Welltower (WELL) 10-Q 29 Oct 20 2020 Q3 Quarterly report Financial data

Cover Page

Cover Page - shares	9 Months Ended
	Sep. 30, 2020	Oct. 23, 2020
Document Information [Line Items]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 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		417,304,860
Entity Central Index Key	0000766704
Amendment Flag	false
Document Fiscal Year Focus	2020
Document Fiscal Period Focus	Q3
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 ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Real property owned:
Land and land improvements	$ 3,386,072	$ 3,486,620
Buildings and improvements	27,782,471	29,163,305
Acquired lease intangibles	1,509,053	1,617,051
Real property held for sale, net of accumulated depreciation	362,886	1,253,008
Construction in progress	414,833	507,931
Less accumulated depreciation and amortization	(6,002,775)	(5,715,459)
Net real property owned	27,452,540	30,312,456
Right of use assets, net	480,861	536,433
Real estate loans receivable, net of credit allowance	414,706	270,382
Net real estate investments	28,348,107	31,119,271
Other assets:
Investments in unconsolidated entities	822,586	583,423
Goodwill	68,321	68,321
Cash and cash equivalents	1,603,740	284,917
Restricted cash	551,593	100,849
Straight-line rent receivable	334,203	466,222
Receivables and other assets	813,047	757,748
Total other assets	4,193,490	2,261,480
Total Assets	32,541,597	33,380,751
Liabilities:
Unsecured credit facility and commercial paper	0	1,587,597
Senior unsecured notes	11,321,573	10,336,513
Secured debt	2,459,659	2,990,962
Lease liabilities	427,842	473,693
Accrued expenses and other liabilities	1,041,368	1,009,482
Total liabilities	15,250,442	16,398,247
Redeemable noncontrolling interests	330,053	475,877
Equity:
Common stock	418,361	411,005
Capital in excess of par value	20,835,022	20,190,107
Treasury stock	(94,022)	(78,955)
Cumulative net income	8,163,869	7,353,966
Cumulative dividends	(13,088,891)	(12,223,534)
Accumulated other comprehensive income (loss)	(126,469)	(112,157)
Other equity	4	12
Total Welltower Inc. stockholders’ equity	16,107,874	15,540,444
Noncontrolling interests	853,228	966,183
Total equity	16,961,102	16,506,627
Total liabilities and equity	$ 32,541,597	$ 33,380,751

