % 79.4 % Sequential occupancy change (0.8) % (2.2) % (1.8) % (0.9) % (0.7) % (1) Spot occupancy represents approximate month end occupancy for properties in operation as of February 2020, including unconsolidated properties but excluding acquisitions, dispositions and development conversions since the start of the COVID-19 pandemic. Increased Seniors Housing Operating expenses are expected to continue until the pandemic subsides. We experienced incremental operational costs of $43,058,000 and $50,352,000 for the three and six months ended June 30, 2020, respectively, included in property operating expenses. These expenses were incurred as a result of the introduction of public health measures and other regulations affecting our properties, as well as additional health and safety measures adopted by us and our operators related to the COVID-19 pandemic, including increases in labor and property cleaning expenses and expenditures related to our efforts to procure PPE and supplies, net of reimbursements. Certain new expenses incurred since the start of the pandemic may continue on an ongoing basis as part of new health and safety protocols. • Our Triple-net operators are experiencing similar occupancy declines and expense increases, however, long-term/post-acute facilities are generally experiencing a higher degree of occupancy declines. These factors may impact our Triple-net operator's ability to pay rent and contractual obligations. Many of our Triple-net operators received funds under the Coronavirus Aid Relief, and Economic Security Act (“CARES Act”) and operators of long-term/post-acute facilities have also received funds under the CARES Act Provider Relief Fund. Accordingly, collection of Triple-net rent due during the COVID-19 pandemic to date (from March to July) has been consistent with historical collection rates and no significant rent concessions or deferrals have been made. Various local and state stay at home orders and the temporary closure of certain medical practices as a result may continue to impact our Outpatient Medical tenants' ability to pay rent. We have either collected or approved short term deferrals for over 99% of Outpatient Medical rent due in the second quarter, consisting of 87% cash collections and 12% of short term deferrals. In most cases, the deferred rent respresents two months of rent with expected repayment by the end of the year. Approximately 98% of Outpatient Medical rent due in July was either collected or aproved for short term deferral, with cash collections accelerating to approximately 95%. Short term deferrals of July rent decreased to 3%, which primarily relates to tenants in local jurisdictions for which relief was mandated. Furthermore, collections of deferred rent due in June and July under executed deferrals were 96%. To the extent that deferred rent is not repaid as expected, or the prolonged impact of the COVID-19 pandemic causes operators or tenants to seek further modifications of their lease agreements, we may recognize reductions in revenue and increases in uncollectible receivables. • Assessing properties for potential impairment involves subjectivity in determining if impairment indicators are present and in estimating the future undiscounted cash flows or estimated fair value of the asset. Key assumptions are made in these assessments including the estimation of future rental revenues, occupancy, operating expenses, capitalization rates and the ability and intent to hold the respective asset. All of these assumptions are significantly affected by our expectations of future market or economic conditions and can be highly impacted by the uncertainty of the COVID-19 pandemic. We will continue to evaluate the assumptions used in these analyses, changes to which may result in impairments in future periods. • The determination of the allowance for credit losses is based on our evaluation of collectability of our loans receivable and includes review of factors such as delinquency status, historical loan charge-offs, financial strength of the borrower and guarantors and the value of the underlying collateral. Reduced economic activity severely impacts our borrowers' businesses, financial conditions and liquidity and may hinder their ability to make contractual payments to us, leading to an increase in loans deemed to have deteriorated credit which could result in an increase in the provision for loan losses. New Accounting Standards • On January 1, 2020, we adopted ASU 2016-13, “Measurement of Credit Losses on Financial Instruments" ("ASU 2016-13"). This standard requires a new forward-looking “expected loss” model to be used for receivables, held-to-maturity debt, loans, and other instruments. In November 2018, the FASB issued an amendment excluding operating lease receivables accounted for under the new leases standard from the scope of the new credit losses standard. ASU 2016-13 primarily impacts our measurement for credit losses related to our real estate and non-real estate loans receivable. In conjunction with our adoption of ASU 2016-13, we recorded a $5,212,000 increase to our allowance for credit losses on loans receivable (both real estate and non-real estate) with a corresponding adjustment to cumulative net income related to the change in accounting principle. See Note 7 for further details. • At the FASB's April 8, 2020 Board meeting, the staff acknowledged that the economics of lease concessions that result from a global pandemic may not be aligned with the underlying premise of the modification framework in ASC 842, under which the concession would be recognized over the remainder of the lease term. In a Q&A document, the FASB provided entities with COVID-19 related lease concessions an option to either (1) apply the modification framework for these concessions in accordance with ASC 842 as applicable or (2) account for concessions as if they were made under the enforceable rights included in the original agreement as long as total cash flows resulting from the modified contract are substantially the same or less than cash flows in the original contract. Due to the continuing adverse economic conditions caused by the COVID-19 pandemic, a subset of outpatient medical tenants have requested rent relief, most often in the form of a short-term rent deferral. Not all tenant requests result in modification of agreements, nor do we intend to forgo our contractual rights under our lease agreements. We evaluate each tenant's rent relief request on an individual basis. Generally we expect the majority of rent deferral agreements to result in two months of full or partial rent relief to repaid by the end of the year. We have elected to apply the accounting relief provided by the FASB to such short-term rent deferrals, and will account for such deferrals as if no change had been made to the original lease contract.

Real Property Acquisitions and

Real Property Acquisitions and Development	6 Months Ended
	Jun. 30, 2020
Real Estate [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 and liabilities at cost on a relative fair value basis. Liabilities assumed and any associated noncontrolling interests are reflected at fair value. 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, 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. The following is a summary of our real property investment activity by segment for the periods presented (in thousands): Six Months Ended June 30, 2020 June 30, 2019 Seniors Housing Operating Triple-net Outpatient Totals Seniors Housing Operating Triple-net Outpatient Totals Land and land improvements $ 15,758 $ — $ 40,847 $ 56,605 $ 103,743 $ 8,099 $ 132,154 $ 243,996 Buildings and improvements 132,480 765 171,457 304,702 1,109,966 96,244 1,198,608 2,404,818 Acquired lease intangibles 10,810 — 23,823 34,633 58,773 — 85,492 144,265 Construction in progress — — — — 36,174 — — 36,174 Right of use assets, net — — — — — — 56,073 56,073 Receivables and other assets 257 — 139 396 4,560 — 376 4,936 Total assets acquired (1) 159,305 765 236,266 396,336 1,313,216 104,343 1,472,703 2,890,262 Secured debt — — — — (43,209) — — (43,209) Lease liabilities — — — — — — (45,287) (45,287) Accrued expenses and other liabilities (671) — (2,036) (2,707) (8,677) — (22,506) (31,183) Total liabilities acquired (671) — (2,036) (2,707) (51,886) — (67,793) (119,679) Noncontrolling interests (2) (2,827) — — (2,827) (38,830) (1,056) — (39,886) Non-cash acquisition related activity (3) — — — — (11,889) — — (11,889) Cash disbursed for acquisitions 155,807 765 234,230 390,802 1,210,611 103,287 1,404,910 2,718,808 Construction in progress additions 53,705 26,262 26,677 106,644 110,902 24,131 26,587 161,620 Less: Capitalized interest (5,470) (1,826) (1,991) (9,287) (3,560) (908) (1,788) (6,256) Accruals (4) (1,343) — (2,983) (4,326) — — 45 45 Cash disbursed for construction in progress 46,892 24,436 21,703 93,031 107,342 23,223 24,844 155,409 Capital improvements to existing properties 87,002 4,700 30,401 122,103 97,867 7,423 18,886 124,176 Total cash invested in real property, net of cash acquired $ 289,701 $ 29,901 $ 286,334 $ 605,936 $ 1,415,820 $ 133,933 $ 1,448,640 $ 2,998,393 (1) Excludes $580,000 and $1,910,000 of unrestricted and restricted cash acquired during the six months ended June 30, 2020 and 2019, respectively. (2) Includes amounts attributable to both redeemable noncontrolling interests and noncontrolling interests. (3) Relates to the acquisition of assets previously recognized as investments in unconsolidated entities. (4) 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): Six Months Ended June 30, 2020 June 30, 2019 Development projects: Seniors Housing Operating $ 93,188 $ 28,117 Triple-net 33,627 — Outpatient Medical 43,493 — Total development projects 170,308 28,117 Expansion projects 35,637 — Total construction in progress conversions $ 205,945 $ 28,117

Real Estate Intangibles

Real Estate Intangibles	6 Months Ended
	Jun. 30, 2020
Goodwill and Intangible Assets Disclosure [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): June 30, 2020 December 31, 2019 Assets: In place lease intangibles $ 1,460,748 $ 1,513,836 Above market tenant leases 58,780 59,540 Lease commissions 46,450 43,675 Gross historical cost 1,565,978 1,617,051 Accumulated amortization (1,178,515) (1,181,158) Net book value $ 387,463 $ 435,893 Weighted-average amortization period in years 10.8 10.3 Liabilities: Below market tenant leases $ 83,037 $ 99,035 Accumulated amortization (40,886) (49,390) Net book value $ 42,151 $ 49,645 Weighted-average amortization period in years 8.4 8.6 The following is a summary of real estate intangible amortization income (expense) for the periods presented (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2020 2019 2020 2019 Rental income related to (above)/below market tenant leases, net $ 402 $ 73 $ 925 $ (82) Amortization related to in place lease intangibles and lease commissions (33,316) (28,518) (69,293) (53,423) The future estimated aggregate amortization of intangible assets and liabilities is as follows for the periods presented (in thousands): Assets Liabilities 2020 $ 54,296 $ 4,354 2021 66,013 8,162 2022 44,822 7,476 2023 36,282 5,238 2024 28,438 3,101 Thereafter 157,612 13,820 Total $ 387,463 $ 42,151

Dispositions and Assets Held fo

Dispositions and Assets Held for Sale	6 Months Ended
	Jun. 30, 2020
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 (i.e., property type, relationship or geography). At June 30, 2020, seven Seniors Housing Operating, three Triple-net, and 13 Outpatient Medical properties with an aggregate real estate balance of $382,580,000 were classified as held for sale. In addition to the real property balances held for sale, secured debt of $12,849,000 and net other assets and (liabilities) of $35,085,000 are included in the Consolidated Balance Sheet related to the held for sale properties. Expected gross sales proceeds related to the held for sale properties is approxi mately $501,008,000. During the three months ended June 30, 2020, the expected sale of a Seniors Housing Operating portfolio, which had previously met the held for sale criteria, was not completed. As a result, 11 properties with a carrying value of $386,744,000 were reclassified to held for use. During the three months ended March 31, 2020, we recorded impairment charges of $27,827,000 related to certain held for use properties for which the carrying value exceeded the fair values. During the three months ended June 30, 2020, we entered into and subsequently closed a definitive purchase and sale agreement to sell six Seniors Housing Operating properties. In conjunction with this transaction, an impairment charge of $56,371,000 was recognized. During the three months ended June 30, 2020, we agreed to terms including pricing for the sale of a portfolio of six Seniors Housing Operating properties previously classified as held for sale resulting in an impairment charge of $18,780,000. The following is a summary of our real property disposition activity for the periods presented (in thousands): Six Months Ended June 30, 2020 2019 Real estate dispositions: Seniors Housing Operating $ 706,964 $ 8,726 Triple-net 33,445 442,865 Outpatient Medical 808,992 — Total dispositions 1,549,401 451,591 Gain (loss) on real estate dispositions, net 418,687 165,727 Net other assets/liabilities disposed 29,999 (498) Proceeds from real estate dispositions $ 1,998,087 $ 616,820 Operating results attributable to properties sold or classified as held for sale which do not meet the definition of discontinued operations, are not 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 June 30, Six Months Ended June 30, 2020 2019 2020 2019 Revenues: Total revenues $ 36,481 $ 177,276 $ 107,933 $ 355,819 Expenses: Interest expense 1,622 4,210 4,591 8,420 Property operating expenses 23,850 101,416 63,300 207,340 Provision for depreciation 7,637 29,488 18,254 58,692 Total expenses 33,109 135,114 86,145 274,452 Income (loss) from real estate dispositions, net $ 3,372 $ 42,162 $ 21,788 $ 81,367

Leases

Leases	6 Months Ended
	Jun. 30, 2020
Leases [Abstract]
Leases	Leases We lease land, buildings, office space and certain equipment. Many of our leases include a renewal option to extend the term from one The components of lease expense were as follows for the period presented (in thousands): Six Months Ended Classification June 30, 2020 June 30, 2019 Operating lease cost: (1) Real estate lease expense Property operating expenses $ 12,516 $ 14,679 Non-real estate investment lease expense General and administrative expenses 2,549 770 Finance lease cost: Amortization of leased assets Property operating expenses 4,043 4,245 Interest on lease liabilities Interest expense 2,695 2,169 Sublease income Rental income (2,087) (2,087) Total $ 19,716 $ 19,776 (1) Includes short-term leases which are immaterial. Supplemental balance sheet information related to leases is as follows (in thousands): Classification June 30, 2020 December 31, 2019 Right of use assets: Operating leases - real estate Right of use assets, net $ 344,011 $ 374,217 Finance leases - real estate Right of use assets, net 158,593 162,216 Real estate right of use assets, net 502,604 536,433 Operating leases - non-real estate investments Receivables and other assets 11,063 12,474 Total right of use assets, net $ 513,667 $ 548,907 Lease liabilities: Operating leases $ 339,589 $ 364,803 Financing leases 107,835 108,890 Total $ 447,424 $ 473,693 Substantially all of our operating leases in which we are the lessor contain escalating rent structures. Leases with fixed annual rental escalators are generally recognized on a straight-line basis over the initial lease period, subject to a collectability assessment. Rental income related to leases with contingent rental escalators is generally recorded based on the contractual cash rental payments due for the period. During the three months ended March 31, 2020, we wrote off straight-line receivables of $32,268,000 in conjunction with the execution of a lease amendment. Additionally, during the three months ended June 30, 2020, we recorded a reserve of $1,842,000 on straight-line receivable balances deemed uncollectible. Leases in our Triple-net and Outpatient Medical portfolios typically include some form of operating expense reimbursement by the tenant. For the six months ended June 30, 2020, we recognized $786,265,000 of rental income related to operating leases, of which $104,605,000 was for variable lease payments which primarily represents the reimbursement of operating costs such as common area maintenance expenses, utilities, insurance and real estate taxes. For the six months ended June 30, 2019, we recognized $ 766,670,000 of rental income related to operating leases, of which $ 94,017,000 was for variable lease payments.
Leases	Leases We lease land, buildings, office space and certain equipment. Many of our leases include a renewal option to extend the term from one The components of lease expense were as follows for the period presented (in thousands): Six Months Ended Classification June 30, 2020 June 30, 2019 Operating lease cost: (1) Real estate lease expense Property operating expenses $ 12,516 $ 14,679 Non-real estate investment lease expense General and administrative expenses 2,549 770 Finance lease cost: Amortization of leased assets Property operating expenses 4,043 4,245 Interest on lease liabilities Interest expense 2,695 2,169 Sublease income Rental income (2,087) (2,087) Total $ 19,716 $ 19,776 (1) Includes short-term leases which are immaterial. Supplemental balance sheet information related to leases is as follows (in thousands): Classification June 30, 2020 December 31, 2019 Right of use assets: Operating leases - real estate Right of use assets, net $ 344,011 $ 374,217 Finance leases - real estate Right of use assets, net 158,593 162,216 Real estate right of use assets, net 502,604 536,433 Operating leases - non-real estate investments Receivables and other assets 11,063 12,474 Total right of use assets, net $ 513,667 $ 548,907 Lease liabilities: Operating leases $ 339,589 $ 364,803 Financing leases 107,835 108,890 Total $ 447,424 $ 473,693 Substantially all of our operating leases in which we are the lessor contain escalating rent structures. Leases with fixed annual rental escalators are generally recognized on a straight-line basis over the initial lease period, subject to a collectability assessment. Rental income related to leases with contingent rental escalators is generally recorded based on the contractual cash rental payments due for the period. During the three months ended March 31, 2020, we wrote off straight-line receivables of $32,268,000 in conjunction with the execution of a lease amendment. Additionally, during the three months ended June 30, 2020, we recorded a reserve of $1,842,000 on straight-line receivable balances deemed uncollectible. Leases in our Triple-net and Outpatient Medical portfolios typically include some form of operating expense reimbursement by the tenant. For the six months ended June 30, 2020, we recognized $786,265,000 of rental income related to operating leases, of which $104,605,000 was for variable lease payments which primarily represents the reimbursement of operating costs such as common area maintenance expenses, utilities, insurance and real estate taxes. For the six months ended June 30, 2019, we recognized $ 766,670,000 of rental income related to operating leases, of which $ 94,017,000 was for variable lease payments.
Leases	Leases We lease land, buildings, office space and certain equipment. Many of our leases include a renewal option to extend the term from one The components of lease expense were as follows for the period presented (in thousands): Six Months Ended Classification June 30, 2020 June 30, 2019 Operating lease cost: (1) Real estate lease expense Property operating expenses $ 12,516 $ 14,679 Non-real estate investment lease expense General and administrative expenses 2,549 770 Finance lease cost: Amortization of leased assets Property operating expenses 4,043 4,245 Interest on lease liabilities Interest expense 2,695 2,169 Sublease income Rental income (2,087) (2,087) Total $ 19,716 $ 19,776 (1) Includes short-term leases which are immaterial. Supplemental balance sheet information related to leases is as follows (in thousands): Classification June 30, 2020 December 31, 2019 Right of use assets: Operating leases - real estate Right of use assets, net $ 344,011 $ 374,217 Finance leases - real estate Right of use assets, net 158,593 162,216 Real estate right of use assets, net 502,604 536,433 Operating leases - non-real estate investments Receivables and other assets 11,063 12,474 Total right of use assets, net $ 513,667 $ 548,907 Lease liabilities: Operating leases $ 339,589 $ 364,803 Financing leases 107,835 108,890 Total $ 447,424 $ 473,693 Substantially all of our operating leases in which we are the lessor contain escalating rent structures. Leases with fixed annual rental escalators are generally recognized on a straight-line basis over the initial lease period, subject to a collectability assessment. Rental income related to leases with contingent rental escalators is generally recorded based on the contractual cash rental payments due for the period. During the three months ended March 31, 2020, we wrote off straight-line receivables of $32,268,000 in conjunction with the execution of a lease amendment. Additionally, during the three months ended June 30, 2020, we recorded a reserve of $1,842,000 on straight-line receivable balances deemed uncollectible. Leases in our Triple-net and Outpatient Medical portfolios typically include some form of operating expense reimbursement by the tenant. For the six months ended June 30, 2020, we recognized $786,265,000 of rental income related to operating leases, of which $104,605,000 was for variable lease payments which primarily represents the reimbursement of operating costs such as common area maintenance expenses, utilities, insurance and real estate taxes. For the six months ended June 30, 2019, we recognized $ 766,670,000 of rental income related to operating leases, of which $ 94,017,000 was for variable lease payments.

Loans Receivable

Loans Receivable	6 Months Ended
	Jun. 30, 2020
Receivables [Abstract]
Loans Receivable	Loans Receivable Loans receivable are recorded on our Consolidated Balance Sheets in real estate loans receivable, net of allowance for credit losses, or for non-real estate loans receivable, in receivables and other assets, net of allowance for credit losses. Real estate loans receivable consists of mortgage loans and other real estate loans which are primarily collateralized by a first, second or third mortgage lien, a leasehold mortgage on, or an assignment of the partnership interest in, the related properties, corporate guarantees and/or personal guarantees. Non-real estate loans are generally corporate loans with no real estate backing. Interest income on loans is recognized as earned based upon the principal amount outstanding subject to an evaluation of the risk of credit loss. Accrued interest receivable was $10,171,000 and $6,897,000 as of June 30, 2020 and December 31, 2019, respectively, and is included in receivables and other assets on the Consolidated Balance Sheets. The following is a summary of our loans receivable (in thousands): June 30, 2020 December 31, 2019 Mortgage loans $ 102,275 $ 188,062 Other real estate loans 126,448 124,696 Allowance for credit losses on real estate loans receivable (3,852) (42,376) Real estate loans receivable, net of credit allowance 224,871 270,382 Non-real estate loans 451,968 362,850 Allowance for credit losses on non-real estate loans receivable (78,133) (25,996) Non-real estate loans receivable, net of credit allowance 373,835 336,854 Total loans receivable, net of credit allowance $ 598,706 $ 607,236 During the six months ended June 30, 2020, the real estate collateral associated with one loan was released, therefore, the principal balance of $86,411,000 and related allowance for credit losses of $42,376,000 was reclassified to a non-real estate loan. The following is a summary of our loan activity for the periods presented (in thousands): Six Months Ended June 30, 2020 June 30, 2019 Advances on loans receivable: Investments in new loans $ 2,477 $ 30,000 Draws on existing loans 17,061 35,422 Net cash advances on loans receivable 19,538 65,422 Receipts on loans receivable: Loan payoffs — 4,384 Principal payments on loans 12,796 4,276 Net cash receipts on loans receivable 12,796 8,660 Net cash advances (receipts) on loans receivable $ 6,742 $ 56,762 The allowance for credit loss on loans receivable is maintained at a level believed adequate to absorb potential losses in our loans receivable. The determination of the credit allowance is based on a quarterly evaluation of each of these loans, including general economic conditions and estimated collectability of loan payments. We evaluate the collectability of our loans receivable based on a combination of credit quality indicators, including, but not limited to, payment status, historical loan charge-offs, financial strength of the borrower and guarantors, and nature, extent, and value of the underlying collateral. A loan is considered to have deteriorated credit quality when, based on current information and events, it is probable that we will be unable to collect all amounts due as scheduled according to the contractual terms of the loan agreement. For those loans we identified as having deteriorated credit quality we determine the amount of credit loss on an individual basis. Placement on non-accrual status may be required. Consistent with this definition, all loans on non-accrual are deemed to have deteriorated credit quality. To the extent circumstances improve and the risk of collectability is diminished, we will return these loans to income accrual status. While a loan is on non-accrual status, any cash receipts are applied against the outstanding principal balance. For the remaining loans we assess credit loss on a collective pool basis and use our historical loss experience for similar loans to determine the reserve for credit losses. The following is a summary of our loans by credit loss category (in thousands): June 30, 2020 Loan category Years of Origination Loan Carrying Value Allowance for Credit Loss Net Loan Balance No. of Loans Deteriorated loans 2007 - 2018 $ 186,584 $ (76,695) $ 109,889 5 Collective loan pool 2007 - 2015 128,447 (1,866) 126,581 15 Collective loan pool (1) 2016 184,620 (1,572) 183,048 6 Collective loan pool 2017 119,662 (999) 118,663 7 Collective loan pool 2018 15,399 (224) 15,175 1 Collective loan pool 2019 45,979 (629) 45,350 7 Total loans $ 680,691 $ (81,985) $ 598,706 41 (1) Carrying value is exclusive of deferred gains of $62,819,000 recorded in accrued expenses and other liabilities on the Consolidated Balance Sheets. In March 2019, we recognized a provision for loan losses of $18,690,000 to fully reserve for certain Triple-net real estate loans receivable that were no longer deemed collectible. During the quarter ended June 30, 2019, these loans were written off. During the six months ended June 30, 2020, we recognized a provision for credit losses of $6,898,000 to fully reserve for one Triple-net non-real estate loan receivable and $1,303,000 to fully reserve for one Triple-net real estate loan receivable that were no longer deemed collectible. The following is a summary of the allowance for credit losses on loans receivable for the periods presented (in thousands): Six Months Ended June 30, 2020 June 30, 2019 Balance at beginning of period $ 68,372 $ 68,372 Adoption of ASU 2016-13 5,212 — Provision for loan losses 8,494 18,690 Loan write-offs — (18,690) Foreign currency translation (93) — Balance at end of period $ 81,985 $ 68,372 The following is a summary of our deteriorated loans (in thousands): Six Months Ended June 30, 2020 June 30, 2019 Balance of deteriorated loans at end of period (1) $ 186,584 $ 188,068 Allowance for credit losses (76,695) (68,372) Balance of deteriorated loans not reserved $ 109,889 $ 119,696 Interest recognized on deteriorated loans (2) $ 7,912 $ 7,964 (1) Current year amounts include $10,716,000 and $2,534,000 of loans on non-accrual as of June 30, 2020 and December 31, 2019, respectively. Prior year amounts include $2,534,000 and$2,567,000 as of June 30, 2019 and December 31, 2018, respectively. (2) Represents cash interest recognized in the period.

Investments in Unconsolidated E

Investments in Unconsolidated Entities	6 Months Ended
	Jun. 30, 2020
Equity Method Investments and Joint Ventures [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 properties 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) June 30, 2020 December 31, 2019 Seniors Housing Operating 10% to 50% $ 568,381 $ 463,741 Triple-net 10% to 25% 7,172 7,740 Outpatient Medical 15% to 50% 211,368 111,942 Total $ 786,921 $ 583,423 (1) Excludes ownership of in substance real estate. At June 30, 2020, the aggregate unamortized basis difference of our joint venture investments of $112,486,000 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. We have made loans totaling $250,215,000 related to eight properties as of June 30, 2020 for the development and construction of certain properties which are classified as in substance real estate investments. We believe that such borrowers typically represent variable interest entities ("VIE" or "VIEs") in accordance with ASC 810 Consolidation. VIEs are required to be consolidated by their primary beneficiary ("PB") which is the enterprise that has both: (i) the power to direct the activities of the VIE that most significantly impacts the entity's economic performance; and (ii) the obligation to absorb losses or the right to receive benefits of the VIE that could be significant to the entity. We have concluded that we are not the PB of such borrowers, therefore, the loan arrangements were assessed based on among other factors, the amount and timing of expected residual profits, the estimated fair value of the collateral and the significance of the borrower's equity in the project. Based on these assessments, the arrangements have been classified as in substance real estate investments. We expect to fund an additional $212,306,000 related to these investments.

Credit Concentration

Credit Concentration	6 Months Ended
	Jun. 30, 2020
Risks and Uncertainties [Abstract]
Credit Concentration	Credit ConcentrationWe use consolidated net operating income (“NOI”) as our credit concentration metric. See Note 18 for additional information and reconciliation. The following table summarizes certain information about our credit concentration for the six months ended June 30, 2020, excluding our share of NOI in unconsolidated entities (dollars in thousands): Concentration by relationship: (1) Number of Properties Total NOI Percent of NOI (2) Sunrise Senior Living (3) 165 $ 134,872 12% ProMedica 215 106,530 10% Genesis Healthcare 52 58,831 5% Revera (3) 94 57,268 5% Avery Healthcare 59 37,298 3% Remaining portfolio 941 709,733 65% Totals 1,526 $ 1,104,532 100% (1) Sunrise Senior Living and Revera are in our Seniors Housing Operating segment. Genesis Healthcare and ProMedica are in our Triple-net segment. Avery Healthcare is in both the Triple-net and Seniors Housing Operating segments. (2) NOI with our top five relationships comprised 37% of total NOI for the year ended December 31, 2019. (3) Revera owns a controlling interest in Sunrise Senior Living.

Borrowings Under Credit Facilit

Borrowings Under Credit Facilities and Commercial Paper Program	6 Months Ended
	Jun. 30, 2020
Debt Disclosure [Abstract]
Borrowings Under Credit Facilities and Commercial Paper Program	Borrowings Under Credit Facilities and Commercial Paper Program At June 30, 2020, we had a primary unsecured credit facility with a consortium of 31 banks that includes a $3,000,000,000 unsecured revolving credit facility (none outstanding at June 30, 2020), 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 June 30, 2020). Borrowings under the unsecured revolving credit facility are subject to interest payable at the applicable margin over LIBOR interest rate. The applicable margin is based on our debt ratings and was 0.825% at June 30, 2020. 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 June 30, 2020. 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. In January 2019, we established an unsecured commercial paper program. Under the terms of the program, we may issue unsecured commercial paper notes with maturities that vary, but do not exceed 397 days from the date of issue, up to a maximum aggregate face or principal amount outstanding at any time o f $1,000,000,000 (none outstanding at June 30, 2020). The following information relates to aggregate borrowings under the unsecured revolving credit facility and commercial paper program for the periods presented (dollars in thousands): Three Months Ended June 30, Six Months Ended June 30, 2020 2019 2020 2019 Balance outstanding at quarter end $ — $ 1,870,000 $ — $ 1,870,000 Maximum amount outstanding at any month end $ 685,000 $ 2,880,000 $ 2,100,000 $ 2,880,000 Average amount outstanding (total of daily principal balances divided by days in period) $ 405,165 $ 1,807,631 $ 999,490 $ 1,301,883 Weighted average interest rate (actual interest expense divided by average borrowings outstanding) 1.57 % 3.08 % 2.08 % 3.11 %

Senior Unsecured Notes and Secu

Senior Unsecured Notes and Secured Debt	6 Months Ended
	Jun. 30, 2020
Debt Disclosure [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: (i) 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 (ii) 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 June 30, 2020, the annual principal payments due on these debt obligations were as follows (in thousands): Senior Unsecured Notes (1,2) Secured Debt (1,3) Totals 2020 $ — $ 257,139 $ 257,139 2021 — 427,969 427,969 2022 (4) 1,010,000 444,119 1,454,119 2023 (5,6) 1,783,621 327,388 2,111,009 2024 1,350,000 176,366 1,526,366 Thereafter (7,8,9) 7,769,090 995,008 8,764,098 Totals $ 11,912,711 $ 2,627,989 $ 14,540,700 (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 Consolidated Balance Sheet. (2) Annual interest rates range from 0.88% to 6.50%. (3) Annual interest rates range from 0.12% to 12.00%. Carrying value of the properties securing the debt totaled $5,774,000 at June 30, 2020. (4) Includes a $1,000,000,000 unsecured term credit facility. The loan matures on April 1, 2022 and bears interest at LIBOR plus 1.20% (1.38% at June 30, 2020). (5) Includes a $250,000,000 Canadian-denominated unsecured term credit facility (approximately $183,621,000 based on the Canadian/U.S. Dollar exchange rate on June 30, 2020). The loan matures on July 19, 2023 and bears interest at the Canadian Dealer Offered Rate plus 0.9% (1.42% at June 30, 2020). (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% (1.09% at June 30, 2020). (7) Includes a $300,000,000 Canadian-denominated 2.95% senior unsecured notes due 2027 (approximately $220,345,000 based on the Canadian/U.S. Dollar exchange rate on June 30, 2020). (8) Includes a £550,000,000 4.80% senior unsecured notes due 2028 (approximately $680,295,000 based on the Sterling/U.S. Dollar exchange rate in effect on June 30, 2020). (9) Includes a $500,000,000 4.50% senior unsecured notes due 2034 (approximately $618,450,000 based on the Sterling/U.S. Dollar exchange rate in effect on June 30, 2020). The following is a summary of our senior unsecured notes principal activity during the periods presented (dollars in thousands): Six Months Ended June 30, 2020 June 30, 2019 Weighted Avg. Weighted Avg. Amount Interest Rate Amount Interest Rate Beginning balance $ 10,427,562 4.03% $ 9,699,984 4.48% Debt issued 1,600,000 1.89% 2,050,000 3.58% Debt extinguished — —% (1,050,000) 4.98% Foreign currency (114,851) 4.30% 11,572 3.52% Ending balance $ 11,912,711 3.65% $ 10,711,556 4.24% In April, we closed on our previously announced $1.0 billion two-year unsecured term loan due April 2022. The term loan bears interest at a rate of 1-month LIBOR + 1.20%, based on our credit rating. On June 30, 2020, we completed the issuance of $600 million senior unsecured notes bearing interest at 2.75% with a maturity date of January 2031. On July 1, 2020 net proceeds were used to extinguish $160,872,000 of our 3.75% senior unsecured notes due March 2023 and $265,376,000 of our 3.95% senior unsecured notes due September 2023. We recognized a loss on extinguishment of $31,940,000 in July in conjunction with the transaction. Additionally, on July 2, 2020 we repaid $140,000,000 on our unsecured term loan. The following is a summary of our secured debt principal activity for the periods presented (dollars in thousands): Six Months Ended June 30, 2020 June 30, 2019 Weighted Avg. Weighted Avg. Amount Interest Rate Amount Interest Rate Beginning balance $ 2,993,342 3.63% $ 2,485,711 3.90% Debt issued 44,921 2.58% 295,969 3.52% Debt assumed — —% 42,000 4.62% Debt extinguished (314,631) 2.94% (151,473) 4.42% Principal payments (30,709) 3.55% (27,227) 3.74% Foreign currency (64,934) 3.13% 45,002 3.37% Ending balance $ 2,627,989 3.09% $ 2,689,982 3.84%

Derivative Instruments

Derivative Instruments	6 Months Ended
	Jun. 30, 2020
Derivative Instruments and Hedging Activities Disclosure [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 and interest rate risk related to our capital structure. Our risk management program is designed to manage the exposure and volatility arising from these risks, and utilizes foreign currency forward contracts, cross currency swap contracts, interest rate swaps, interest rate locks 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. Cash Flow Hedges of Interest Rate Risk We enter into interest rate swaps in order to maintain a capital structure containing targeted amounts of fixed and floating-rate debt and manage interest rate risk. Interest rate swaps designated as cash flow hedges involve the receipt of variable amounts from a counterparty in exchange for our fixed-rate payments. These interest rate swap agreements were used to hedge the variable cash flows associated with variable-rate debt. Periodically, we enter into and designate interest rate locks to partially hedge the risk of changes in interest payments attributable to increases in the benchmark interest rate during the period leading up to the probable issuance of fixed-rate debt. We designate our interest rate locks as cash flow hedges. Gains and losses when we settle our interest rate locks are amortized into income over the life of the related debt, except where a material amount is deemed to be ineffective, which would be immediately reclassified to the Consolidated Statements of Comprehensive Income. 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. During the six months ended June 30, 2020 and 2019, we settled certain net investment hedges generating cash proceeds of $3,485,000 and $6,716,000, 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 Statements 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): June 30, 2020 December 31, 2019 Derivatives designated as net investment hedges: Denominated in Canadian Dollars $ 650,000 $ 725,000 Denominated in Pounds Sterling £ 1,340,708 £ 1,340,708 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 Interest rate swaps designated as cash flow hedges: Denominated in U.S Dollars (1) $ 1,188,250 $ 1,188,250 Derivative instruments not designated: Interest rate caps denominated in U.S. Dollars $ 112,726 $ 405,819 Forward sales contracts denominated in Canadian Dollars $ 80,000 $ — Forward purchase contracts denominated in Pounds Sterling £ — £ (125,000) Forward sales contracts denominated in Pounds Sterling £ — £ 125,000 (1) At June 30, 2020 the maximum maturity date was July 15, 2021. The following presents the impact of derivative instruments on the Consolidated Statements of Comprehensive Income for the periods presented (in thousands): Three Months Ended June 30, Six Months Ended June 30, Description Location 2020 2019 2020 2019 Gain (loss) on derivative instruments designated as hedges recognized in income Interest expense $ 4,106 $ 7,134 $ 10,751 $ 12,467 Gain (loss) on derivative instruments not designated as hedges recognized in income Interest expense $ (1,953) $ (1,128) $ (2,048) $ (2,666) Gain (loss) on derivative and financial instruments designated as hedges recognized in OCI OCI $ (27,171) $ 100,407 $ 231,941 $ 12,725

Commitments and Contingencies

Commitments and Contingencies	6 Months Ended
	Jun. 30, 2020
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and ContingenciesAt June 30, 2020, we had 8 outstanding letter of credit obligations totaling $37,014,000 and expiring between 2020 and 2024. At June 30, 2020, we had outstanding construction in progress of $411,700,000 and were committed to providing additional funds of approximately $332,074,000 to complete construction. Additionally, at June 30, 2020, we had outstanding investments classified as in substance real estate of $250,215,000 and were committed to provide additional funds of $212,306,000 (see Note 8 for additional information). Purchase obligations at June 30, 2020 also include $19,442,000 of contingent purchase obligations to fund capital improvements. Rents due from the tenant are increased to reflect the additional investment in the property.