CONSOLIDATED STATEMENTS OF COMP

CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (UNAUDITED) - USD ($) shares in Thousands, $ in Thousands		3 Months Ended		9 Months Ended
		Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Revenues:
Rental income		$ 275,046	$ 412,147	$ 1,061,311	$ 1,178,817
Total revenues		1,036,874	1,266,133	3,483,951	3,858,484
Expenses:
Property operating expenses		634,717	655,588	1,977,262	2,027,522
Depreciation and amortization		255,532	272,445	795,704	764,429
Interest expense		124,851	137,343	393,215	423,911
General and administrative expenses		31,003	31,019	100,546	100,042
Loss (gain) on derivatives and financial instruments, net		1,395	1,244	10,480	670
Loss (gain) on extinguishment of debt, net		33,004	65,824	33,253	81,543
Provision for loan losses		2,857	0	11,351	18,690
Impairment of assets		23,313	18,096	126,291	28,035
Other expenses		11,544	6,186	37,247	36,570
Total expenses		1,118,216	1,187,745	3,485,349	3,481,412
Income (loss) from continuing operations before income taxes and other items		(81,342)	78,388	(1,398)	377,072
Income tax (expense) benefit		(2,003)	(3,968)	(9,678)	(7,789)
Income (loss) from unconsolidated entities		(5,981)	3,262	(8,341)	(14,986)
Gain (loss) on real estate dispositions, net		484,304	570,250	902,991	735,977
Income (loss) from continuing operations		394,978	647,932	883,574	1,090,274
Net income		394,978	647,932	883,574	1,090,274
Less: Net income (loss) attributable to noncontrolling interests	[1]	69,393	58,056	68,459	82,166
Net income (loss) attributable to common stockholders		$ 325,585	$ 589,876	$ 815,115	$ 1,008,108
Average number of common shares outstanding:
Basic (in shares)		417,027	405,023	414,822	400,441
Diluted (in shares)		418,987	406,891	416,860	402,412
Basic:
Income (loss) from continuing operations (in dollars per share)		$ 0.95	$ 1.60	$ 2.13	$ 2.72
Net income (loss) attributable to common stockholders (in dollars per share)		0.78	1.46	1.96	2.52
Diluted:
Income (loss) from continuing operations (in dollars per share)		0.94	1.59	2.12	2.71
Net income (loss) attributable to common stockholders (in dollars per share)	[2]	0.77	1.45	1.94	2.51
Dividends declared and paid per common share (in dollars per share)		$ 0.61	$ 0.87	$ 2.09	$ 2.61
Other comprehensive income (loss):
Foreign currency translation gain (loss)		$ 143,353	$ (100,837)	$ (109,209)	$ (76,241)
Gain (loss) on derivative and financial instruments designated as hedges recognized in OCI		(145,512)	78,947	86,429	91,672
Total other comprehensive income (loss)		(2,159)	(21,890)	(22,780)	15,431
Total comprehensive income (loss)		392,819	626,042	860,794	1,105,705
Less: Total comprehensive income (loss) attributable to noncontrolling interests	[1]	76,847	53,220	59,991	85,504
Total comprehensive income (loss) attributable to common stockholders		315,972	572,822	800,803	1,020,201
Resident fees and services
Revenues:
Revenue from contract with customer		740,956	834,121	2,360,488	2,616,491
Interest income
Revenues:
Revenue from contract with customer		16,750	15,637	48,060	48,112
Other income
Revenues:
Revenue from contract with customer		$ 4,122	$ 4,228	$ 14,092	$ 15,064
[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)	15,431
Balances at end of period at Sep. 30, 2019	16,225,729			0	406,498		19,796,676		(78,843)		7,129,642			(11,870,244)		(117,676)		12		959,664
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
Comprehensive income:
Net income (loss)	619,824										589,876									29,948
Other comprehensive income (loss)	(21,890)															(17,054)				(4,836)
Total comprehensive income	597,934
Net change in noncontrolling interests	(27,527)						13,038													(40,565)
Amounts related to stock incentive plans, net of forfeitures	127				4		5,100		(4,801)									(176)
Net proceeds from issuance of common stock	38,873				480		38,393
Dividends paid:
Common stock dividends	(353,250)													(353,250)
Balances at end of period at Sep. 30, 2019	16,225,729			$ 0	406,498		19,796,676		(78,843)		7,129,642			(11,870,244)		(117,676)		12		959,664
Balances at beginning of period at Dec. 31, 2019	16,506,627	$ (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	$ (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)	(22,780)
Balances at end of period at Sep. 30, 2020	16,961,102				418,361		20,835,022		(94,022)		8,163,869			(13,088,891)		(126,469)		4		853,228
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
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
Comprehensive income:
Net income (loss)	393,235										325,585									67,650
Other comprehensive income (loss)	(2,275)															(9,613)				7,338
Other comprehensive income (loss)	(2,159)
Total comprehensive income	390,960
Net change in noncontrolling interests	(118,041)						(7,894)													(110,147)
Amounts related to stock incentive plans, net of forfeitures	6,364				18		6,569		(223)
Net proceeds from issuance of common stock	(198)						(198)
Dividends paid:
Common stock dividends	(254,510)													(254,510)
Balances at end of period at Sep. 30, 2020	$ 16,961,102				$ 418,361		$ 20,835,022		$ (94,022)		$ 8,163,869			$ (13,088,891)		$ (126,469)		$ 4		$ 853,228

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS (UNAUDITED) - USD ($) $ in Thousands		9 Months Ended
		Sep. 30, 2020	Sep. 30, 2019
Operating activities:
Net income		$ 883,574	$ 1,090,274
Adjustments to reconcile net income to net cash provided from (used in) operating activities:
Depreciation and amortization		795,704	764,429
Other amortization expenses		9,613	13,474
Provision for loan losses		11,351	18,690
Impairment of assets		126,291	28,035
Stock-based compensation expense		20,938	20,501
Loss (gain) on derivatives and financial instruments, net		10,480	670
Loss (gain) on extinguishment of debt, net		33,253	81,543
Loss (income) from unconsolidated entities		8,341	14,986
Rental income less than (in excess of) cash received		66,874	(78,980)
Amortization related to above (below) market leases, net		(1,373)	(335)
Loss (gain) on real estate dispositions, net		(902,991)	(735,977)
Distributions by unconsolidated entities		7,835	0
Increase (decrease) in accrued expenses and other liabilities		40,443	845
Decrease (increase) in receivables and other assets		(749)	(8,255)
Net cash provided from (used in) operating activities		1,109,584	1,209,900
Investing activities:
Cash disbursed for acquisitions, net of cash acquired		(393,374)	(3,004,768)
Cash disbursed for capital improvements to existing properties		(183,324)	(206,413)
Cash disbursed for construction in progress		(126,699)	(258,113)
Capitalized interest		(13,234)	(10,404)
Investment in loans receivable		(216,307)	(90,856)
Principal collected on loans receivable		14,345	57,125
Other investments, net of payments		(2,145)	(29,788)
Contributions to unconsolidated entities		(301,031)	(194,490)
Distributions by unconsolidated entities		41,884	98,880
Proceeds from (payments on) derivatives		(13,319)	(20,569)
Proceeds from sales of real property		3,522,949	2,601,071
Net cash provided from (used in) investing activities		2,329,745	(1,058,325)
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			187,586
Proceeds from issuance of senior unsecured notes		1,588,549	3,253,516
Payments to extinguish senior unsecured notes		(566,248)	(3,107,500)
Net proceeds from the issuance of secured debt		44,921	318,854
Payments on secured debt		(538,091)	(233,952)
Net proceeds from the issuance of common stock		595,313	686,105
Repurchase of common stock		(7,656)	0
Payments for deferred financing costs and prepayment penalties		(35,925)	(82,249)
Contributions by noncontrolling interests	[1]	14,267	42,988
Distributions to noncontrolling interests	[1]	(298,369)	(138,270)
Cash distributions to stockholders		(864,115)	(1,047,968)
Other financing activities		(11,244)	(11,643)
Net cash provided from (used in) financing activities		(1,666,195)	(132,533)
Effect of foreign currency translation on cash and cash equivalents and restricted cash		(3,566)	(4,436)
Increase (decrease) in cash, cash equivalents and restricted cash		1,769,568	14,606
Cash, cash equivalents and restricted cash at beginning of period		385,765	316,129
Cash, cash equivalents and restricted cash at end of period		2,155,333	330,735
Supplemental cash flow information:
Interest paid		362,130	416,523
Income taxes paid (received), net		$ (485)	$ 4,784
[1]	(1) Includes amounts attributable to redeemable noncontrolling interests.