Stockholders' Equity

Stockholders' Equity	6 Months Ended
	Jun. 30, 2020
Equity [Abstract]
Stockholders' Equity	Stockholders’ Equity The following is a summary of our stockholders’ equity capital accounts as of the dates indicated: June 30, 2020 December 31, 2019 Preferred Stock: Authorized shares 50,000,000 50,000,000 Issued shares — — Outstanding shares — — Common Stock, $1.00 par value: Authorized shares 700,000,000 700,000,000 Issued shares 418,869,381 411,550,857 Outstanding shares 417,302,448 410,256,615 Preferred Stock The following is a summary of our preferred stock activity during the periods indicated: Six Months Ended June 30, 2020 June 30, 2019 Weighted Avg. Weighted Avg. Shares Dividend Rate Shares Dividend Rate Beginning balance — —% 14,369,965 6.50% Shares converted — —% (14,369,965) 6.50% Ending balance — —% — —% During the six months ended June 30, 2019, we converted all of the outstanding Series I Preferred Stock. Each share was converted into 0.8857 shares of common stock. Common Stock In February 2019, we entered into an amended and restated equity distribution agreement whereby we can offer and sell up to $1,500,000,000 aggregate amount of our common stock ("Equity Shelf Program"). The Equity Shelf Program also allows us to enter into forward sale agreements. During the six months ended June 30, 2020, we physically settled all of our outstanding forward sales agreements for cash proceeds of $576,196,000. As of June 30, 2020, we h ad $499,341,000 of remaining capacity under the Equity Shelf Program. On May 1, 2020, our Board of Directors authorized a share repurchase program whereby we may repurchase up to $1 billion of common stock through December 31, 2021 (the "Repurchase Program"). Under this authorization, we are not required to purchase shares but may choose to do so in the open market or through private transactions at times and amounts based on our evaluation of market conditions and other factors. We expect to finance any share repurchases under the Repurchase Program using available cash and may use proceeds from borrowings or debt offerings. During the six months ended June 30, 2020, we repurchased 201,947 shares at an averag e price of $37.89 per share. The following is a summary of our common stock issuances during the six months ended June 30, 2020 and 2019 (dollars in thousands, except shares and average price amounts): Shares Issued Average Price Gross Proceeds Net Proceeds 2019 Dividend reinvestment plan issuances 4,304,712 $ 75.20 $ 323,724 $ 320,243 2019 Option exercises 10,736 51.32 551 551 2019 Equity shelf program issuances 4,384,045 74.97 328,665 326,362 2019 Preferred stock conversions 12,712,452 — — 2019 Stock incentive plans, net of forfeitures 167,565 — — 2019 Totals 21,579,510 $ 652,940 $ 647,156 2020 Dividend reinvestment plan issuances 264,153 $ 72.33 $ 19,105 $ 19,105 2020 Option exercises 251 47.81 12 12 2020 Equity shelf program issuances 6,799,978 86.48 588,072 576,196 2020 Stock incentive plans, net of forfeitures 183,398 — — 2020 Totals 7,247,780 $ 607,189 $ 595,313 Dividends The decrease in dividends is attributable to the declaration of a reduced cash dividend beginning with the quarter ending March 31, 2020. The following is a summary of our dividend payments (in thousands, except per share amounts): Six Months Ended June 30, 2020 June 30, 2019 Per Share Amount Per Share Amount Common stock $ 1.48 $ 610,847 $ 1.74 $ 698,437 Accumulated Other Comprehensive Income The following is a summary of accumulated other comprehensive income (loss) for the periods presented (in thousands): June 30, 2020 December 31, 2019 Foreign currency translation $ (956,454) $ (719,814) Derivative and financial instruments designated as hedges 839,598 607,657 Total accumulated other comprehensive income (loss) $ (116,856) $ (112,157)

Stock Incentive Plans

Stock Incentive Plans	6 Months Ended
	Jun. 30, 2020
Share-based Payment Arrangement [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 $7,662,000 and $15,192,000 for the same periods in 2019.

Earnings Per Share

Earnings Per Share	6 Months Ended
	Jun. 30, 2020
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 June 30, Six Months Ended June 30, 2020 2019 2020 2019 Numerator for basic earnings per share - net income (loss) attributable to common stockholders $ 179,246 $ 137,762 $ 489,530 $ 418,232 Adjustment for net income (loss) attributable to OP units (1,366) 35 (2,754) 88 Numerator for diluted earnings per share $ 177,880 $ 137,797 $ 486,776 $ 418,320 Denominator for basic earnings per share - weighted average shares 417,084 404,607 413,696 398,073 Effect of dilutive securities: Employee stock options — — — 1 Non-vested restricted shares 619 955 661 911 Redeemable OP units 1,396 1,096 1,396 1,096 Employee stock purchase program 22 15 22 15 Dilutive potential common shares 2,037 2,066 2,079 2,023 Denominator for diluted earnings per share - adjusted weighted average shares 419,121 406,673 415,775 400,096 Basic earnings per share $ 0.43 $ 0.34 $ 1.18 $ 1.05 Diluted earnings per share $ 0.42 $ 0.34 $ 1.17 $ 1.05

Disclosure about Fair Value of

Disclosure about Fair Value of Financial Instruments	6 Months Ended
	Jun. 30, 2020
Fair Value Disclosures [Abstract]
Disclosure about Fair Value of Financial Instruments	Disclosure about Fair Value of Financial Instruments Fair value is defined 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. A three-level valuation hierarchy exists for disclosures of fair value measurements based upon the transparency of inputs to the valuation of an asset or liability as of the measurement date. A financial instrument's categorization within the valuation hierarchy is based upon the lowest level of input that is significant to the fair value measurement. Please see Note 2 to the financial statements included in our Annual Report on Form 10-K for the year ended December 31, 2019 for additional information. The three levels are defined below: • 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, Other Real Estate Loans and Non-real Estate Loans Receivable — The fair value of mortgage loans, other real estate loans and non-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 and Commercial Paper Program — The carrying amount of the primary unsecured credit facility and commercial paper program 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, Interest Rate Swaps and Cross Currency Swaps — Foreign currency forward contracts, interest rate swaps and cross currency swaps are recorded in other assets or other liabilities on the balance sheet at fair value that is derived from observable market data, including yield curves and foreign exchange rates (all of our derivatives are Level 2). Redeemable OP Unitholder Interests — Our redeemable OP unitholder interests are recorded on the balance sheet at fair value using Level 2 inputs unless the fair value is below the initial amount in which case the redeemable OP unitholder interests are recorded at the initial amount adjusted for distributions to the unitholders and income or loss attributable to the unitholders. 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): June 30, 2020 December 31, 2019 Carrying Amount Fair Value Carrying Amount Fair Value Financial assets: Mortgage loans receivable $ 100,782 $ 107,407 $ 145,686 $ 150,217 Other real estate loans receivable 124,089 124,291 124,696 128,512 Equity securities 6,600 6,600 15,685 15,685 Cash and cash equivalents 1,678,770 1,678,770 284,917 284,917 Restricted cash 147,473 147,473 100,849 100,849 Non-real estate loans receivable 373,835 419,325 336,854 379,239 Foreign currency forward contracts, interest rate swaps and cross currency swaps 165,968 165,968 18,554 18,554 Financial liabilities: Borrowings under unsecured credit facility and commercial paper program $ — $ — $ 1,587,597 $ 1,587,597 Senior unsecured notes 11,815,972 12,890,274 10,336,513 11,400,571 Secured debt 2,619,678 2,668,133 2,990,962 3,041,893 Foreign currency forward contracts, interest rate swaps and cross currency swaps 64,077 64,077 53,601 53,601 Redeemable OP unitholder interests $ 97,179 $ 92,373 $ 121,440 $ 121,440 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 June 30, 2020 Total Level 1 Level 2 Level 3 Equity securities $ 6,600 $ 6,600 $ — $ — Foreign currency forward contracts, interest rate swaps and cross currency swaps, net asset (liability) (1) 101,891 — 101,891 — Totals $ 108,491 $ 6,600 $ 101,891 $ — (1) Please see Note 12 for additional information. Items Measured at Fair Value on a Nonrecurring Basis

Segment Reporting

Segment Reporting	6 Months Ended
	Jun. 30, 2020
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: Seniors Housing Operating, Triple-net and Outpatient Medical. Our Seniors Housing Operating properties include seniors apartments, assisted living, independent living/continuing care retirement communities, independent supportive living communities (Canada), care homes with and without nursing (U.K.) and combinations thereof that are owned and/or operated through RIDEA structures (see Note 19). Our Triple-net properties include the property types described above as well as long-term/post-acute care facilities. 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 Outpatient Medical properties are typically leased to multiple tenants and generally require a certain level of property management by us. We evaluate performance based upon consolidated 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, 2019). 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 June 30, 2020: Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 769,560 $ — $ — $ — $ 769,560 Rental income — 217,492 178,813 — 396,305 Interest income 88 15,520 461 — 16,069 Other income 4,002 607 1,557 375 6,541 Total revenues 773,650 233,619 180,831 375 1,188,475 Property operating expenses 595,513 13,563 51,688 — 660,764 Consolidated net operating income 178,137 220,056 129,143 375 527,711 Depreciation and amortization 139,163 58,138 68,070 — 265,371 Interest expense 14,029 2,746 4,326 105,256 126,357 General and administrative expenses — — — 34,062 34,062 Loss (gain) on derivatives and financial instruments, net — 1,434 — — 1,434 Loss (gain) on extinguishment of debt, net (492) — 741 — 249 Provision for loan losses — 1,451 (29) — 1,422 Impairment of assets 75,151 — — — 75,151 Other expenses 5,251 3,500 6,456 4,204 19,411 Income (loss) from continuing operations before income taxes and other items (54,965) 152,787 49,579 (143,147) 4,254 Income tax (expense) benefit — — — (2,233) (2,233) Income (loss) from unconsolidated entities (6,787) 6,403 1,716 — 1,332 Gain (loss) on real estate dispositions, net 14,465 2,148 139,250 — 155,863 Income (loss) from continuing operations (47,287) 161,338 190,545 (145,380) 159,216 Net income (loss) $ (47,287) $ 161,338 $ 190,545 $ (145,380) $ 159,216 Total assets $ 14,915,588 $ 9,189,707 $ 7,434,364 $ 1,622,993 $ 33,162,652 Three Months Ended June 30, 2019: Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 914,085 $ — $ — $ — $ 914,085 Rental income — 222,362 163,224 — 385,586 Interest income — 17,118 238 — 17,356 Other income 1,444 1,278 (97) 454 3,079 Total revenues 915,529 240,758 163,365 454 1,320,106 Property operating expenses 637,317 12,823 50,987 — 701,127 Consolidated net operating income 278,212 227,935 112,378 454 618,979 Depreciation and amortization 136,551 56,056 55,445 — 248,052 Interest expense 17,572 3,225 3,386 117,153 141,336 General and administrative expenses — — — 33,741 33,741 Loss (gain) on derivatives and financial instruments, net — 1,913 — — 1,913 Impairment of assets — (940) 10,879 — 9,939 Other expenses 11,857 5,560 (4) 4,215 21,628 Income (loss) from continuing operations before income taxes and other items 112,232 162,121 42,672 (154,655) 162,370 Income tax (expense) benefit — — — (1,599) (1,599) Income (loss) from unconsolidated entities (17,453) 6,578 1,826 — (9,049) Gain (loss) on real estate dispositions, net (550) (1,130) (2) — (1,682) Income (loss) from continuing operations 94,229 167,569 44,496 (156,254) 150,040 Net income (loss) $ 94,229 $ 167,569 $ 44,496 $ (156,254) $ 150,040 Six Months Ended June 30, 2020 Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 1,619,532 $ — $ — $ — $ 1,619,532 Rental income — 408,877 377,388 — 786,265 Interest income 192 30,191 927 — 31,310 Other income 5,054 2,280 1,845 791 9,970 Total revenues 1,624,778 441,348 380,160 791 2,447,077 Property operating expenses 1,203,384 26,865 112,296 — 1,342,545 Consolidated net operating income 421,394 414,483 267,864 791 1,104,532 Depreciation and amortization 285,937 115,832 138,403 — 540,172 Interest expense 30,463 5,598 9,134 223,169 268,364 General and administrative expenses — — — 69,543 69,543 Loss (gain) on derivatives and financial instruments, net — 9,085 — — 9,085 Loss (gain) on extinguishment of debt, net (492) — 741 — 249 Provision for loan losses — 8,523 (29) — 8,494 Impairment of assets 78,646 24,332 — — 102,978 Other expenses 8,240 4,013 7,463 5,987 25,703 Income (loss) from continuing operations before income taxes and other items 18,600 247,100 112,152 (297,908) 79,944 Income tax (expense) benefit — — — (7,675) (7,675) Income (loss) from unconsolidated entities (17,811) 12,199 3,252 — (2,360) Gain (loss) on real estate dispositions, net 14,316 51,785 352,586 — 418,687 Income (loss) from continuing operations 15,105 311,084 467,990 (305,583) 488,596 Net income (loss) $ 15,105 $ 311,084 $ 467,990 $ (305,583) $ 488,596 Six Months Ended June 30, 2019 Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 1,782,370 $ — $ — $ — $ 1,782,370 Rental income — 454,394 312,276 — 766,670 Interest income — 32,064 411 — 32,475 Other income 5,545 2,541 139 2,611 10,836 Total revenues 1,787,915 488,999 312,826 2,611 2,592,351 Property operating expenses 1,245,003 27,778 99,153 — 1,371,934 Consolidated net operating income 542,912 461,221 213,673 2,611 1,220,417 Depreciation and amortization 268,126 117,404 106,454 — 491,984 Interest expense 35,823 6,665 6,734 237,346 286,568 General and administrative expenses — — — 69,023 69,023 Loss (gain) on derivatives and financial — (574) — — (574) Loss (gain) on extinguishment of debt, net — — — 15,719 15,719 Provision for loan losses — 18.69 18,690 — — 18.69 — 18,690 Impairment of assets — (940) 10,879 — 9,939 Other expenses 14,803 8,589 750 6,242 30,384 Income (loss) from continuing operations before income taxes and other items 224,160 311,387 88,856 (325,719) 298,684 Income tax (expense) benefit — — — (3,821) (3,821) Income (loss) from unconsolidated entities (34,033) 12,236 3,549 — (18,248) Gain (loss) on real estate dispositions, net (710) 166,444 (7) — 165,727 Income (loss) from continuing operations 189,417 490,067 92,398 (329,540) 442,342 Net income (loss) $ 189,417 $ 490,067 $ 92,398 $ (329,540) $ 442,342 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 Six Months Ended June 30, 2020 June 30, 2019 June 30, 2020 June 30, 2019 Revenues: Amount (1) % Amount % Amount (1) % Amount % United States $ 973,772 81.9 % $ 1,092,376 82.8 % $ 2,001,553 81.8 % $ 2,136,042 82.4 % United Kingdom 109,437 9.2 % 112,647 8.5 % 227,319 9.3 % 225,065 8.7 % Canada 105,266 8.9 % 115,083 8.7 % 218,205 8.9 % 231,244 8.9 % Total $ 1,188,475 100.0 % $ 1,320,106 100.0 % $ 2,447,077 100.0 % $ 2,592,351 100.0 % As of June 30, 2020 December 31, 2019 Assets: Amount % Amount % United States $ 27,655,745 83.4 % $ 27,513,911 82.4 % United Kingdom 3,175,033 9.6 % 3,405,388 10.2 % Canada 2,331,874 7.0 % 2,461,452 7.4 % Total $ 33,162,652 100.0 % $ 33,380,751 100.0 % (1) The United States, United Kingdom and Canada represent 77%, 10% and 13%, respectively, of our resident fees and services revenue stream for the three and six months ended June 30, 2020.

Income Taxes and Distributions

Income Taxes and Distributions	6 Months Ended
	Jun. 30, 2020
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 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 six months ended June 30, 2020 and 2019, 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. Subsequent to 2014 we transferred certain subsidiaries to the United Kingdom, while some wholly-owned direct and indirect subsidiaries remain in Luxembourg and Jersey. The company reflects current and deferred tax liabilities for any such withholding taxes incurred from this holding company structure in its consolidated financial statements. Generally, given current statutes of limitations, we are subject to audit by the foreign, federal, state and local taxing authorities under applicable local laws.

Variable Interest Entities

Variable Interest Entities	6 Months Ended
	Jun. 30, 2020
Organization, Consolidation and Presentation of Financial Statements [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 VIEs. 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): June 30, 2020 December 31, 2019 Assets: Net real estate investments $ 457,107 $ 960,093 Cash and cash equivalents 30,438 27,522 Receivables and other assets 12,596 14,586 Total assets (1) $ 500,141 $ 1,002,201 Liabilities and equity: Secured debt $ 166,567 $ 460,117 Lease liabilities 1,326 1,326 Accrued expenses and other liabilities 14,810 22,215 Total equity 317,438 518,543 Total liabilities and equity $ 500,141 $ 1,002,201 (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)	6 Months Ended
	Jun. 30, 2020
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 six months ended June 30, 2020 are not necessarily an indication of the results that may be expected for the year ending December 31, 2020. 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, 2019.
New Accounting Standards	New Accounting Standards • On January 1, 2020, we adopted ASU 2016-13, “Measurement of Credit Losses on Financial Instruments" ("ASU 2016-13"). This standard requires a new forward-looking “expected loss” model to be used for receivables, held-to-maturity debt, loans, and other instruments. In November 2018, the FASB issued an amendment excluding operating lease receivables accounted for under the new leases standard from the scope of the new credit losses standard. ASU 2016-13 primarily impacts our measurement for credit losses related to our real estate and non-real estate loans receivable. In conjunction with our adoption of ASU 2016-13, we recorded a $5,212,000 increase to our allowance for credit losses on loans receivable (both real estate and non-real estate) with a corresponding adjustment to cumulative net income related to the change in accounting principle. See Note 7 for further details. • At the FASB's April 8, 2020 Board meeting, the staff acknowledged that the economics of lease concessions that result from a global pandemic may not be aligned with the underlying premise of the modification framework in ASC 842, under which the concession would be recognized over the remainder of the lease term. In a Q&A document, the FASB provided entities with COVID-19 related lease concessions an option to either (1) apply the modification framework for these concessions in accordance with ASC 842 as applicable or (2) account for concessions as if they were made under the enforceable rights included in the original agreement as long as total cash flows resulting from the modified contract are substantially the same or less than cash flows in the original contract. Due to the continuing adverse economic conditions caused by the COVID-19 pandemic, a subset of outpatient medical tenants have requested rent relief, most often in the form of a short-term rent deferral. Not all tenant requests result in modification of agreements, nor do we intend to forgo our contractual rights under our lease agreements. We evaluate each tenant's rent relief request on an individual basis. Generally we expect the majority of rent deferral agreements to result in two months of full or partial rent relief to repaid by the end of the year. We have elected to apply the accounting relief provided by the FASB to such short-term rent deferrals, and will account for such deferrals as if no change had been made to the original lease contract.

Accounting Policies (Tables)

Accounting Policies (Tables)	6 Months Ended
	Jun. 30, 2020
Accounting Policies [Abstract]
Schedule of Seniors Housing Operating portfolio	Occupancy within our total Seniors Housing Operating portfolio has declined as follows: February March April May June July Spot occupancy (1) 85.8 % 85.0 % 82.8 % 81.0 % 80.1 % 79.4 % Sequential occupancy change (0.8) % (2.2) % (1.8) % (0.9) % (0.7) % (1) Spot occupancy represents approximate month end occupancy for properties in operation as of February 2020, including unconsolidated properties but excluding acquisitions, dispositions and development conversions since the start of the COVID-19 pandemic.

Real Property Acquisitions an_2

Real Property Acquisitions and Development (Tables)	6 Months Ended
	Jun. 30, 2020
Real Estate [Abstract]
Estimated Fair Value of Allocated Purchase Price of Asset and Liabilities	The following is a summary of our real property investment activity by segment for the periods presented (in thousands): Six Months Ended June 30, 2020 June 30, 2019 Seniors Housing Operating Triple-net Outpatient Totals Seniors Housing Operating Triple-net Outpatient Totals Land and land improvements $ 15,758 $ — $ 40,847 $ 56,605 $ 103,743 $ 8,099 $ 132,154 $ 243,996 Buildings and improvements 132,480 765 171,457 304,702 1,109,966 96,244 1,198,608 2,404,818 Acquired lease intangibles 10,810 — 23,823 34,633 58,773 — 85,492 144,265 Construction in progress — — — — 36,174 — — 36,174 Right of use assets, net — — — — — — 56,073 56,073 Receivables and other assets 257 — 139 396 4,560 — 376 4,936 Total assets acquired (1) 159,305 765 236,266 396,336 1,313,216 104,343 1,472,703 2,890,262 Secured debt — — — — (43,209) — — (43,209) Lease liabilities — — — — — — (45,287) (45,287) Accrued expenses and other liabilities (671) — (2,036) (2,707) (8,677) — (22,506) (31,183) Total liabilities acquired (671) — (2,036) (2,707) (51,886) — (67,793) (119,679) Noncontrolling interests (2) (2,827) — — (2,827) (38,830) (1,056) — (39,886) Non-cash acquisition related activity (3) — — — — (11,889) — — (11,889) Cash disbursed for acquisitions 155,807 765 234,230 390,802 1,210,611 103,287 1,404,910 2,718,808 Construction in progress additions 53,705 26,262 26,677 106,644 110,902 24,131 26,587 161,620 Less: Capitalized interest (5,470) (1,826) (1,991) (9,287) (3,560) (908) (1,788) (6,256) Accruals (4) (1,343) — (2,983) (4,326) — — 45 45 Cash disbursed for construction in progress 46,892 24,436 21,703 93,031 107,342 23,223 24,844 155,409 Capital improvements to existing properties 87,002 4,700 30,401 122,103 97,867 7,423 18,886 124,176 Total cash invested in real property, net of cash acquired $ 289,701 $ 29,901 $ 286,334 $ 605,936 $ 1,415,820 $ 133,933 $ 1,448,640 $ 2,998,393 (1) Excludes $580,000 and $1,910,000 of unrestricted and restricted cash acquired during the six months ended June 30, 2020 and 2019, respectively. (2) Includes amounts attributable to both redeemable noncontrolling interests and noncontrolling interests. (3) Relates to the acquisition of assets previously recognized as investments in unconsolidated entities. (4) 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. The following is a summary of the construction projects that were placed into service and began generating revenues during the periods presented (in thousands): Six Months Ended June 30, 2020 June 30, 2019 Development projects: Seniors Housing Operating $ 93,188 $ 28,117 Triple-net 33,627 — Outpatient Medical 43,493 — Total development projects 170,308 28,117 Expansion projects 35,637 — Total construction in progress conversions $ 205,945 $ 28,117

Real Estate Intangibles (Tables

Real Estate Intangibles (Tables)	6 Months Ended
	Jun. 30, 2020
Goodwill and Intangible Assets Disclosure [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): June 30, 2020 December 31, 2019 Assets: In place lease intangibles $ 1,460,748 $ 1,513,836 Above market tenant leases 58,780 59,540 Lease commissions 46,450 43,675 Gross historical cost 1,565,978 1,617,051 Accumulated amortization (1,178,515) (1,181,158) Net book value $ 387,463 $ 435,893 Weighted-average amortization period in years 10.8 10.3 Liabilities: Below market tenant leases $ 83,037 $ 99,035 Accumulated amortization (40,886) (49,390) Net book value $ 42,151 $ 49,645 Weighted-average amortization period in years 8.4 8.6
Summary of Real Estate Intangible Amortization	The following is a summary of real estate intangible amortization income (expense) for the periods presented (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2020 2019 2020 2019 Rental income related to (above)/below market tenant leases, net $ 402 $ 73 $ 925 $ (82) Amortization related to in place lease intangibles and lease commissions (33,316) (28,518) (69,293) (53,423)
Schedule of Future Estimated Aggregate Amortization of Intangible Assets and Liabilities	The future estimated aggregate amortization of intangible assets and liabilities is as follows for the periods presented (in thousands): Assets Liabilities 2020 $ 54,296 $ 4,354 2021 66,013 8,162 2022 44,822 7,476 2023 36,282 5,238 2024 28,438 3,101 Thereafter 157,612 13,820 Total $ 387,463 $ 42,151

Dispositions and Assets Held _2

Dispositions and Assets Held for Sale (Tables)	6 Months Ended
	Jun. 30, 2020
Discontinued Operations and Disposal Groups [Abstract]
Summary of Real Property Disposition Activity	The following is a summary of our real property disposition activity for the periods presented (in thousands): Six Months Ended June 30, 2020 2019 Real estate dispositions: Seniors Housing Operating $ 706,964 $ 8,726 Triple-net 33,445 442,865 Outpatient Medical 808,992 — Total dispositions 1,549,401 451,591 Gain (loss) on real estate dispositions, net 418,687 165,727 Net other assets/liabilities disposed 29,999 (498) Proceeds from real estate dispositions $ 1,998,087 $ 616,820
Dispositions and Assets Held for Sale	The following represents the activity related to these properties for the periods presented (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2020 2019 2020 2019 Revenues: Total revenues $ 36,481 $ 177,276 $ 107,933 $ 355,819 Expenses: Interest expense 1,622 4,210 4,591 8,420 Property operating expenses 23,850 101,416 63,300 207,340 Provision for depreciation 7,637 29,488 18,254 58,692 Total expenses 33,109 135,114 86,145 274,452 Income (loss) from real estate dispositions, net $ 3,372 $ 42,162 $ 21,788 $ 81,367

Leases (Tables)

Leases (Tables)	6 Months Ended
	Jun. 30, 2020
Leases [Abstract]
Components of Lease Expense, Lease Terms and Discount Rate, and Supplemental Cash Flow Information	The components of lease expense were as follows for the period presented (in thousands): Six Months Ended Classification June 30, 2020 June 30, 2019 Operating lease cost: (1) Real estate lease expense Property operating expenses $ 12,516 $ 14,679 Non-real estate investment lease expense General and administrative expenses 2,549 770 Finance lease cost: Amortization of leased assets Property operating expenses 4,043 4,245 Interest on lease liabilities Interest expense 2,695 2,169 Sublease income Rental income (2,087) (2,087) Total $ 19,716 $ 19,776 (1) Includes short-term leases which are immaterial.
Supplemental Balance Sheet Information Related to Leases	Supplemental balance sheet information related to leases is as follows (in thousands): Classification June 30, 2020 December 31, 2019 Right of use assets: Operating leases - real estate Right of use assets, net $ 344,011 $ 374,217 Finance leases - real estate Right of use assets, net 158,593 162,216 Real estate right of use assets, net 502,604 536,433 Operating leases - non-real estate investments Receivables and other assets 11,063 12,474 Total right of use assets, net $ 513,667 $ 548,907 Lease liabilities: Operating leases $ 339,589 $ 364,803 Financing leases 107,835 108,890 Total $ 447,424 $ 473,693

Loans Receivable (Tables)

Loans Receivable (Tables)	6 Months Ended
	Jun. 30, 2020
Receivables [Abstract]
Summary of Loans Receivable	The following is a summary of our loans receivable (in thousands): June 30, 2020 December 31, 2019 Mortgage loans $ 102,275 $ 188,062 Other real estate loans 126,448 124,696 Allowance for credit losses on real estate loans receivable (3,852) (42,376) Real estate loans receivable, net of credit allowance 224,871 270,382 Non-real estate loans 451,968 362,850 Allowance for credit losses on non-real estate loans receivable (78,133) (25,996) Non-real estate loans receivable, net of credit allowance 373,835 336,854 Total loans receivable, net of credit allowance $ 598,706 $ 607,236
Summary of Loan Activity	The following is a summary of our loan activity for the periods presented (in thousands): Six Months Ended June 30, 2020 June 30, 2019 Advances on loans receivable: Investments in new loans $ 2,477 $ 30,000 Draws on existing loans 17,061 35,422 Net cash advances on loans receivable 19,538 65,422 Receipts on loans receivable: Loan payoffs — 4,384 Principal payments on loans 12,796 4,276 Net cash receipts on loans receivable 12,796 8,660 Net cash advances (receipts) on loans receivable $ 6,742 $ 56,762
Schedule of Credit Loss	The following is a summary of our loans by credit loss category (in thousands): June 30, 2020 Loan category Years of Origination Loan Carrying Value Allowance for Credit Loss Net Loan Balance No. of Loans Deteriorated loans 2007 - 2018 $ 186,584 $ (76,695) $ 109,889 5 Collective loan pool 2007 - 2015 128,447 (1,866) 126,581 15 Collective loan pool (1) 2016 184,620 (1,572) 183,048 6 Collective loan pool 2017 119,662 (999) 118,663 7 Collective loan pool 2018 15,399 (224) 15,175 1 Collective loan pool 2019 45,979 (629) 45,350 7 Total loans $ 680,691 $ (81,985) $ 598,706 41 (1) Carrying value is exclusive of deferred gains of $62,819,000 recorded in accrued expenses and other liabilities on the Consolidated Balance Sheets. Six Months Ended June 30, 2020 June 30, 2019 Balance at beginning of period $ 68,372 $ 68,372 Adoption of ASU 2016-13 5,212 — Provision for loan losses 8,494 18,690 Loan write-offs — (18,690) Foreign currency translation (93) — Balance at end of period $ 81,985 $ 68,372
Summary of Impaired Loans	The following is a summary of our deteriorated loans (in thousands): Six Months Ended June 30, 2020 June 30, 2019 Balance of deteriorated loans at end of period (1) $ 186,584 $ 188,068 Allowance for credit losses (76,695) (68,372) Balance of deteriorated loans not reserved $ 109,889 $ 119,696 Interest recognized on deteriorated loans (2) $ 7,912 $ 7,964 (1) Current year amounts include $10,716,000 and $2,534,000 of loans on non-accrual as of June 30, 2020 and December 31, 2019, respectively. Prior year amounts include $2,534,000 and$2,567,000 as of June 30, 2019 and December 31, 2018, respectively. (2) Represents cash interest recognized in the period.

Investments in Unconsolidated_2

Investments in Unconsolidated Entities (Tables)	6 Months Ended
	Jun. 30, 2020
Equity Method Investments and Joint Ventures [Abstract]
Summary of Seniors Housing Operating portfolio	The following is a summary of our investments in unconsolidated entities (dollars in thousands): Percentage Ownership (1) June 30, 2020 December 31, 2019 Seniors Housing Operating 10% to 50% $ 568,381 $ 463,741 Triple-net 10% to 25% 7,172 7,740 Outpatient Medical 15% to 50% 211,368 111,942 Total $ 786,921 $ 583,423 (1) Excludes ownership of in substance real estate.

Credit Concentration (Tables)

Credit Concentration (Tables)	6 Months Ended
	Jun. 30, 2020
Risks and Uncertainties [Abstract]
Summary of Credit Concentration	The following table summarizes certain information about our credit concentration for the six months ended June 30, 2020, excluding our share of NOI in unconsolidated entities (dollars in thousands): Concentration by relationship: (1) Number of Properties Total NOI Percent of NOI (2) Sunrise Senior Living (3) 165 $ 134,872 12% ProMedica 215 106,530 10% Genesis Healthcare 52 58,831 5% Revera (3) 94 57,268 5% Avery Healthcare 59 37,298 3% Remaining portfolio 941 709,733 65% Totals 1,526 $ 1,104,532 100% (1) Sunrise Senior Living and Revera are in our Seniors Housing Operating segment. Genesis Healthcare and ProMedica are in our Triple-net segment. Avery Healthcare is in both the Triple-net and Seniors Housing Operating segments. (2) NOI with our top five relationships comprised 37% of total NOI for the year ended December 31, 2019. (3) Revera owns a controlling interest in Sunrise Senior Living.

Borrowings Under Credit Facil_2

Borrowings Under Credit Facilities and Commercial Paper Program (Tables)	6 Months Ended
	Jun. 30, 2020
Debt Disclosure [Abstract]
Aggregate Borrowings Under Unsecured Revolving Credit Facility and Commercial Paper	The following information relates to aggregate borrowings under the unsecured revolving credit facility and commercial paper program for the periods presented (dollars in thousands): Three Months Ended June 30, Six Months Ended June 30, 2020 2019 2020 2019 Balance outstanding at quarter end $ — $ 1,870,000 $ — $ 1,870,000 Maximum amount outstanding at any month end $ 685,000 $ 2,880,000 $ 2,100,000 $ 2,880,000 Average amount outstanding (total of daily principal balances divided by days in period) $ 405,165 $ 1,807,631 $ 999,490 $ 1,301,883 Weighted average interest rate (actual interest expense divided by average borrowings outstanding) 1.57 % 3.08 % 2.08 % 3.11 %

Senior Unsecured Notes and Se_2

Senior Unsecured Notes and Secured Debt (Tables)	6 Months Ended
	Jun. 30, 2020
Debt Disclosure [Abstract]
Annual Principal Payments Due on Debt Obligations	At June 30, 2020, the annual principal payments due on these debt obligations were as follows (in thousands): Senior Unsecured Notes (1,2) Secured Debt (1,3) Totals 2020 $ — $ 257,139 $ 257,139 2021 — 427,969 427,969 2022 (4) 1,010,000 444,119 1,454,119 2023 (5,6) 1,783,621 327,388 2,111,009 2024 1,350,000 176,366 1,526,366 Thereafter (7,8,9) 7,769,090 995,008 8,764,098 Totals $ 11,912,711 $ 2,627,989 $ 14,540,700 (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 Consolidated Balance Sheet. (2) Annual interest rates range from 0.88% to 6.50%. (3) Annual interest rates range from 0.12% to 12.00%. Carrying value of the properties securing the debt totaled $5,774,000 at June 30, 2020. (4) Includes a $1,000,000,000 unsecured term credit facility. The loan matures on April 1, 2022 and bears interest at LIBOR plus 1.20% (1.38% at June 30, 2020). (5) Includes a $250,000,000 Canadian-denominated unsecured term credit facility (approximately $183,621,000 based on the Canadian/U.S. Dollar exchange rate on June 30, 2020). The loan matures on July 19, 2023 and bears interest at the Canadian Dealer Offered Rate plus 0.9% (1.42% at June 30, 2020). (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% (1.09% at June 30, 2020). (7) Includes a $300,000,000 Canadian-denominated 2.95% senior unsecured notes due 2027 (approximately $220,345,000 based on the Canadian/U.S. Dollar exchange rate on June 30, 2020). (8) Includes a £550,000,000 4.80% senior unsecured notes due 2028 (approximately $680,295,000 based on the Sterling/U.S. Dollar exchange rate in effect on June 30, 2020). (9) Includes a $500,000,000 4.50% senior unsecured notes due 2034 (approximately $618,450,000 based on the Sterling/U.S. Dollar exchange rate in effect on June 30, 2020).
Summary of Principal Activity	The following is a summary of our senior unsecured notes principal activity during the periods presented (dollars in thousands): Six Months Ended June 30, 2020 June 30, 2019 Weighted Avg. Weighted Avg. Amount Interest Rate Amount Interest Rate Beginning balance $ 10,427,562 4.03% $ 9,699,984 4.48% Debt issued 1,600,000 1.89% 2,050,000 3.58% Debt extinguished — —% (1,050,000) 4.98% Foreign currency (114,851) 4.30% 11,572 3.52% Ending balance $ 11,912,711 3.65% $ 10,711,556 4.24% In April, we closed on our previously announced $1.0 billion two-year unsecured term loan due April 2022. The term loan bears interest at a rate of 1-month LIBOR + 1.20%, based on our credit rating. On June 30, 2020, we completed the issuance of $600 million senior unsecured notes bearing interest at 2.75% with a maturity date of January 2031. On July 1, 2020 net proceeds were used to extinguish $160,872,000 of our 3.75% senior unsecured notes due March 2023 and $265,376,000 of our 3.95% senior unsecured notes due September 2023. We recognized a loss on extinguishment of $31,940,000 in July in conjunction with the transaction. Additionally, on July 2, 2020 we repaid $140,000,000 on our unsecured term loan. The following is a summary of our secured debt principal activity for the periods presented (dollars in thousands): Six Months Ended June 30, 2020 June 30, 2019 Weighted Avg. Weighted Avg. Amount Interest Rate Amount Interest Rate Beginning balance $ 2,993,342 3.63% $ 2,485,711 3.90% Debt issued 44,921 2.58% 295,969 3.52% Debt assumed — —% 42,000 4.62% Debt extinguished (314,631) 2.94% (151,473) 4.42% Principal payments (30,709) 3.55% (27,227) 3.74% Foreign currency (64,934) 3.13% 45,002 3.37% Ending balance $ 2,627,989 3.09% $ 2,689,982 3.84%