Business

Business	9 Months Ended
	Sep. 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	9 Months Ended
	Sep. 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 nine months ended September 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 August September Spot occupancy (1) 85.6 % 84.8 % 82.5 % 80.8 % 79.9 % 79.2 % 78.7 % 78.4 % Sequential occupancy change (0.8) % (2.3) % (1.7) % (0.9) % (0.7) % (0.5) % (0.3) % (1) Spot occupancy represents approximate month end occupancy for properties in operation as of February 29, 2020, including unconsolidated properties but excluding acquisitions, dispositions and development conversions since this date. Increased Seniors Housing Operating expenses are expected to continue until the pandemic subsides. We experienced incremental operational costs, net of reimbursements, of $18,192,000 and $68,628,000 for the three and nine months ended September 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 personal protective equipment ("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. In September, applications were made for Provider Relief Funds related to our Seniors Housing Operating portfolio following the announcement from the Department of Health and Human Services that it expanded the eligibility of the Coronavirus Aid Relief, and Economic Security Act (“CARES Act”) Provider Relief Fund to include assisted living facilities. Our share of the Phase 2 general distribution is expected to be approximately $46 million and we anticipate receiving and recognizing these funds as an offset to property operating expenses in the fourth quarter. However, we continue to expect total portfolio expenses to remain elevated during the pandemic and potentially beyond as these additional health and safety measures become standard practice. • Our Triple-net operators are experiencing similar occupancy declines and expense increases, however, long-term/post-acute care facilities are generally experiencing a higher degree of occupancy declines. These factors may impact our Triple-net operators' ability to pay rent and contractual obligations. Many of our Triple-net operators have received funds under the CARES Act Paycheck Protection Program. In addition, operators of long-term/post-acute care facilities have generally received funds from Phase 1 of the Provider Relief Fund and operators of assisted living facilities are generally expecting funds from Phase 2 of the Provider Relief Fund. Accordingly, collection of Triple-net rent due during the COVID-19 pandemic to date (from March to September) has generally been consistent with historical collection rates and no significant rent concessions or deferrals have been made. We have either collected or approved short term deferrals for over 99% of Outpatient Medical rent due in the third quarter, consisting of 97% cash collections and 2% of short term deferrals. In most cases, unless local ordinances mandate otherwise, the deferred rent represents two months of rent with repayment expected by the end of the year. Furthermore, collections of deferred rent due in the third quarter under executed deferrals was over 99%. 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 • 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, certain tenants and operators have requested rent relief, most often in the form of a short-term rent deferral. Not all requests result in modification of agreements, nor do we intend to forgo our contractual rights under our lease agreements. We evaluate each rent relief request on an individual basis. To date, the majority of rent deferral agreements result in two months of full or partial rent relief to repaid by the end of the year and we generally expect this to continue to be the case unless local ordinances mandate otherwise. 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	9 Months Ended
	Sep. 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): Nine Months Ended September 30, 2020 September 30, 2019 Seniors Housing Operating Triple-net Outpatient Totals Seniors Housing Operating Triple-net Outpatient Totals Land and land improvements $ 15,758 $ — $ 43,252 $ 59,010 $ 107,945 $ 14,172 $ 187,301 $ 309,418 Buildings and improvements 132,481 765 171,630 304,876 1,138,484 125,763 1,324,371 2,588,618 Acquired lease intangibles 10,810 — 23,823 34,633 61,163 — 104,309 165,472 Construction in progress — — — — 36,174 — — 36,174 Real property held for sale — — — — 17,435 — — 17,435 Right of use assets, net — — — — — — 58,377 58,377 Total net real estate assets 159,049 765 238,705 398,519 1,361,201 139,935 1,674,358 3,175,494 Receivables and other assets 257 — 139 396 6,742 — 419 7,161 Total assets acquired (1) 159,306 765 238,844 398,915 1,367,943 139,935 1,674,777 3,182,655 Secured debt — — — — (43,209) — — (43,209) Lease liabilities — — — — — — (47,740) (47,740) Accrued expenses and other liabilities (671) — (2,043) (2,714) (9,639) (100) (23,483) (33,222) Total liabilities acquired (671) — (2,043) (2,714) (52,848) (100) (71,223) (124,171) Noncontrolling interests (2) (2,827) — — (2,827) (39,570) (1,056) (1,201) (41,827) Non-cash acquisition related activity (3) — — — — (11,889) — — (11,889) Cash disbursed for acquisitions 155,808 765 236,801 393,374 1,263,636 138,779 1,602,353 3,004,768 Construction in progress additions 75,617 33,021 33,593 142,231 188,178 37,978 42,316 268,472 Less: Capitalized interest (7,760) (2,569) (2,905) (13,234) (5,972) (1,565) (2,867) (10,404) Accruals (4) (1,376) — (922) (2,298) — — 45 45 Cash disbursed for construction in progress 66,481 30,452 29,766 126,699 182,206 36,413 39,494 258,113 Capital improvements to existing properties 130,465 5,971 46,888 183,324 160,260 10,337 35,816 206,413 Total cash invested in real property, net of cash acquired $ 352,754 $ 37,188 $ 313,455 $ 703,397 $ 1,606,102 $ 185,529 $ 1,677,663 $ 3,469,294 (1) Excludes $580,000 and $1,910,000 of unrestricted and restricted cash acquired during the nine months ended September 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): Nine Months Ended September 30, 2020 September 30, 2019 Development projects: Seniors Housing Operating $ 93,188 $ 28,117 Triple-net 59,201 — Outpatient Medical 43,493 — Total development projects 195,882 28,117 Expansion projects 48,600 — Total construction in progress conversions $ 244,482 $ 28,117

Real Estate Intangibles

Real Estate Intangibles	9 Months Ended
	Sep. 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): September 30, 2020 December 31, 2019 Assets: In place lease intangibles $ 1,410,935 $ 1,513,836 Above market tenant leases 55,437 59,540 Lease commissions 42,681 43,675 Gross historical cost 1,509,053 1,617,051 Accumulated amortization (1,171,721) (1,181,158) Net book value $ 337,332 $ 435,893 Weighted-average amortization period in years 10.9 10.3 Liabilities: Below market tenant leases $ 81,385 $ 99,035 Accumulated amortization (41,662) (49,390) Net book value $ 39,723 $ 49,645 Weighted-average amortization period in years 8.3 8.6 The following is a summary of real estate intangible amortization income (expense) for the periods presented (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Rental income related to (above)/below market tenant leases, net $ 327 $ 291 $ 1,252 $ 210 Amortization related to in place lease intangibles and lease commissions (28,948) (48,414) (98,241) (101,837) The future estimated aggregate amortization of intangible assets and liabilities is as follows for the periods presented (in thousands): Assets Liabilities 2020 $ 23,561 $ 2,146 2021 63,988 8,135 2022 43,080 7,448 2023 34,711 5,228 2024 27,088 3,082 Thereafter 144,904 13,684 Total $ 337,332 $ 39,723

Dispositions and Assets Held fo

Dispositions and Assets Held for Sale	9 Months Ended
	Sep. 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 September 30, 2020, eight Seniors Housing Operating, two Triple-net, and 11 Outpatient Medical properties with an aggregate real estate balance of $362,886,000 were classified as held for sale. In addition to the real property balances held for sale, secured debt of $12,737,000 and net other assets and (liabilities) of $21,063,000 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 approximately $437,116,000. During the nine months ended September 30, 2020, we recorded $79,905,000 of impairment charges related to 13 Seniors Housing Operating and one Triple-net properties which were disposed of or classified as held for sale for which the carrying value exceeded the estimated fair value less cost to sell. Additionally, during the nine months ended September 30, 2020, we recorded $46,386,000 of impairment charges related to four Seniors Housing Operating and four Triple-net properties that were held for use in which the carrying value exceeded the estimated fair value. The following is a summary of our real property disposition activity for the periods presented (in thousands): Nine Months Ended September 30, 2020 2019 Real estate dispositions: Seniors Housing Operating $ 1,093,477 $ 1,204,084 Triple-net 33,445 660,885 Outpatient Medical 1,394,971 482 Total dispositions 2,521,893 1,865,451 Gain (loss) on real estate dispositions, net 902,991 735,977 Net other assets/liabilities disposed 98,065 (357) Proceeds from real estate dispositions $ 3,522,949 $ 2,601,071 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 September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Revenues: Total revenues $ 36,820 $ 133,661 $ 207,918 $ 554,744 Expenses: Interest expense 584 4,593 6,579 14,801 Property operating expenses 22,485 68,848 117,069 305,598 Provision for depreciation 5,907 23,627 37,254 94,694 Total expenses 28,976 97,068 160,902 415,093 Income (loss) from real estate dispositions, net $ 7,844 $ 36,593 $ 47,016 $ 139,651