Derivative Instruments (Tables)

Derivative Instruments (Tables)	6 Months Ended
	Jun. 30, 2020
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Notional Amount of Derivatives and Other Financial Instruments	The following presents the notional amount of derivatives and other financial instruments as of the dates indicated (in thousands): June 30, 2020 December 31, 2019 Derivatives designated as net investment hedges: Denominated in Canadian Dollars $ 650,000 $ 725,000 Denominated in Pounds Sterling £ 1,340,708 £ 1,340,708 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 Interest rate swaps designated as cash flow hedges: Denominated in U.S Dollars (1) $ 1,188,250 $ 1,188,250 Derivative instruments not designated: Interest rate caps denominated in U.S. Dollars $ 112,726 $ 405,819 Forward sales contracts denominated in Canadian Dollars $ 80,000 $ — Forward purchase contracts denominated in Pounds Sterling £ — £ (125,000) Forward sales contracts denominated in Pounds Sterling £ — £ 125,000
Impact of Derivative Instruments on the Consolidated Statements of Comprehensive Income	The following presents the impact of derivative instruments on the Consolidated Statements of Comprehensive Income for the periods presented (in thousands): Three Months Ended June 30, Six Months Ended June 30, Description Location 2020 2019 2020 2019 Gain (loss) on derivative instruments designated as hedges recognized in income Interest expense $ 4,106 $ 7,134 $ 10,751 $ 12,467 Gain (loss) on derivative instruments not designated as hedges recognized in income Interest expense $ (1,953) $ (1,128) $ (2,048) $ (2,666) Gain (loss) on derivative and financial instruments designated as hedges recognized in OCI OCI $ (27,171) $ 100,407 $ 231,941 $ 12,725

Stockholders' Equity (Tables)

Stockholders' Equity (Tables)	6 Months Ended
	Jun. 30, 2020
Equity [Abstract]
Summary of Stockholders' Equity Capital Accounts	The following is a summary of our stockholders’ equity capital accounts as of the dates indicated: June 30, 2020 December 31, 2019 Preferred Stock: Authorized shares 50,000,000 50,000,000 Issued shares — — Outstanding shares — — Common Stock, $1.00 par value: Authorized shares 700,000,000 700,000,000 Issued shares 418,869,381 411,550,857 Outstanding shares 417,302,448 410,256,615 Six Months Ended June 30, 2020 June 30, 2019 Weighted Avg. Weighted Avg. Shares Dividend Rate Shares Dividend Rate Beginning balance — —% 14,369,965 6.50% Shares converted — —% (14,369,965) 6.50% Ending balance — —% — —% The following is a summary of our common stock issuances during the six months ended June 30, 2020 and 2019 (dollars in thousands, except shares and average price amounts): Shares Issued Average Price Gross Proceeds Net Proceeds 2019 Dividend reinvestment plan issuances 4,304,712 $ 75.20 $ 323,724 $ 320,243 2019 Option exercises 10,736 51.32 551 551 2019 Equity shelf program issuances 4,384,045 74.97 328,665 326,362 2019 Preferred stock conversions 12,712,452 — — 2019 Stock incentive plans, net of forfeitures 167,565 — — 2019 Totals 21,579,510 $ 652,940 $ 647,156 2020 Dividend reinvestment plan issuances 264,153 $ 72.33 $ 19,105 $ 19,105 2020 Option exercises 251 47.81 12 12 2020 Equity shelf program issuances 6,799,978 86.48 588,072 576,196 2020 Stock incentive plans, net of forfeitures 183,398 — — 2020 Totals 7,247,780 $ 607,189 $ 595,313
Summary of Dividend Payments	The following is a summary of our dividend payments (in thousands, except per share amounts): Six Months Ended June 30, 2020 June 30, 2019 Per Share Amount Per Share Amount Common stock $ 1.48 $ 610,847 $ 1.74 $ 698,437
Summary of Accumulated Other Comprehensive Income (Loss)	The following is a summary of accumulated other comprehensive income (loss) for the periods presented (in thousands): June 30, 2020 December 31, 2019 Foreign currency translation $ (956,454) $ (719,814) Derivative and financial instruments designated as hedges 839,598 607,657 Total accumulated other comprehensive income (loss) $ (116,856) $ (112,157)

Earnings Per Share (Tables)

Earnings Per Share (Tables)	6 Months Ended
	Jun. 30, 2020
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 June 30, Six Months Ended June 30, 2020 2019 2020 2019 Numerator for basic earnings per share - net income (loss) attributable to common stockholders $ 179,246 $ 137,762 $ 489,530 $ 418,232 Adjustment for net income (loss) attributable to OP units (1,366) 35 (2,754) 88 Numerator for diluted earnings per share $ 177,880 $ 137,797 $ 486,776 $ 418,320 Denominator for basic earnings per share - weighted average shares 417,084 404,607 413,696 398,073 Effect of dilutive securities: Employee stock options — — — 1 Non-vested restricted shares 619 955 661 911 Redeemable OP units 1,396 1,096 1,396 1,096 Employee stock purchase program 22 15 22 15 Dilutive potential common shares 2,037 2,066 2,079 2,023 Denominator for diluted earnings per share - adjusted weighted average shares 419,121 406,673 415,775 400,096 Basic earnings per share $ 0.43 $ 0.34 $ 1.18 $ 1.05 Diluted earnings per share $ 0.42 $ 0.34 $ 1.17 $ 1.05

Disclosure about Fair Value o_2

Disclosure about Fair Value of Financial Instruments (Tables)	6 Months Ended
	Jun. 30, 2020
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): June 30, 2020 December 31, 2019 Carrying Amount Fair Value Carrying Amount Fair Value Financial assets: Mortgage loans receivable $ 100,782 $ 107,407 $ 145,686 $ 150,217 Other real estate loans receivable 124,089 124,291 124,696 128,512 Equity securities 6,600 6,600 15,685 15,685 Cash and cash equivalents 1,678,770 1,678,770 284,917 284,917 Restricted cash 147,473 147,473 100,849 100,849 Non-real estate loans receivable 373,835 419,325 336,854 379,239 Foreign currency forward contracts, interest rate swaps and cross currency swaps 165,968 165,968 18,554 18,554 Financial liabilities: Borrowings under unsecured credit facility and commercial paper program $ — $ — $ 1,587,597 $ 1,587,597 Senior unsecured notes 11,815,972 12,890,274 10,336,513 11,400,571 Secured debt 2,619,678 2,668,133 2,990,962 3,041,893 Foreign currency forward contracts, interest rate swaps and cross currency swaps 64,077 64,077 53,601 53,601 Redeemable OP unitholder interests $ 97,179 $ 92,373 $ 121,440 $ 121,440
Summary of Items Measured at Fair Value on a Recurring Basis	The following summarizes items measured at fair value on a recurring basis (in thousands): Fair Value Measurements as of June 30, 2020 Total Level 1 Level 2 Level 3 Equity securities $ 6,600 $ 6,600 $ — $ — Foreign currency forward contracts, interest rate swaps and cross currency swaps, net asset (liability) (1) 101,891 — 101,891 — Totals $ 108,491 $ 6,600 $ 101,891 $ — (1) Please see Note 12 for additional information.

Segment Reporting (Tables)

Segment Reporting (Tables)	6 Months Ended
	Jun. 30, 2020
Segment Reporting [Abstract]
Summary Information for Reportable Segments	Summary information for the reportable segments (which excludes unconsolidated entities) is as follows (in thousands): Three Months Ended June 30, 2020: Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 769,560 $ — $ — $ — $ 769,560 Rental income — 217,492 178,813 — 396,305 Interest income 88 15,520 461 — 16,069 Other income 4,002 607 1,557 375 6,541 Total revenues 773,650 233,619 180,831 375 1,188,475 Property operating expenses 595,513 13,563 51,688 — 660,764 Consolidated net operating income 178,137 220,056 129,143 375 527,711 Depreciation and amortization 139,163 58,138 68,070 — 265,371 Interest expense 14,029 2,746 4,326 105,256 126,357 General and administrative expenses — — — 34,062 34,062 Loss (gain) on derivatives and financial instruments, net — 1,434 — — 1,434 Loss (gain) on extinguishment of debt, net (492) — 741 — 249 Provision for loan losses — 1,451 (29) — 1,422 Impairment of assets 75,151 — — — 75,151 Other expenses 5,251 3,500 6,456 4,204 19,411 Income (loss) from continuing operations before income taxes and other items (54,965) 152,787 49,579 (143,147) 4,254 Income tax (expense) benefit — — — (2,233) (2,233) Income (loss) from unconsolidated entities (6,787) 6,403 1,716 — 1,332 Gain (loss) on real estate dispositions, net 14,465 2,148 139,250 — 155,863 Income (loss) from continuing operations (47,287) 161,338 190,545 (145,380) 159,216 Net income (loss) $ (47,287) $ 161,338 $ 190,545 $ (145,380) $ 159,216 Total assets $ 14,915,588 $ 9,189,707 $ 7,434,364 $ 1,622,993 $ 33,162,652 Three Months Ended June 30, 2019: Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 914,085 $ — $ — $ — $ 914,085 Rental income — 222,362 163,224 — 385,586 Interest income — 17,118 238 — 17,356 Other income 1,444 1,278 (97) 454 3,079 Total revenues 915,529 240,758 163,365 454 1,320,106 Property operating expenses 637,317 12,823 50,987 — 701,127 Consolidated net operating income 278,212 227,935 112,378 454 618,979 Depreciation and amortization 136,551 56,056 55,445 — 248,052 Interest expense 17,572 3,225 3,386 117,153 141,336 General and administrative expenses — — — 33,741 33,741 Loss (gain) on derivatives and financial instruments, net — 1,913 — — 1,913 Impairment of assets — (940) 10,879 — 9,939 Other expenses 11,857 5,560 (4) 4,215 21,628 Income (loss) from continuing operations before income taxes and other items 112,232 162,121 42,672 (154,655) 162,370 Income tax (expense) benefit — — — (1,599) (1,599) Income (loss) from unconsolidated entities (17,453) 6,578 1,826 — (9,049) Gain (loss) on real estate dispositions, net (550) (1,130) (2) — (1,682) Income (loss) from continuing operations 94,229 167,569 44,496 (156,254) 150,040 Net income (loss) $ 94,229 $ 167,569 $ 44,496 $ (156,254) $ 150,040 Six Months Ended June 30, 2020 Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 1,619,532 $ — $ — $ — $ 1,619,532 Rental income — 408,877 377,388 — 786,265 Interest income 192 30,191 927 — 31,310 Other income 5,054 2,280 1,845 791 9,970 Total revenues 1,624,778 441,348 380,160 791 2,447,077 Property operating expenses 1,203,384 26,865 112,296 — 1,342,545 Consolidated net operating income 421,394 414,483 267,864 791 1,104,532 Depreciation and amortization 285,937 115,832 138,403 — 540,172 Interest expense 30,463 5,598 9,134 223,169 268,364 General and administrative expenses — — — 69,543 69,543 Loss (gain) on derivatives and financial instruments, net — 9,085 — — 9,085 Loss (gain) on extinguishment of debt, net (492) — 741 — 249 Provision for loan losses — 8,523 (29) — 8,494 Impairment of assets 78,646 24,332 — — 102,978 Other expenses 8,240 4,013 7,463 5,987 25,703 Income (loss) from continuing operations before income taxes and other items 18,600 247,100 112,152 (297,908) 79,944 Income tax (expense) benefit — — — (7,675) (7,675) Income (loss) from unconsolidated entities (17,811) 12,199 3,252 — (2,360) Gain (loss) on real estate dispositions, net 14,316 51,785 352,586 — 418,687 Income (loss) from continuing operations 15,105 311,084 467,990 (305,583) 488,596 Net income (loss) $ 15,105 $ 311,084 $ 467,990 $ (305,583) $ 488,596 Six Months Ended June 30, 2019 Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 1,782,370 $ — $ — $ — $ 1,782,370 Rental income — 454,394 312,276 — 766,670 Interest income — 32,064 411 — 32,475 Other income 5,545 2,541 139 2,611 10,836 Total revenues 1,787,915 488,999 312,826 2,611 2,592,351 Property operating expenses 1,245,003 27,778 99,153 — 1,371,934 Consolidated net operating income 542,912 461,221 213,673 2,611 1,220,417 Depreciation and amortization 268,126 117,404 106,454 — 491,984 Interest expense 35,823 6,665 6,734 237,346 286,568 General and administrative expenses — — — 69,023 69,023 Loss (gain) on derivatives and financial — (574) — — (574) Loss (gain) on extinguishment of debt, net — — — 15,719 15,719 Provision for loan losses — 18.69 18,690 — — 18.69 — 18,690 Impairment of assets — (940) 10,879 — 9,939 Other expenses 14,803 8,589 750 6,242 30,384 Income (loss) from continuing operations before income taxes and other items 224,160 311,387 88,856 (325,719) 298,684 Income tax (expense) benefit — — — (3,821) (3,821) Income (loss) from unconsolidated entities (34,033) 12,236 3,549 — (18,248) Gain (loss) on real estate dispositions, net (710) 166,444 (7) — 165,727 Income (loss) from continuing operations 189,417 490,067 92,398 (329,540) 442,342 Net income (loss) $ 189,417 $ 490,067 $ 92,398 $ (329,540) $ 442,342
Summary of Geographic Information	The following is a summary of geographic information for the periods presented (dollars in thousands): Three Months Ended Six Months Ended June 30, 2020 June 30, 2019 June 30, 2020 June 30, 2019 Revenues: Amount (1) % Amount % Amount (1) % Amount % United States $ 973,772 81.9 % $ 1,092,376 82.8 % $ 2,001,553 81.8 % $ 2,136,042 82.4 % United Kingdom 109,437 9.2 % 112,647 8.5 % 227,319 9.3 % 225,065 8.7 % Canada 105,266 8.9 % 115,083 8.7 % 218,205 8.9 % 231,244 8.9 % Total $ 1,188,475 100.0 % $ 1,320,106 100.0 % $ 2,447,077 100.0 % $ 2,592,351 100.0 % As of June 30, 2020 December 31, 2019 Assets: Amount % Amount % United States $ 27,655,745 83.4 % $ 27,513,911 82.4 % United Kingdom 3,175,033 9.6 % 3,405,388 10.2 % Canada 2,331,874 7.0 % 2,461,452 7.4 % Total $ 33,162,652 100.0 % $ 33,380,751 100.0 % (1) The United States, United Kingdom and Canada represent 77%, 10% and 13%, respectively, of our resident fees and services revenue stream for the three and six months ended June 30, 2020.