Leases

Leases	9 Months Ended
	Sep. 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): Nine Months Ended Classification September 30, 2020 September 30, 2019 Operating lease cost: (1) Real estate lease expense Property operating expenses $ 17,397 $ 18,326 Non-real estate investment lease expense General and administrative expenses 3,673 1,286 Finance lease cost: Amortization of leased assets Property operating expenses 6,229 6,549 Interest on lease liabilities Interest expense 4,693 3,497 Sublease income Rental income (3,130) (3,130) Total $ 28,862 $ 26,528 (1) Includes short-term leases which are immaterial. Supplemental balance sheet information related to leases is as follows (in thousands): Classification September 30, 2020 December 31, 2019 Right of use assets: Operating leases - real estate Right of use assets, net $ 323,200 $ 374,217 Finance leases - real estate Right of use assets, net 157,661 162,216 Real estate right of use assets, net 480,861 536,433 Operating leases - non-real estate investments Receivables and other assets 10,328 12,474 Total right of use assets, net $ 491,189 $ 548,907 Lease liabilities: Operating leases $ 320,044 $ 364,803 Financing leases 107,798 108,890 Total $ 427,842 $ 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 and nine month periods ended September 30, 2020, we wrote off straight-line rent receivable balances of $112,398,000 and $146,508,000, respectively, relating to leases for which collection of substantially all contractual lease payments was no longer deemed probable. Included in such amounts was $91,025,000 relating to Genesis Healthcare whom noted substantial doubt as to their ability to continue as a going concern in August. Leases in our Triple-net and Outpatient Medical portfolios typically include some form of operating expense reimbursement by the tenant. For the nine months ended September 30, 2020, we recognized $1,061,311,000 of rental income related to operating leases, of which $153,217,000 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 nine months ended September 30, 2019, we recognized $ 1,178,817,000 of rental income related to operating leases, of which $ 147,815,000 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): Nine Months Ended Classification September 30, 2020 September 30, 2019 Operating lease cost: (1) Real estate lease expense Property operating expenses $ 17,397 $ 18,326 Non-real estate investment lease expense General and administrative expenses 3,673 1,286 Finance lease cost: Amortization of leased assets Property operating expenses 6,229 6,549 Interest on lease liabilities Interest expense 4,693 3,497 Sublease income Rental income (3,130) (3,130) Total $ 28,862 $ 26,528 (1) Includes short-term leases which are immaterial. Supplemental balance sheet information related to leases is as follows (in thousands): Classification September 30, 2020 December 31, 2019 Right of use assets: Operating leases - real estate Right of use assets, net $ 323,200 $ 374,217 Finance leases - real estate Right of use assets, net 157,661 162,216 Real estate right of use assets, net 480,861 536,433 Operating leases - non-real estate investments Receivables and other assets 10,328 12,474 Total right of use assets, net $ 491,189 $ 548,907 Lease liabilities: Operating leases $ 320,044 $ 364,803 Financing leases 107,798 108,890 Total $ 427,842 $ 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 and nine month periods ended September 30, 2020, we wrote off straight-line rent receivable balances of $112,398,000 and $146,508,000, respectively, relating to leases for which collection of substantially all contractual lease payments was no longer deemed probable. Included in such amounts was $91,025,000 relating to Genesis Healthcare whom noted substantial doubt as to their ability to continue as a going concern in August. Leases in our Triple-net and Outpatient Medical portfolios typically include some form of operating expense reimbursement by the tenant. For the nine months ended September 30, 2020, we recognized $1,061,311,000 of rental income related to operating leases, of which $153,217,000 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 nine months ended September 30, 2019, we recognized $ 1,178,817,000 of rental income related to operating leases, of which $ 147,815,000 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): Nine Months Ended Classification September 30, 2020 September 30, 2019 Operating lease cost: (1) Real estate lease expense Property operating expenses $ 17,397 $ 18,326 Non-real estate investment lease expense General and administrative expenses 3,673 1,286 Finance lease cost: Amortization of leased assets Property operating expenses 6,229 6,549 Interest on lease liabilities Interest expense 4,693 3,497 Sublease income Rental income (3,130) (3,130) Total $ 28,862 $ 26,528 (1) Includes short-term leases which are immaterial. Supplemental balance sheet information related to leases is as follows (in thousands): Classification September 30, 2020 December 31, 2019 Right of use assets: Operating leases - real estate Right of use assets, net $ 323,200 $ 374,217 Finance leases - real estate Right of use assets, net 157,661 162,216 Real estate right of use assets, net 480,861 536,433 Operating leases - non-real estate investments Receivables and other assets 10,328 12,474 Total right of use assets, net $ 491,189 $ 548,907 Lease liabilities: Operating leases $ 320,044 $ 364,803 Financing leases 107,798 108,890 Total $ 427,842 $ 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 and nine month periods ended September 30, 2020, we wrote off straight-line rent receivable balances of $112,398,000 and $146,508,000, respectively, relating to leases for which collection of substantially all contractual lease payments was no longer deemed probable. Included in such amounts was $91,025,000 relating to Genesis Healthcare whom noted substantial doubt as to their ability to continue as a going concern in August. Leases in our Triple-net and Outpatient Medical portfolios typically include some form of operating expense reimbursement by the tenant. For the nine months ended September 30, 2020, we recognized $1,061,311,000 of rental income related to operating leases, of which $153,217,000 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 nine months ended September 30, 2019, we recognized $ 1,178,817,000 of rental income related to operating leases, of which $ 147,815,000 was for variable lease payments.

Loans Receivable

Loans Receivable	9 Months Ended
	Sep. 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 $12,039,000 and $6,897,000 as of September 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): September 30, 2020 December 31, 2019 Mortgage loans $ 293,351 $ 188,062 Other real estate loans 127,988 124,696 Allowance for credit losses on real estate loans receivable (6,633) (42,376) Real estate loans receivable, net of credit allowance 414,706 270,382 Non-real estate loans 460,411 362,850 Allowance for credit losses on non-real estate loans receivable (78,262) (25,996) Non-real estate loans receivable, net of credit allowance 382,149 336,854 Total loans receivable, net of credit allowance $ 796,855 $ 607,236 During the nine months ended September 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 non-real estate loans. The following is a summary of our loan activity for the periods presented (in thousands): Nine Months Ended September 30, 2020 September 30, 2019 Advances on loans receivable: Investments in new loans $ 194,942 $ 36,024 Draws on existing loans 21,365 54,832 Net cash advances on loans receivable 216,307 90,856 Receipts on loans receivable: Loan payoffs — 37,686 Principal payments on loans 14,345 19,439 Net cash receipts on loans receivable 14,345 57,125 Net cash advances (receipts) on loans receivable $ 201,962 $ 33,731 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): September 30, 2020 Loan category Years of Origination Loan Carrying Value Allowance for Credit Loss Net Loan Balance No. of Loans Deteriorated loans (1) 2007 - 2018 $ 249,314 $ (76,695) $ 172,619 7 Collective loan pool 2007 - 2015 129,949 (1,886) 128,063 15 Collective loan pool 2016 124,599 (1,612) 122,987 4 Collective loan pool 2017 124,840 (1,074) 123,766 7 Collective loan pool 2018 17,314 (251) 17,063 1 Collective loan pool 2019 49,274 (684) 48,590 7 Collective loan pool 2020 186,460 (2,693) 183,767 6 Total loans $ 881,750 $ (84,895) $ 796,855 47 (1) During the three months ended September 30, 2020, two loans receivable originated in 2016 to Genesis Healthcare with an aggregate carrying value of $62,753,000 were transferred to the deteriorated loan pool. The 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 nine months ended September 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): Nine Months Ended September 30, 2020 September 30, 2019 Balance at beginning of period $ 68,372 $ 68,372 Adoption of ASU 2016-13 5,212 — Provision for loan losses 11,351 18,690 Loan write-offs — (18,690) Foreign currency translation (40) — Balance at end of period $ 84,895 $ 68,372 The following is a summary of our deteriorated loans (in thousands): Nine Months Ended September 30, 2020 September 30, 2019 Balance of deteriorated loans at end of period (1) $ 249,314 $ 188,043 Allowance for credit losses (76,695) (68,372) Balance of deteriorated loans not reserved $ 172,619 $ 119,671 Interest recognized on deteriorated loans (2) $ 13,847 $ 12,082 (1) Current year amounts include $10,686,000 and $2,534,000 of loans on non-accrual as of September 30, 2020 and December 31, 2019, respectively. Prior year amounts include $2,534,000 and $2,567,000 as of September 30, 2019 and December 31, 2018, respectively. (2) Represents cash interest recognized in the period.

Investments in Unconsolidated E

Investments in Unconsolidated Entities	9 Months Ended
	Sep. 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) September 30, 2020 December 31, 2019 Seniors Housing Operating 10% to 65% $ 582,378 $ 463,741 Triple-net 10% to 25% 160 7,740 Outpatient Medical 15% to 50% 240,048 111,942 Total $ 822,586 $ 583,423 (1) Excludes ownership of in substance real estate. At September 30, 2020, the aggregate unamortized basis difference of our joint venture investments of $113,217,000 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 $285,369,000 related to eight properties as of September 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 $172,169,000 related to these investments.

Credit Concentration

Credit Concentration	9 Months Ended
	Sep. 30, 2020
Risks and Uncertainties [Abstract]
Credit Concentration	Credit Concentration We 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 nine months ended September 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 $ 194,952 13% ProMedica 215 159,562 11% Revera (3) 94 81,317 5% Avery Healthcare 59 56,192 4% Sagora Senior Living 31 50,539 3% Remaining portfolio 924 964,127 64% Totals 1,488 $ 1,506,689 100% (1) Sunrise Senior Living and Revera are in our Seniors Housing Operating segment. ProMedica is in our Triple-net segment. Avery Healthcare and Sagora Senior Living are 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	9 Months Ended
	Sep. 30, 2020
Debt Disclosure [Abstract]
Borrowings Under Credit Facilities and Commercial Paper Program	Borrowings Under Credit Facilities and Commercial Paper Program At September 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 September 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 September 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 September 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 September 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 of $1,000,000,000 (none outstanding at September 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 September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Balance outstanding at quarter end $ — $ 1,335,000 $ — $ 1,335,000 Maximum amount outstanding at any month end $ — $ 1,335,000 $ 2,100,000 $ 2,880,000 Average amount outstanding (total of daily principal balances divided by days in period) $ — $ 1,296,185 $ 663,895 $ 1,299,963 Weighted average interest rate (actual interest expense divided by average borrowings outstanding) — % 2.82 % 2.09 % 3.02 %