Variable Interest Entities (Tab

Variable Interest Entities (Tables)	6 Months Ended
	Jun. 30, 2020
Organization, Consolidation and Presentation of Financial Statements [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): June 30, 2020 December 31, 2019 Assets: Net real estate investments $ 457,107 $ 960,093 Cash and cash equivalents 30,438 27,522 Receivables and other assets 12,596 14,586 Total assets (1) $ 500,141 $ 1,002,201 Liabilities and equity: Secured debt $ 166,567 $ 460,117 Lease liabilities 1,326 1,326 Accrued expenses and other liabilities 14,810 22,215 Total equity 317,438 518,543 Total liabilities and equity $ 500,141 $ 1,002,201 (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_3

Accounting Policies and Related Matters - Spot Occupancy (Details) - Seniors Housing Operating - COVID-19	Jul. 31, 2020	Jun. 30, 2020	May 31, 2020	Apr. 30, 2020	Mar. 31, 2020	Feb. 29, 2020
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Spot occupancy		80.10%	81.00%	82.80%	85.00%	85.80%
Sequential occupancy change		(0.90%)	(1.80%)	(2.20%)	(0.80%)
Subsequent event
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Spot occupancy	79.40%
Sequential occupancy change	(0.70%)

Accounting Policies and Relat_4

Accounting Policies and Related Matters - Additional Information (Details) - USD ($) $ in Thousands	1 Months Ended	2 Months Ended	3 Months Ended	6 Months Ended
	Jul. 31, 2020	Jul. 31, 2020	Jun. 30, 2020	Jun. 30, 2020	Dec. 31, 2019	Jun. 30, 2019	Dec. 31, 2018
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Allowance for credit loss on loans receivable			$ 81,985	$ 81,985	$ 68,372	$ 68,372	$ 68,372
COVID-19
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Increase in operational cost			$ 43,058	$ 50,352
Rent collected percentage			99.00%
Percentage of rent cash collection			87.00%
Percentage of rent approved for deferral			12.00%
COVID-19 | Subsequent event
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Rent collected percentage	98.00%
Percentage of rent cash collection	95.00%
Percentage of rent approved for deferral	3.00%
Percentage of deferred rent collected		96.00%
Accounting Standards Update 2016-13 | Cumulative effect, period of adoption, adjustment
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Allowance for credit loss on loans receivable					$ 5,212		$ 0

Real Property Acquisitions an_3

Real Property Acquisitions and Development - Estimated Fair Value of Allocated Purchase Price of Asset and Liabilities (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019
Business Acquisition [Line Items]
Land and land improvements	$ 56,605	$ 243,996
Buildings and improvements	304,702	2,404,818
Acquired lease intangibles	34,633	144,265
Construction in progress	0	36,174
Right of use assets, net	0	56,073
Receivables and other assets	396	4,936
Total assets acquired	396,336	2,890,262
Secured debt	0	(43,209)
Lease liabilities	0	(45,287)
Accrued expenses and other liabilities	(2,707)	(31,183)
Total liabilities acquired	(2,707)	(119,679)
Noncontrolling interests	(2,827)	(39,886)
Non-cash acquisition related activity	0	(11,889)
Cash disbursed for acquisitions	390,802	2,718,808
Construction in progress additions	106,644	161,620
Less: Capitalized interest	(9,287)	(6,256)
Accruals	(4,326)	45
Cash disbursed for construction in progress	93,031	155,409
Capital improvements to existing properties	122,103	124,176
Total cash invested in real property, net of cash acquired	605,936	2,998,393
Cash acquired from acquisition	580	1,910
Seniors Housing Operating
Business Acquisition [Line Items]
Land and land improvements	15,758	103,743
Buildings and improvements	132,480	1,109,966
Acquired lease intangibles	10,810	58,773
Construction in progress	0	36,174
Right of use assets, net	0	0
Receivables and other assets	257	4,560
Total assets acquired	159,305	1,313,216
Secured debt	0	(43,209)
Lease liabilities	0	0
Accrued expenses and other liabilities	(671)	(8,677)
Total liabilities acquired	(671)	(51,886)
Noncontrolling interests	(2,827)	(38,830)
Non-cash acquisition related activity	0	(11,889)
Cash disbursed for acquisitions	155,807	1,210,611
Construction in progress additions	53,705	110,902
Less: Capitalized interest	(5,470)	(3,560)
Accruals	(1,343)	0
Cash disbursed for construction in progress	46,892	107,342
Capital improvements to existing properties	87,002	97,867
Total cash invested in real property, net of cash acquired	289,701	1,415,820
Triple-net
Business Acquisition [Line Items]
Land and land improvements	0	8,099
Buildings and improvements	765	96,244
Acquired lease intangibles	0	0
Construction in progress	0	0
Right of use assets, net	0	0
Receivables and other assets	0	0
Total assets acquired	765	104,343
Secured debt	0	0
Lease liabilities	0	0
Accrued expenses and other liabilities	0	0
Total liabilities acquired	0	0
Noncontrolling interests	0	(1,056)
Non-cash acquisition related activity	0	0
Cash disbursed for acquisitions	765	103,287
Construction in progress additions	26,262	24,131
Less: Capitalized interest	(1,826)	(908)
Accruals	0	0
Cash disbursed for construction in progress	24,436	23,223
Capital improvements to existing properties	4,700	7,423
Total cash invested in real property, net of cash acquired	29,901	133,933
Outpatient Medical
Business Acquisition [Line Items]
Land and land improvements	40,847	132,154
Buildings and improvements	171,457	1,198,608
Acquired lease intangibles	23,823	85,492
Construction in progress	0	0
Right of use assets, net	0	56,073
Receivables and other assets	139	376
Total assets acquired	236,266	1,472,703
Secured debt	0	0
Lease liabilities	0	(45,287)
Accrued expenses and other liabilities	(2,036)	(22,506)
Total liabilities acquired	(2,036)	(67,793)
Noncontrolling interests	0	0
Non-cash acquisition related activity	0	0
Cash disbursed for acquisitions	234,230	1,404,910
Construction in progress additions	26,677	26,587
Less: Capitalized interest	(1,991)	(1,788)
Accruals	(2,983)	45
Cash disbursed for construction in progress	21,703	24,844
Capital improvements to existing properties	30,401	18,886
Total cash invested in real property, net of cash acquired	$ 286,334	$ 1,448,640

Real Property Acquisitions an_4

Real Property Acquisitions and Development - Construction Activity (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019
Segment Reporting Information [Line Items]
Total development projects	$ 170,308	$ 28,117
Expansion projects	35,637	0
Total construction in progress conversions	205,945	28,117
Seniors Housing Operating
Segment Reporting Information [Line Items]
Total development projects	93,188	28,117
Triple-net
Segment Reporting Information [Line Items]
Total development projects	33,627	0
Outpatient Medical
Segment Reporting Information [Line Items]
Total development projects	$ 43,493	$ 0

Real Estate Intangibles - Summa

Real Estate Intangibles - Summary of Real Estate Intangibles Excluding Those Classified as Held For Sale (Details) - USD ($) $ in Thousands	6 Months Ended	12 Months Ended
	Jun. 30, 2020	Dec. 31, 2019
Assets:
Gross historical cost	$ 1,565,978	$ 1,617,051
Accumulated amortization	(1,178,515)	(1,181,158)
Net book value	$ 387,463	$ 435,893
Weighted-average amortization period in years	10 years 9 months 18 days	10 years 3 months 18 days
Liabilities:
Below market tenant leases	$ 83,037	$ 99,035
Accumulated amortization	(40,886)	(49,390)
Net book value	$ 42,151	$ 49,645
Weighted-average amortization period in years	8 years 4 months 24 days	8 years 7 months 6 days
In place lease intangibles
Assets:
Gross historical cost	$ 1,460,748	$ 1,513,836
Above market tenant leases
Assets:
Gross historical cost	58,780	59,540
Lease commissions
Assets:
Gross historical cost	$ 46,450	$ 43,675

Real Estate Intangibles - Sum_2

Real Estate Intangibles - Summary of Real Estate Intangible Amortization (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Goodwill and Intangible Assets Disclosure [Abstract]
Rental income related to (above)/below market tenant leases, net	$ 402	$ 73	$ 925	$ (82)
Amortization related to in place lease intangibles and lease commissions	$ (33,316)	$ (28,518)	$ (69,293)	$ (53,423)

Real Estate Intangibles - Sched

Real Estate Intangibles - Schedule of Future Estimated Aggregate Amortization of Intangible Assets and Liabilities (Details) - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Assets
2020	$ 54,296
2021	66,013
2022	44,822
2023	36,282
2024	28,438
Thereafter	157,612
Net book value	387,463	$ 435,893
Liabilities
2020	4,354
2021	8,162
2022	7,476
2023	5,238
2024	3,101
Thereafter	13,820
Net book value	$ 42,151	$ 49,645

Dispositions and Assets Held _3

Dispositions and Assets Held for Sale - Narrative (Details) $ in Thousands	1 Months Ended	3 Months Ended		6 Months Ended
	Aug. 06, 2020USD ($)	Jun. 30, 2020USD ($)propertyproperties	Mar. 31, 2020USD ($)	Jun. 30, 2020USD ($)property	Dec. 31, 2019USD ($)	[1]
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Real property held for sale		$ 382,580		$ 382,580	$ 1,253,008
Impairment of assets held for sale				18,780
Subsequent event
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Expected proceeds from properties held for sale	$ 501,008
Held for sale
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Secured debt		12,849		12,849
Net other assets and liabilities		35,085		$ 35,085
Net impairment charges		$ 56,371	$ 27,827
Seniors Housing Operating
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of properties classified as held for sale | property		7		7
Number of properties reclassified as held for use | properties		11
Assets held for use		$ 386,744		$ 386,744
Seniors Housing Operating | Held for sale
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of properties classified as held for sale | property		6		6
Triple-net
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of properties classified as held for sale | property		3		3
Outpatient Medical
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of properties classified as held for sale | property		13		13
[1]	The consolidated balance sheet at December 31, 2019 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by U.S. generally accepted accounting principles for complete financial statements.

Dispositions and Assets Held _4

Dispositions and Assets Held for Sale - Summary of Real Property Disposition Activity (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Real estate dispositions:
Total dispositions			$ 1,549,401	$ 451,591
Gain (loss) on real estate dispositions, net	$ 155,863	$ (1,682)	418,687	165,727
Net other assets/liabilities disposed			29,999	(498)
Proceeds from real estate dispositions			1,998,087	616,820
Seniors Housing Operating
Real estate dispositions:
Total dispositions			706,964	8,726
Triple-net
Real estate dispositions:
Total dispositions			33,445	442,865
Outpatient Medical
Real estate dispositions:
Total dispositions			$ 808,992	$ 0

Dispositions and Assets Held _5

Dispositions and Assets Held for Sale - Dispositions and Assets Held for Sale (Details) - Disposal group, disposed of by sale, not discontinued operations - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Revenues:
Total revenues	$ 36,481	$ 177,276	$ 107,933	$ 355,819
Expenses:
Interest expense	1,622	4,210	4,591	8,420
Property operating expenses	23,850	101,416	63,300	207,340
Provision for depreciation	7,637	29,488	18,254	58,692
Total expenses	33,109	135,114	86,145	274,452
Income (loss) from real estate dispositions, net	$ 3,372	$ 42,162	$ 21,788	$ 81,367

Leases - Narrative (Details)

Leases - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended			6 Months Ended
	Jun. 30, 2020	Mar. 31, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019	Dec. 31, 2019
Lessee, Lease, Description [Line Items]
Straight line rent adjustment		$ 32,268
Uncollectible rent receivable	$ 1,842			$ 1,842
Rental and other revenues related to operating lease payments	$ 396,305		$ 385,586	786,265	$ 766,670
Rental and other revenues related to operating lease payments, variable leases				$ 104,605	$ 94,017
Operating Lease, Right-of-Use Asset, Statement of Financial Position [Extensible List]		well:LeaseRightOfUseAsset				well:LeaseRightOfUseAsset
Finance Lease, Right-of-Use Asset, Statement of Financial Position [Extensible List]	well:LeaseRightOfUseAsset			well:LeaseRightOfUseAsset		well:LeaseRightOfUseAsset
Operating Lease, Liability, Statement of Financial Position [Extensible List]	well:LeaseLiability			well:LeaseLiability		well:LeaseLiability
Finance Lease, Liability, Statement of Financial Position [Extensible List]	well:LeaseLiability			well:LeaseLiability		well:LeaseLiability
Minimum
Lessee, Lease, Description [Line Items]
Lease term extension period				1 year
Maximum
Lessee, Lease, Description [Line Items]
Lease term extension period				25 years

Leases - Components of Lease Ex

Leases - Components of Lease Expense (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019
Finance lease cost:
Amortization of leased assets	$ 4,043	$ 4,245
Interest on lease liabilities	2,695	2,169
Sublease income	(2,087)	(2,087)
Total	19,716	19,776
Property operating expenses
Operating lease cost:
Lease expense	12,516	14,679
General and administrative expenses
Operating lease cost:
Lease expense	$ 2,549	$ 770

Leases - Supplemental Balance S

Leases - Supplemental Balance Sheet Information Related to Leases (Details) - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Right of use assets:
Total right of use assets, net	$ 502,604	$ 536,433	[1]
Lease liabilities:
Operating leases	339,589	364,803
Financing leases	107,835	108,890
Total	447,424	473,693	[1]
Real estate
Right of use assets:
Operating leases	344,011	374,217
Finance leases	158,593	162,216
Corporate
Right of use assets:
Operating leases	11,063	12,474
Real estate and Corporate
Right of use assets:
Total right of use assets, net	$ 513,667	$ 548,907
[1]	The consolidated balance sheet at December 31, 2019 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by U.S. generally accepted accounting principles for complete financial statements.

Loans Receivable - Narrative (D

Loans Receivable - Narrative (Details) $ in Thousands	1 Months Ended	3 Months Ended		6 Months Ended
	Mar. 31, 2019USD ($)	Jun. 30, 2020USD ($)loan	Jun. 30, 2019USD ($)	Jun. 30, 2020USD ($)loan	Jun. 30, 2019USD ($)	Dec. 31, 2019USD ($)	Dec. 31, 2018USD ($)
Financing Receivable, Troubled Debt Restructuring [Line Items]
Interest receivable		$ 10,171		$ 10,171		$ 6,897
Non-real estate loans		451,968		451,968		362,850
Allowance for credit losses on non-real estate loans receivable		78,133		78,133		25,996
Provision for loan losses	$ 18,690	1,422	$ 0	8,494	$ 18,690
Allowance for credit losses		$ 76,695	68,372	$ 76,695	68,372
Number of real estate loans on non-accrual status | loan		41		41
Carrying value of nonaccrual status		$ 10,716	$ 2,534	$ 10,716	$ 2,534	$ 2,534	$ 2,567
Non-real estate loans receivable
Financing Receivable, Troubled Debt Restructuring [Line Items]
Non-real estate loans		86,411		86,411
Allowance for credit losses on non-real estate loans receivable		$ 42,376		42,376
Provision for loan losses				6,898
Real estate loan receivable
Financing Receivable, Troubled Debt Restructuring [Line Items]
Provision for loan losses				$ 1,303

Loans Receivable - Summary of R

Loans Receivable - Summary of Real Estate Loans Receivable (Details) - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019		Jun. 30, 2019	Dec. 31, 2018
Accounts, Notes, Loans and Financing Receivable [Line Items]
Loan Carrying Value	$ 680,691
Allowance for credit losses on real estate loans receivable	(81,985)	$ (68,372)		$ (68,372)	$ (68,372)
Real estate loans receivable, net of credit allowance	224,871	270,382	[1]
Non-real estate loans	451,968	362,850
Allowance for credit losses on non-real estate loans receivable	(78,133)	(25,996)
Non real estate loans receivable, net of allowance	373,835	336,854
Total loans receivable, net of credit allowance	598,706	607,236
Mortgage loans
Accounts, Notes, Loans and Financing Receivable [Line Items]
Loan Carrying Value	102,275	188,062
Other real estate loans
Accounts, Notes, Loans and Financing Receivable [Line Items]
Loan Carrying Value	126,448	124,696
Allowance for credit losses on real estate loans receivable
Accounts, Notes, Loans and Financing Receivable [Line Items]
Allowance for credit losses on real estate loans receivable	$ (3,852)	$ (42,376)
[1]	The consolidated balance sheet at December 31, 2019 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by U.S. generally accepted accounting principles for complete financial statements.

Loans Receivable - Summary of_2

Loans Receivable - Summary of Real Estate Loan Activity (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019
Advances on loans receivable:
Net cash advances on loans receivable	$ 19,538	$ 65,422
Receipts on loans receivable:
Net cash receipts on loans receivable	12,796	8,660
Seniors Housing Operating
Advances on loans receivable:
Investments in new loans	2,477	30,000
Draws on existing loans	17,061	35,422
Net cash advances on loans receivable	19,538	65,422
Receipts on loans receivable:
Loan payoffs	0	4,384
Principal payments on loans	12,796	4,276
Net cash receipts on loans receivable	12,796	8,660
Net cash advances (receipts) on loans receivable	$ 6,742	$ 56,762

Loans Receivable - Collective P

Loans Receivable - Collective Pool Basis (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2020USD ($)loan	Dec. 31, 2019USD ($)	Jun. 30, 2019USD ($)	Dec. 31, 2018USD ($)
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan Carrying Value	$ 680,691
Allowance for Credit Loss	(81,985)	$ (68,372)	$ (68,372)	$ (68,372)
Real estate loans receivable, net of credit allowance	$ 598,706
No. of Loans | loan	41
Accrued expenses and other liabilities
Financing Receivable, Allowance for Credit Loss [Line Items]
Deferred gains	$ 62,819
Deteriorated loans
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan Carrying Value	186,584
Allowance for Credit Loss	(76,695)
Real estate loans receivable, net of credit allowance	$ 109,889
No. of Loans | loan	5
Collective loan pool
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan Carrying Value	$ 128,447
Allowance for Credit Loss	(1,866)
Real estate loans receivable, net of credit allowance	$ 126,581
No. of Loans | loan	15
Collective loan pool
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan Carrying Value	$ 184,620
Allowance for Credit Loss	(1,572)
Real estate loans receivable, net of credit allowance	$ 183,048
No. of Loans | loan	6
Collective loan pool
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan Carrying Value	$ 119,662
Allowance for Credit Loss	(999)
Real estate loans receivable, net of credit allowance	$ 118,663
No. of Loans | loan	7
Collective loan pool
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan Carrying Value	$ 15,399
Allowance for Credit Loss	(224)
Real estate loans receivable, net of credit allowance	$ 15,175
No. of Loans | loan	1
Collective loan pool
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan Carrying Value	$ 45,979
Allowance for Credit Loss	(629)
Real estate loans receivable, net of credit allowance	$ 45,350
No. of Loans | loan	7

Loans Receivable - Credit Loss

Loans Receivable - Credit Loss Roll Forward (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019
Financing Receivable, Allowance for Credit Loss [Roll Forward]
Balance at beginning of period	$ 68,372	$ 68,372
Provision for loan losses	8,494	18,690
Loan write-offs	0	(18,690)
Foreign currency translation	(93)	0
Balance at end of period	$ 81,985	68,372
Accounting Standards Update [Extensible List]	us-gaap:AccountingStandardsUpdate201613Member
Accounting Standards Update 2016-13 | Cumulative effect, period of adoption, adjustment
Financing Receivable, Allowance for Credit Loss [Roll Forward]
Balance at beginning of period	$ 5,212	$ 0

Loans Receivable - Summary of I

Loans Receivable - Summary of Impaired Loans (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Dec. 31, 2019	Dec. 31, 2018
Receivables [Abstract]
Balance of impaired loans at end of period	$ 186,584	$ 188,068
Allowance for credit losses	(76,695)	(68,372)
Balance of deteriorated loans not reserved	109,889	119,696
Interest recognized on impaired loans	7,912	7,964
Carrying value of nonaccrual status	$ 10,716	$ 2,534	$ 2,534	$ 2,567