Senior Unsecured Notes and Secu

Senior Unsecured Notes and Secured Debt	9 Months Ended
	Sep. 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 September 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 $ — $ 75,915 $ 75,915 2021 — 433,616 433,616 2022 (4) 870,000 449,248 1,319,248 2023 (5,6) 1,361,397 329,650 1,691,047 2024 1,350,000 178,285 1,528,285 Thereafter (7,8,9) 7,831,880 1,002,474 8,834,354 Totals $ 11,413,277 $ 2,469,188 $ 13,882,465 (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 0.86% to 6.50%. (3) Annual interest rates range from 0.10% to 12.00%. Carrying value of the properties securing the debt totaled $5,315,000,000 at September 30, 2020. (4) Includes a $860,000,000 unsecured term credit facility. The loan matures on April 1, 2022 and bears interest at LIBOR plus 1.20% (1.34% at September 30, 2020). (5) Includes a $250,000,000 Canadian-denominated unsecured term credit facility (approximately $187,645,000 based on the Canadian/U.S. Dollar exchange rate on September 30, 2020). The loan matures on July 19, 2023 and bears interest at the Canadian Dealer Offered Rate plus 0.9% (1.38% at September 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% (1.06% at September 30, 2020). (7) Includes a $300,000,000 Canadian-denominated 2.95% senior unsecured notes due 2027 (approximately $225,175,000 based on the Canadian/U.S. Dollar exchange rate on September 30, 2020). (8) Includes a £550,000,000 4.80% senior unsecured notes due 2028 (approximately $710,655,000 based on the Sterling/U.S. Dollar exchange rate in effect on September 30, 2020). (9) Includes a £500,000,000 4.50% senior unsecured notes due 2034 (approximately $646,050,000 based on the Sterling/U.S. Dollar exchange rate in effect on September 30, 2020). The following is a summary of our senior unsecured notes principal activity during the periods presented (dollars in thousands): Nine Months Ended September 30, 2020 September 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% 3,260,000 3.47% Debt extinguished (566,248) 3.26% (3,107,500) 4.47% Foreign currency (48,037) 4.14% (35,208) 4.35% Ending balance $ 11,413,277 3.67% $ 9,817,276 4.12% The following is a summary of our secured debt principal activity for the periods presented (dollars in thousands): Nine Months Ended September 30, 2020 September 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% 318,854 3.51% Debt assumed — —% 42,000 4.62% Debt extinguished (491,506) 2.61% (193,604) 4.37% Principal payments (46,585) 3.60% (40,348) 3.69% Foreign currency (30,984) 3.19% 26,402 3.20% Ending balance $ 2,469,188 3.16% $ 2,639,015 3.66% In October of 2020, we extinguished $20,790,000 of secured bonds due 2038, $17,640,000 of secured bonds due 2040 and $73,140,000 of secured bonds due 2041 that were defeased in September of 2020. We recognized a loss on extinguishment of $12,204,000 in conjunction with the transaction.

Derivative Instruments

Derivative Instruments	9 Months Ended
	Sep. 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. Approximately $1,557,000 of losses, which are included in OCI, are expected to be reclassified into earnings in the next 12 months. 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 nine months ended September 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): September 30, 2020 December 31, 2019 Derivatives designated as net investment hedges: Denominated in Canadian Dollars $ 650,000 $ 725,000 Denominated in Pound Sterling £ 1,340,708 £ 1,340,708 Financial instruments designated as net investment hedges: Denominated in Canadian Dollars $ 250,000 $ 250,000 Denominated in Pound Sterling £ 1,050,000 £ 1,050,000 Interest rate swaps designated as cash flow hedges: Denominated in U.S Dollars (1) $ 450,000 $ 1,188,250 Derivative instruments not designated: Interest rate caps denominated in U.S. Dollars $ 95,086 $ 405,819 Forward sales contracts denominated in Canadian Dollars $ 80,000 $ — Forward purchase contracts denominated in Pound Sterling £ — £ (125,000) Forward sales contracts denominated in Pound Sterling £ — £ 125,000 (1) At September 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 September 30, Nine Months Ended September 30, Description Location 2020 2019 2020 2019 Gain (loss) on derivative instruments designated as hedges recognized in income Interest expense $ 5,724 $ 7,478 $ 16,475 $ 19,945 Gain (loss) on derivative instruments not designated as hedges recognized in income Interest expense $ (1,159) $ 600 $ (3,207) $ (2,065) Gain (loss) on derivative and financial instruments designated as hedges recognized in OCI OCI $ (145,512) $ 78,947 $ 86,429 $ 91,672