Investments in Unconsolidated_3

Investments in Unconsolidated Entities - Summary of Investments in Unconsolidated Entities (Details) - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated entities	$ 786,921	$ 583,423
Seniors Housing Operating
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated entities	$ 568,381	463,741
Seniors Housing Operating | Minimum
Schedule of Equity Method Investments [Line Items]
Percentage ownership	10.00%
Seniors Housing Operating | Maximum
Schedule of Equity Method Investments [Line Items]
Percentage ownership	50.00%
Triple-net
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated entities	$ 7,172	7,740
Triple-net | Minimum
Schedule of Equity Method Investments [Line Items]
Percentage ownership	10.00%
Triple-net | Maximum
Schedule of Equity Method Investments [Line Items]
Percentage ownership	25.00%
Outpatient Medical
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated entities	$ 211,368	$ 111,942
Outpatient Medical | Minimum
Schedule of Equity Method Investments [Line Items]
Percentage ownership	15.00%
Outpatient Medical | Maximum
Schedule of Equity Method Investments [Line Items]
Percentage ownership	50.00%

Investments in Unconsolidated_4

Investments in Unconsolidated Entities - Narrative (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2020USD ($)property
Schedule of Equity Method Investments [Line Items]
Aggregate unamortized basis difference of joint venture investments	$ 112,486
Total loans made	250,215
Expected additional funding for investments	$ 212,306
Not Primary Beneficiary
Schedule of Equity Method Investments [Line Items]
Number of properties | property	8

Credit Concentration (Details)

Credit Concentration (Details) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020USD ($)property	Jun. 30, 2019USD ($)	Jun. 30, 2020USD ($)property	Jun. 30, 2019USD ($)	Dec. 31, 2019
Concentration Risk [Line Items]
Total NOI	$ 527,711	$ 618,979	$ 1,104,532	$ 1,220,417
Percentage total investments with top five customers					37.00%
Net operating income
Concentration Risk [Line Items]
Number of Properties | property	1,526		1,526
Total NOI			$ 1,104,532
Percent of NOI			100.00%
Net operating income | Sunrise Senior Living
Concentration Risk [Line Items]
Number of Properties | property	165		165
Total NOI			$ 134,872
Percent of NOI			12.00%
Net operating income | ProMedica
Concentration Risk [Line Items]
Number of Properties | property	215		215
Total NOI			$ 106,530
Percent of NOI			10.00%
Net operating income | Genesis Healthcare
Concentration Risk [Line Items]
Number of Properties | property	52		52
Total NOI			$ 58,831
Percent of NOI			5.00%
Net operating income | Revera
Concentration Risk [Line Items]
Number of Properties | property	94		94
Total NOI			$ 57,268
Percent of NOI			5.00%
Net operating income | Avery Healthcare
Concentration Risk [Line Items]
Number of Properties | property	59		59
Total NOI			$ 37,298
Percent of NOI			3.00%
Net operating income | Remaining portfolio
Concentration Risk [Line Items]
Number of Properties | property	941		941
Total NOI			$ 709,733
Percent of NOI			65.00%

Borrowings Under Credit Facil_3

Borrowings Under Credit Facilities and Commercial Paper Program - Narrative (Details)	1 Months Ended	6 Months Ended
	Jan. 31, 2019USD ($)	Jun. 30, 2020USD ($)bankterm	Dec. 31, 2019USD ($)	[1]
Line of Credit Facility [Line Items]
Number of banks in consortium | bank		31
Borrowings outstanding		$ 0	$ 1,587,597,000
Available to borrow in alternate currencies		$ 1,000,000,000
Facility fee		0.15%
LIBOR
Line of Credit Facility [Line Items]
Debt instrument, basis spread on variable rate		0.825%
Accordion feature
Line of Credit Facility [Line Items]
Unsecured line of credit arrangement		$ 1,000,000,000
Unsecured revolving credit facility
Line of Credit Facility [Line Items]
Unsecured line of credit arrangement		$ 3,000,000,000
Number of successive terms | term		2
Successive term		6 months
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
Term credit facility, CAD denominated | Accordion feature
Line of Credit Facility [Line Items]
Unsecured line of credit arrangement		$ 250,000,000
Commercial paper note program
Line of Credit Facility [Line Items]
Unsecured line of credit arrangement	$ 1,000,000,000
Commercial paper note program | Maximum
Line of Credit Facility [Line Items]
Debt instrument, term	397 days
[1]	The consolidated balance sheet at December 31, 2019 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by U.S. generally accepted accounting principles for complete financial statements.

Borrowings Under Credit Facil_4

Borrowings Under Credit Facilities and Commercial Paper Program - Aggregate Borrowings Under Unsecured Revolving Credit Facility and Commercial Paper (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019	Mar. 31, 2020	Dec. 31, 2019	Mar. 31, 2019	Dec. 31, 2018
Debt Disclosure [Abstract]
Balance outstanding at quarter end					$ 0	$ 0	$ 1,870,000	$ 1,870,000
Maximum amount outstanding at any month end	$ 685,000	$ 2,880,000	$ 2,100,000	$ 2,880,000
Average amount outstanding (total of daily principal balances divided by days in period)	$ 405,165	$ 1,807,631	$ 999,490	$ 1,301,883
Weighted average interest rate (actual interest expense divided by average borrowings outstanding)	1.57%	3.08%	2.08%	3.11%

Senior Unsecured Notes and Se_3

Senior Unsecured Notes and Secured Debt - Annual Principal Payments Due on Debt Obligations (Details)	6 Months Ended
	Jun. 30, 2020USD ($)	Jun. 30, 2019USD ($)	Jun. 30, 2020CAD ($)	Jun. 30, 2020GBP (£)	Dec. 31, 2019USD ($)	Dec. 31, 2018USD ($)
Annual principal payments due
2020	$ 257,139,000
2021	427,969,000
2022	1,454,119,000
2023	2,111,009,000
2024	1,526,366,000
Thereafter	8,764,098,000
Totals	$ 14,540,700,000
LIBOR
Annual principal payments due
Debt instrument, basis spread on variable rate	0.825%
Senior unsecured notes
Annual principal payments due
2020	$ 0
2021	0
2022	1,010,000,000
2023	1,783,621,000
2024	1,350,000,000
Thereafter	7,769,090,000
Totals	11,912,711,000	$ 10,711,556,000			$ 10,427,562,000	$ 9,699,984,000
Debt extinguished	$ 0	1,050,000,000
Senior unsecured notes | Minimum
Annual principal payments due
Interest rate	0.88%		0.88%	0.88%
Senior unsecured notes | Maximum
Annual principal payments due
Interest rate	6.50%		6.50%	6.50%
Senior unsecured notes | Unsecured term credit facility
Annual principal payments due
Face amount	$ 1,000,000,000
Senior unsecured notes | Unsecured term credit facility | LIBOR
Annual principal payments due
Debt instrument, basis spread on variable rate	1.20%
Interest rate at period end	1.38%		1.38%	1.38%
Senior unsecured notes | Canadian-denominated unsecured term credit facility
Annual principal payments due
Face amount	$ 183,621,000		$ 250,000,000
Senior unsecured notes | Canadian-denominated unsecured term credit facility | Canadian dealer offered rate
Annual principal payments due
Debt instrument, basis spread on variable rate	0.90%
Interest rate at period end	1.42%		1.42%	1.42%
Senior unsecured notes | Unsecured term credit facility
Annual principal payments due
Face amount	$ 500,000,000
Senior unsecured notes | Unsecured term credit facility | LIBOR
Annual principal payments due
Debt instrument, basis spread on variable rate	0.90%
Interest rate at period end	1.09%		1.09%	1.09%
Senior unsecured notes | 2.95% Senior unsecured notes due 2023
Annual principal payments due
Interest rate	2.95%		2.95%	2.95%
Face amount	$ 220,345,000		$ 300,000,000
Senior unsecured notes | Senior unsecured notes due 2028
Annual principal payments due
Interest rate	4.80%		4.80%	4.80%
Face amount	$ 680,295,000			£ 550,000,000
Senior unsecured notes | 4.50% Senior unsecured notes due 2034
Annual principal payments due
Interest rate	4.50%		4.50%	4.50%
Face amount	$ 618,450,000			£ 500,000,000
Secured debt
Annual principal payments due
2020	257,139,000
2021	427,969,000
2022	444,119,000
2023	327,388,000
2024	176,366,000
Thereafter	995,008,000
Totals	2,627,989,000	2,689,982,000			$ 2,993,342,000	$ 2,485,711,000
Carrying values of properties securing the debt	5,774,000
Debt extinguished	$ 314,631,000	$ 151,473,000
Secured debt | Minimum
Annual principal payments due
Interest rate	0.12%		0.12%	0.12%
Secured debt | Maximum
Annual principal payments due
Interest rate	12.00%		12.00%	12.00%

Senior Unsecured Notes and Se_4

Senior Unsecured Notes and Secured Debt - Summary of Principal Activity (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2020USD ($)	Jun. 30, 2019USD ($)
Amount
Beginning balance
Debt issued	$ 1,588,549	$ 2,036,964
Debt issued	44,921	295,969
Ending balance	14,540,700
Senior unsecured notes
Amount
Beginning balance	10,427,562	9,699,984
Debt issued	1,600,000	2,050,000
Debt extinguished	0	(1,050,000)
Foreign currency	(114,851)	11,572
Ending balance	$ 11,912,711	$ 10,711,556
Weighted Avg. Interest Rate
Beginning balance	4.03%	4.48%
Debt issued	0.0189	0.0358
Debt extinguished	0	0.0498
Foreign currency	0.0430	0.0352
Ending balance	3.65%	4.24%
Secured debt
Amount
Beginning balance	$ 2,993,342	$ 2,485,711
Debt issued	44,921	295,969
Debt assumed	0	42,000
Debt extinguished	(314,631)	(151,473)
Principal payments	(30,709)	(27,227)
Foreign currency	(64,934)	45,002
Ending balance	$ 2,627,989	$ 2,689,982
Weighted Avg. Interest Rate
Beginning balance	3.63%	3.90%
Debt issued	0.0258	0.0352
Debt assumed	0	0.0462
Debt extinguished	0.0294	0.0442
Principal payments	0.0355	0.0374
Foreign currency	0.0313	0.0337
Ending balance	3.09%	3.84%

Senior Unsecured Notes and Se_5

Senior Unsecured Notes and Secured Debt - Narrative (Details) - USD ($)	Jul. 02, 2020	Jul. 01, 2020	Apr. 30, 2020	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Debt Instrument [Line Items]
Loss (gain) on extinguishment of debt, net				$ 249,000	$ 0	$ 249,000	$ 15,719,000
Debt issued						$ 1,588,549,000	2,036,964,000
Subsequent event
Debt Instrument [Line Items]
Loss (gain) on extinguishment of debt, net		$ 31,940,000
LIBOR
Debt Instrument [Line Items]
Debt instrument, basis spread on variable rate						0.825%
Senior unsecured notes
Debt Instrument [Line Items]
Debt extinguished						$ 0	1,050,000,000
Debt issued						1,600,000,000	$ 2,050,000,000
Senior unsecured notes | Term credit facility
Debt Instrument [Line Items]
Face amount			$ 1,000,000,000
Debt instrument, term			2 years
Senior unsecured notes | Term credit facility | Subsequent event
Debt Instrument [Line Items]
Debt extinguished	$ 140,000,000
Senior unsecured notes | Term credit facility | LIBOR
Debt Instrument [Line Items]
Debt instrument, basis spread on variable rate			120.00%
Senior unsecured notes | 2.75% senior unsecured notes
Debt Instrument [Line Items]
Face amount				$ 600,000,000		$ 600,000,000
Interest rate			2.75%
Senior unsecured notes | 3.75% senior unsecured notes | Subsequent event
Debt Instrument [Line Items]
Interest rate		3.75%
Debt extinguished		$ 160,872,000
Senior unsecured notes | 3.95% senior unsecured notes | Subsequent event
Debt Instrument [Line Items]
Interest rate		3.95%
Debt extinguished		$ 265,376,000

Derivative Instruments - Narrat

Derivative Instruments - Narrative (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Proceeds from hedge	$ 3,485	$ 6,716

Derivative Instruments - Notion

Derivative Instruments - Notional Amount of Derivatives and Other Financial Instruments (Details) £ in Thousands, $ in Thousands, $ in Thousands	6 Months Ended		12 Months Ended
	Jun. 30, 2020CAD ($)	Jun. 30, 2020GBP (£)	Dec. 31, 2019CAD ($)	Dec. 31, 2019GBP (£)	Jun. 30, 2020GBP (£)	Jun. 30, 2020USD ($)	Dec. 31, 2019GBP (£)	Dec. 31, 2019USD ($)
Denominated in Canadian Dollars | Designated as Hedging Instrument | Net Investment Hedging
Derivatives, Fair Value [Line Items]
Derivative asset	$ 650,000		$ 725,000
Net investment hedges	250,000		250,000
Denominated in Canadian Dollars | Derivative Instruments Not Designated | Purchase Contracts
Derivatives, Fair Value [Line Items]
Derivative asset	$ 80,000		$ 0
Denominated in Pounds Sterling | Designated as Hedging Instrument | Net Investment Hedging
Derivatives, Fair Value [Line Items]
Derivative asset | £					£ 1,340,708		£ 1,340,708
Net investment hedges | £		£ 1,050,000		£ 1,050,000
Denominated in Pounds Sterling | Derivative Instruments Not Designated | Purchase Contracts
Derivatives, Fair Value [Line Items]
Derivative asset | £					0		125,000
Denominated in Pounds Sterling | Derivative Instruments Not Designated | Sales Contracts
Derivatives, Fair Value [Line Items]
Derivative liability | £					£ 0		£ (125,000)
Denominated in U.S Dollars | Designated as Hedging Instrument | Cash Flow Hedging
Derivatives, Fair Value [Line Items]
Derivative asset						$ 1,188,250		$ 1,188,250
Denominated in U.S Dollars | Derivative Instruments Not Designated
Derivatives, Fair Value [Line Items]
Derivative asset						$ 112,726		$ 405,819

Derivative Instruments - Impact

Derivative Instruments - Impact of Derivative Instruments on the Consolidated Statements of Comprehensive Income (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Derivative [Line Items]
Gain (loss) on derivative instruments designated as hedges recognized in income	$ (1,434)	$ (1,913)	$ (9,085)	$ 574
Gain (loss) on derivative and financial instruments designated as hedges recognized in OCI	(27,171)	100,407	231,941	12,725
Foreign Exchange Contract
Derivative [Line Items]
Gain (loss) on derivative and financial instruments designated as hedges recognized in OCI		100,407		12,725
Designated as Hedging Instrument
Derivative [Line Items]
Gain (loss) on derivative instruments designated as hedges recognized in income	4,106	7,134	10,751	12,467
Derivative Instruments Not Designated
Derivative [Line Items]
Gain (loss) on derivative instruments designated as hedges recognized in income	$ (1,953)	$ (1,128)	$ (2,048)	$ (2,666)

Commitments and Contingencies (

Commitments and Contingencies (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2020USD ($)obligation	Dec. 31, 2019USD ($)	[1]
Commitments and Contingencies Disclosure [Abstract]
Number of outstanding credit obligations | obligation	8
Letter of credit obligation	$ 37,014
Outstanding construction financings for leased properties	411,700	$ 507,931
Additional financing to complete construction	332,074
Total loans made	250,215
Expected additional funding for investments	212,306
Total contingent purchase obligations	$ 19,442
[1]	The consolidated balance sheet at December 31, 2019 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by U.S. generally accepted accounting principles for complete financial statements.

Stockholders' Equity - Summary

Stockholders' Equity - Summary of Stockholders' Equity Capital Accounts (Details) - shares	Jun. 30, 2020	Dec. 31, 2019	Jun. 30, 2019	Dec. 31, 2018
Preferred Stock:
Authorized shares	50,000,000	50,000,000
Issued shares	0	0
Outstanding shares	0	0	0	14,369,965
Common Stock, $1.00 par value:
Authorized shares	700,000,000	700,000,000
Issued shares	418,869,381	411,550,857
Outstanding shares	417,302,448	410,256,615

Stockholders' Equity - Preferre

Stockholders' Equity - Preferred Stock (Details) - shares	6 Months Ended		12 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Dec. 31, 2019	Dec. 31, 2018
Shares
Beginning balance (in shares)	0	14,369,965	14,369,965
Shares converted (in shares)	0	(14,369,965)
Ending balance (in shares)	0	0	0	14,369,965
Weighted Avg. Dividend Rate
Balance	0.00%	0.00%	0.00%	6.50%
Shares converted	0.00%	6.50%

Stockholders' Equity - Addition

Stockholders' Equity - Additional Information (Details) - USD ($)	6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	May 01, 2020	Feb. 28, 2019
Class of Stock [Line Items]
Equity shelf plan issuances	$ 576,196,000	$ 326,362,000
Equity Shelf Program
Class of Stock [Line Items]
Share conversion		0.8857
Authorized amount				$ 1,500,000,000
Remaining authorized amount	$ 499,341,000
Repurchase program
Class of Stock [Line Items]
Number of shares authorized to be repurchased (in shares)			1,000,000,000
Number of shares repurchased (in shares)	201,947
Average price repurchased (in dollars per share)	$ 37.89

Stockholders' Equity - Common S

Stockholders' Equity - Common Stock (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2020USD ($)shares	Jun. 30, 2019USD ($)shares
Shares Issued
Dividend reinvestment plan issuances (in shares) | shares	264,153	4,304,712
Option exercises (in shares) | shares	251	10,736
Equity shelf program issuances (in shares) | shares	6,799,978	4,384,045
Preferred stock conversions (in shares) | shares		12,712,452
Stock incentive plans, net of forfeitures (in shares) | shares	183,398	167,565
Totals (in shares) | shares	7,247,780	21,579,510
Average Price
Dividend reinvestment plan issuances (in dollars per share)	72.33	75.20
Option exercises (in dollars per share)	47.81	51.32
Equity shelf plan issuances (in dollars per share)	86.48	74.97
Gross Proceeds
Dividend reinvestment plan issuances	$ 19,105	$ 323,724
Option exercises	12	551
Equity shelf plan issuances	588,072	328,665
Totals	607,189	652,940
Net Proceeds
Dividend reinvestment plan issuances	19,105	320,243
Option exercises	12	551
Equity shelf plan issuances	576,196	326,362
Totals	$ 595,313	$ 647,156

Stockholders' Equity - Dividend

Stockholders' Equity - Dividends (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Per Share
Common Stock (in dollars per share)	$ 0.61	$ 0.87	$ 1.48	$ 1.74
Amount
Common stock			$ 610,847	$ 698,437

Stockholders' Equity - Accumula

Stockholders' Equity - Accumulated Other Comprehensive Income (Details) - USD ($) $ in Thousands	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2019		Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018
Summary of accumulated other comprehensive income/(loss) [Line Items]
Total accumulated other comprehensive income (loss)	$ 16,936,527	$ 17,066,337	$ 16,506,627	[1]	$ 15,969,572	$ 16,047,831	$ 15,586,599
Foreign currency translation
Summary of accumulated other comprehensive income/(loss) [Line Items]
Total accumulated other comprehensive income (loss)	(956,454)		(719,814)
Derivative and financial instruments designated as hedges
Summary of accumulated other comprehensive income/(loss) [Line Items]
Total accumulated other comprehensive income (loss)	839,598		607,657
Total accumulated other comprehensive income (loss)
Summary of accumulated other comprehensive income/(loss) [Line Items]
Total accumulated other comprehensive income (loss)	$ (116,856)	$ (96,213)	$ (112,157)		$ (100,622)	$ (144,618)	$ (129,769)
[1]	The consolidated balance sheet at December 31, 2019 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by U.S. generally accepted accounting principles for complete financial statements.

Stock Incentive Plans (Details)

Stock Incentive Plans (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of common stock authorized (in shares)	10,000,000		10,000,000
Option expiration period			10 years
Stock-based compensation expense	$ 7,290	$ 7,662	$ 14,373	$ 15,192
Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period			3 years
Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period			5 years

Earnings Per Share (Details)

Earnings Per Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands		3 Months Ended		6 Months Ended
		Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Earnings Per Share [Abstract]
Numerator for basic and diluted earnings per share - net income (loss) attributable to common stockholders		$ 179,246	$ 137,762	$ 489,530	$ 418,232
Adjustment for net income (loss) attributable to OP units		(1,366)	35	(2,754)	88
Numerator for diluted earnings per share		$ 177,880	$ 137,797	$ 486,776	$ 418,320
Denominator for basic earnings per share - weighted average shares (in shares)		417,084	404,607	413,696	398,073
Effect of dilutive securities:
Employee stock options (in shares)		0	0	0	1
Non-vested restricted shares (in shares)		619	955	661	911
Redeemable op units (in shares)		1,396	1,096	1,396	1,096
Employee stock purchase program (in shares)		22	15	22	15
Dilutive potential common shares (in shares)		2,037	2,066	2,079	2,023
Denominator for diluted earnings per share - adjusted weighted average shares (in shares)		419,121	406,673	415,775	400,096
Basic earnings per share (in dollars per share)		$ 0.43	$ 0.34	$ 1.18	$ 1.05
Diluted earnings per share (in dollars per share)	[1]	$ 0.42	$ 0.34	$ 1.17	$ 1.05
[1]	Includes adjustment to the numerator for income (loss) attributable to OP unitholders.

Disclosure about Fair Value o_3

Disclosure about Fair Value of Financial Instruments - Carrying Amounts and Estimated Fair Values of Financial Instruments (Details) - USD ($) $ in Thousands		Jun. 30, 2020	Dec. 31, 2019
Financial assets:
Equity securities		$ 6,600
Restricted cash	[1]		$ 100,849
Carrying Amount
Financial assets:
Equity securities		6,600	15,685
Cash and cash equivalents		1,678,770	284,917
Restricted cash		147,473	100,849
Foreign currency forward contracts, interest rate swaps and cross currency swaps		165,968	18,554
Financial liabilities:
Borrowings under unsecured credit facility and commercial paper program		0	1,587,597
Senior unsecured notes		11,815,972	10,336,513
Secured debt		2,619,678	2,990,962
Foreign currency forward contracts, interest rate swaps and cross currency swaps		64,077	53,601
Redeemable OP unitholder interests		97,179	121,440
Carrying Amount | Mortgage loans receivable
Financial assets:
Loans receivable		100,782	145,686
Carrying Amount | Other real estate loans receivable
Financial assets:
Loans receivable		124,089	124,696
Carrying Amount | Non-real estate loans receivable
Financial assets:
Loans receivable		373,835	336,854
Fair Value
Financial assets:
Equity securities		6,600	15,685
Cash and cash equivalents		1,678,770	284,917
Restricted cash		147,473	100,849
Foreign currency forward contracts, interest rate swaps and cross currency swaps		165,968	18,554
Financial liabilities:
Borrowings under unsecured credit facility and commercial paper program		0	1,587,597
Senior unsecured notes		12,890,274	11,400,571
Secured debt		2,668,133	3,041,893
Foreign currency forward contracts, interest rate swaps and cross currency swaps		64,077	53,601
Redeemable OP unitholder interests		92,373	121,440
Fair Value | Mortgage loans receivable
Financial assets:
Loans receivable		107,407	150,217
Fair Value | Other real estate loans receivable
Financial assets:
Loans receivable		124,291	128,512
Fair Value | Non-real estate loans receivable
Financial assets:
Loans receivable		$ 419,325	$ 379,239
[1]	The consolidated balance sheet at December 31, 2019 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by U.S. generally accepted accounting principles for complete financial statements.

Disclosure about Fair Value o_4

Disclosure about Fair Value of Financial Instruments - Summary of Items Measured at Fair Value on a Recurring Basis (Details) $ in Thousands	Jun. 30, 2020USD ($)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Equity securities	$ 6,600
Foreign currency forward contracts, interest rate swaps and cross currency swaps, net asset (liability)	101,891
Totals	108,491
Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Equity securities	6,600
Foreign currency forward contracts, interest rate swaps and cross currency swaps, net asset (liability)	0
Totals	6,600
Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Equity securities	0
Foreign currency forward contracts, interest rate swaps and cross currency swaps, net asset (liability)	101,891
Totals	101,891
Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Equity securities	0
Foreign currency forward contracts, interest rate swaps and cross currency swaps, net asset (liability)	0
Totals	$ 0

Segment Reporting - Summary Inf

Segment Reporting - Summary Information for Reportable Segments (Details) $ in Thousands	1 Months Ended	3 Months Ended			6 Months Ended
	Mar. 31, 2019USD ($)	Jun. 30, 2020USD ($)	Mar. 31, 2020USD ($)	Jun. 30, 2019USD ($)	Jun. 30, 2020USD ($)segment	Jun. 30, 2019USD ($)	Dec. 31, 2019USD ($)	[1]
Segment Reporting [Abstract]
Number of operating segments | segment					3
Segment Reporting Information [Line Items]
Rental income		$ 396,305		$ 385,586	$ 786,265	$ 766,670
Total revenues		1,188,475		1,320,106	2,447,077	2,592,351
Property operating expenses		660,764		701,127	1,342,545	1,371,934
Consolidated net operating income		527,711		618,979	1,104,532	1,220,417
Depreciation and amortization		265,371		248,052	540,172	491,984
Interest expense		126,357		141,336	268,364	286,568
General and administrative expenses		34,062		33,741	69,543	69,023
Loss (gain) on derivatives and financial instruments, net		1,434		1,913	9,085	(574)
Loss (gain) on extinguishment of debt, net		249		0	249	15,719
Provision for loan losses	$ 18,690	1,422		0	8,494	18,690
Impairment of assets		75,151		9,939	102,978	9,939
Other expenses		19,411		21,628	25,703	30,384
Income (loss) from continuing operations before income taxes and other items		4,254		162,370	79,944	298,684
Income tax (expense) benefit		(2,233)		(1,599)	(7,675)	(3,821)
Income (loss) from unconsolidated entities		1,332		(9,049)	(2,360)	(18,248)
Gain (loss) on real estate dispositions, net		155,863		(1,682)	418,687	165,727
Income (loss) from continuing operations		159,216		150,040	488,596	442,342
Net income (loss)		159,216		150,040	488,596	442,342
Total assets		33,162,652			33,162,652		$ 33,380,751
Straight line rent adjustment			$ 32,268
Resident fees and services
Segment Reporting Information [Line Items]
Revenue from contract with customer		769,560		914,085	1,619,532	1,782,370
Interest income
Segment Reporting Information [Line Items]
Revenue from contract with customer		16,069		17,356	31,310	32,475
Other income
Segment Reporting Information [Line Items]
Revenue from contract with customer		6,541		3,079	9,970	10,836
Operating Segments | Seniors Housing Operating
Segment Reporting Information [Line Items]
Rental income		0		0	0	0
Total revenues		773,650		915,529	1,624,778	1,787,915
Property operating expenses		595,513		637,317	1,203,384	1,245,003
Consolidated net operating income		178,137		278,212	421,394	542,912
Depreciation and amortization		139,163		136,551	285,937	268,126
Interest expense		14,029		17,572	30,463	35,823
General and administrative expenses		0		0	0	0
Loss (gain) on derivatives and financial instruments, net		0		0	0	0
Loss (gain) on extinguishment of debt, net		(492)			(492)	0
Provision for loan losses		0			0	0
Impairment of assets		75,151		0	78,646	0
Other expenses		5,251		11,857	8,240	14,803
Income (loss) from continuing operations before income taxes and other items		(54,965)		112,232	18,600	224,160
Income tax (expense) benefit		0		0	0	0
Income (loss) from unconsolidated entities		(6,787)		(17,453)	(17,811)	(34,033)
Gain (loss) on real estate dispositions, net		14,465		(550)	14,316	(710)
Income (loss) from continuing operations		(47,287)		94,229	15,105	189,417
Net income (loss)		(47,287)		94,229	15,105	189,417
Total assets		14,915,588			14,915,588
Operating Segments | Seniors Housing Operating | Resident fees and services
Segment Reporting Information [Line Items]
Revenue from contract with customer		769,560		914,085	1,619,532	1,782,370
Operating Segments | Seniors Housing Operating | Interest income
Segment Reporting Information [Line Items]
Revenue from contract with customer		88		0	192	0
Operating Segments | Seniors Housing Operating | Other income
Segment Reporting Information [Line Items]
Revenue from contract with customer		4,002		1,444	5,054	5,545
Operating Segments | Triple-net
Segment Reporting Information [Line Items]
Rental income		217,492		222,362	408,877	454,394
Total revenues		233,619		240,758	441,348	488,999
Property operating expenses		13,563		12,823	26,865	27,778
Consolidated net operating income		220,056		227,935	414,483	461,221
Depreciation and amortization		58,138		56,056	115,832	117,404
Interest expense		2,746		3,225	5,598	6,665
General and administrative expenses		0		0	0	0
Loss (gain) on derivatives and financial instruments, net		1,434		1,913	9,085	(574)
Loss (gain) on extinguishment of debt, net		0			0	0
Provision for loan losses		1,451			8,523	18,690
Impairment of assets		0		(940)	24,332	(940)
Other expenses		3,500		5,560	4,013	8,589
Income (loss) from continuing operations before income taxes and other items		152,787		162,121	247,100	311,387
Income tax (expense) benefit		0		0	0	0
Income (loss) from unconsolidated entities		6,403		6,578	12,199	12,236
Gain (loss) on real estate dispositions, net		2,148		(1,130)	51,785	166,444
Income (loss) from continuing operations		161,338		167,569	311,084	490,067
Net income (loss)		161,338		167,569	311,084	490,067
Total assets		9,189,707			9,189,707
Operating Segments | Triple-net | Resident fees and services
Segment Reporting Information [Line Items]
Revenue from contract with customer		0		0	0	0
Operating Segments | Triple-net | Interest income
Segment Reporting Information [Line Items]
Revenue from contract with customer		15,520		17,118	30,191	32,064
Operating Segments | Triple-net | Other income
Segment Reporting Information [Line Items]
Revenue from contract with customer		607		1,278	2,280	2,541
Operating Segments | Outpatient Medical
Segment Reporting Information [Line Items]
Rental income		178,813		163,224	377,388	312,276
Total revenues		180,831		163,365	380,160	312,826
Property operating expenses		51,688		50,987	112,296	99,153
Consolidated net operating income		129,143		112,378	267,864	213,673
Depreciation and amortization		68,070		55,445	138,403	106,454
Interest expense		4,326		3,386	9,134	6,734
General and administrative expenses		0		0	0	0
Loss (gain) on derivatives and financial instruments, net		0		0	0	0
Loss (gain) on extinguishment of debt, net		741			741	0
Provision for loan losses		(29)			(29)	0
Impairment of assets		0		10,879	0	10,879
Other expenses		6,456		(4)	7,463	750
Income (loss) from continuing operations before income taxes and other items		49,579		42,672	112,152	88,856
Income tax (expense) benefit		0		0	0	0
Income (loss) from unconsolidated entities		1,716		1,826	3,252	3,549
Gain (loss) on real estate dispositions, net		139,250		(2)	352,586	(7)
Income (loss) from continuing operations		190,545		44,496	467,990	92,398
Net income (loss)		190,545		44,496	467,990	92,398
Total assets		7,434,364			7,434,364
Operating Segments | Outpatient Medical | Resident fees and services
Segment Reporting Information [Line Items]
Revenue from contract with customer		0		0	0	0
Operating Segments | Outpatient Medical | Interest income
Segment Reporting Information [Line Items]
Revenue from contract with customer		461		238	927	411
Operating Segments | Outpatient Medical | Other income
Segment Reporting Information [Line Items]
Revenue from contract with customer		1,557		(97)	1,845	139
Non-segment / Corporate
Segment Reporting Information [Line Items]
Rental income		0		0	0	0
Total revenues		375		454	791	2,611
Property operating expenses		0		0	0	0
Consolidated net operating income		375		454	791	2,611
Depreciation and amortization		0		0	0	0
Interest expense		105,256		117,153	223,169	237,346
General and administrative expenses		34,062		33,741	69,543	69,023
Loss (gain) on derivatives and financial instruments, net		0		0	0	0
Loss (gain) on extinguishment of debt, net		0			0	15,719
Provision for loan losses		0			0	0
Impairment of assets		0		0	0	0
Other expenses		4,204		4,215	5,987	6,242
Income (loss) from continuing operations before income taxes and other items		(143,147)		(154,655)	(297,908)	(325,719)
Income tax (expense) benefit		(2,233)		(1,599)	(7,675)	(3,821)
Income (loss) from unconsolidated entities		0		0	0	0
Gain (loss) on real estate dispositions, net		0		0	0	0
Income (loss) from continuing operations		(145,380)		(156,254)	(305,583)	(329,540)
Net income (loss)		(145,380)		(156,254)	(305,583)	(329,540)
Total assets		1,622,993			1,622,993
Non-segment / Corporate | Resident fees and services
Segment Reporting Information [Line Items]
Revenue from contract with customer		0		0	0	0
Non-segment / Corporate | Interest income
Segment Reporting Information [Line Items]
Revenue from contract with customer		0		0	0	0
Non-segment / Corporate | Other income
Segment Reporting Information [Line Items]
Revenue from contract with customer		$ 375		$ 454	$ 791	$ 2,611
[1]	The consolidated balance sheet at December 31, 2019 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by U.S. generally accepted accounting principles for complete financial statements.

Segment Reporting - Summary of

Segment Reporting - Summary of Geographic Information (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended		12 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019	Dec. 31, 2019
Revenues from External Customers and Long-Lived Assets [Line Items]
Total revenues	$ 1,188,475	$ 1,320,106	$ 2,447,077	$ 2,592,351
Total assets	33,162,652		33,162,652		$ 33,380,751	[1]
United States
Revenues from External Customers and Long-Lived Assets [Line Items]
Total revenues	973,772	1,092,376	2,001,553	2,136,042
Total assets	27,655,745		27,655,745		27,513,911
United Kingdom
Revenues from External Customers and Long-Lived Assets [Line Items]
Total revenues	109,437	112,647	227,319	225,065
Total assets	3,175,033		3,175,033		3,405,388
Canada
Revenues from External Customers and Long-Lived Assets [Line Items]
Total revenues	105,266	$ 115,083	218,205	$ 231,244
Total assets	$ 2,331,874		$ 2,331,874		$ 2,461,452
Revenue
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage	100.00%	100.00%	100.00%	100.00%
Revenue | United States
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage	81.90%	82.80%	81.80%	82.40%
Revenue | United Kingdom
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage	9.20%	8.50%	9.30%	8.70%
Revenue | Canada
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage	8.90%	8.70%	8.90%	8.90%
Assets
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage			100.00%		100.00%
Assets | United States
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage			83.40%		82.40%
Assets | United Kingdom
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage			9.60%		10.20%
Assets | Canada
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage			7.00%		7.40%
Resident fees and services | Revenue | United States
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage	77.00%
Resident fees and services | Revenue | United Kingdom
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage	10.00%
Resident fees and services | Revenue | Canada
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage	13.00%
[1]	The consolidated balance sheet at December 31, 2019 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by U.S. generally accepted accounting principles for complete financial statements.

Variable Interest Entities (Det

Variable Interest Entities (Details) - USD ($) $ in Thousands		Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2019		Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018
Assets:
Net real estate investments		$ 29,155,194		$ 31,119,271	[1]
Cash and cash equivalents	[1]			284,917
Receivables and other assets		861,257		757,748	[1]
Total Assets		33,162,652		33,380,751	[1]
Liabilities and equity:
Secured debt	[1]			2,990,962
Lease liabilities		447,424		473,693	[1]
Total equity		16,936,527	$ 17,066,337	16,506,627	[1]	$ 15,969,572	$ 16,047,831	$ 15,586,599
Total liabilities and equity		33,162,652		33,380,751	[1]
VIE, Primary Beneficiary
Assets:
Net real estate investments		457,107		960,093
Cash and cash equivalents		30,438		27,522
Receivables and other assets		12,596		14,586
Total Assets		500,141		1,002,201
Liabilities and equity:
Secured debt		166,567		460,117
Lease liabilities		1,326		1,326
Accrued expenses and other liabilities		14,810		22,215
Total equity		317,438		518,543
Total liabilities and equity		$ 500,141		$ 1,002,201
[1]	The consolidated balance sheet at December 31, 2019 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by U.S. generally accepted accounting principles for complete financial statements.