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
	Sep. 30, 2020
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and ContingenciesAt September 30, 2020, we had 8 outstanding letter of credit obligations totaling $14,200,000 and expiring between 2020 and 2024. At September 30, 2020, we had outstanding construction in progress of $414,833,000 and were committed to providing additional funds of approximately $342,232,000 to complete construction. Additionally, at September 30, 2020, we had outstanding investments classified as in substance real estate of $285,369,000 and were committed to provide additional funds of $172,169,000 (see Note 8 for additional information). Purchase obligations at September 30, 2020 also include $18,488,000 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	9 Months Ended
	Sep. 30, 2020
Equity [Abstract]
Stockholders' Equity	Stockholders’ Equity The following is a summary of our stockholders’ equity capital accounts as of the dates indicated: September 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 418,877,323 411,550,857 Outstanding shares 417,305,044 410,256,615 Preferred Stock The following is a summary of our preferred stock activity during the periods indicated: Nine Months Ended September 30, 2020 September 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 nine months ended September 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 nine months ended September 30, 2020, we physically settled all of our outstanding forward sales agreements for cash proceeds of $576,196,000. As of September 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 nine months ended September 30, 2020, we repurchase d 201,947 shares at an average price of $37.89 per share. The following is a summary of our common stock issuances during the nine months ended September 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 4,438,787 $ 75.59 $ 335,535 $ 332,054 2019 Option exercises 10,736 51.32 551 551 2019 Equity shelf program issuances 4,729,045 75.24 355,803 353,500 2019 Preferred stock conversions 12,712,452 — — 2019 Stock incentive plans, net of forfeitures 192,237 — — 2019 Totals 22,083,257 $ 691,889 $ 686,105 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 185,994 — — 2020 Totals 7,250,376 $ 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): Nine Months Ended September 30, 2020 September 30, 2019 Per Share Amount Per Share Amount Common stock $ 2.09 $ 865,357 $ 2.61 $ 1,051,687 Accumulated Other Comprehensive Income The following is a summary of accumulated other comprehensive income (loss) for the periods presented (in thousands): September 30, 2020 December 31, 2019 Foreign currency translation $ (820,555) $ (719,814) Derivative and financial instruments designated as hedges 694,086 607,657 Total accumulated other comprehensive income (loss) $ (126,469) $ (112,157)

Stock Incentive Plans

Stock Incentive Plans	9 Months Ended
	Sep. 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 $5,309,000 and $20,501,000 for the same periods in 2019.

Earnings Per Share

Earnings Per Share	9 Months Ended
	Sep. 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 September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Numerator for basic earnings per share - net income (loss) attributable to common stockholders $ 325,585 $ 589,876 $ 815,115 $ 1,008,108 Adjustment for net income (loss) attributable to OP units (1,716) 492 (4,470) 580 Numerator for diluted earnings per share $ 323,869 $ 590,368 $ 810,645 $ 1,008,688 Denominator for basic earnings per share - weighted average shares 417,027 405,023 414,822 400,441 Effect of dilutive securities: Non-vested restricted shares 542 757 620 860 Redeemable OP units 1,396 1,096 1,396 1,096 Employee stock purchase program 22 15 22 15 Dilutive potential common shares 1,960 1,868 2,038 1,971 Denominator for diluted earnings per share - adjusted weighted average shares 418,987 406,891 416,860 402,412 Basic earnings per share $ 0.78 $ 1.46 $ 1.96 $ 2.52 Diluted earnings per share $ 0.77 $ 1.45 $ 1.94 $ 2.51

Disclosure about Fair Value of

Disclosure about Fair Value of Financial Instruments	9 Months Ended
	Sep. 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): September 30, 2020 December 31, 2019 Carrying Amount Fair Value Carrying Amount Fair Value Financial assets: Mortgage loans receivable $ 289,082 $ 295,597 $ 145,686 $ 150,217 Other real estate loans receivable 125,624 129,069 124,696 128,512 Equity securities 5,205 5,205 15,685 15,685 Cash and cash equivalents 1,603,740 1,603,740 284,917 284,917 Restricted cash 551,593 551,593 100,849 100,849 Non-real estate loans receivable 382,149 430,558 336,854 379,239 Foreign currency forward contracts, interest rate swaps and cross currency swaps 81,964 81,964 18,554 18,554 Financial liabilities: Borrowings under unsecured credit facility and commercial paper program $ — $ — $ 1,587,597 $ 1,587,597 Senior unsecured notes 11,321,573 12,603,853 10,336,513 11,400,571 Secured debt 2,459,659 2,541,260 2,990,962 3,041,893 Foreign currency forward contracts, interest rate swaps and cross currency swaps 64,100 64,100 53,601 53,601 Redeemable OP unitholder interests $ 100,513 $ 98,335 $ 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 September 30, 2020 Total Level 1 Level 2 Level 3 Equity securities $ 5,205 $ 5,205 $ — $ — Foreign currency forward contracts, interest rate swaps and cross currency swaps, net asset (liability) (1) 17,864 — 17,864 — Totals $ 23,069 $ 5,205 $ 17,864 $ — (1) Please see Note 12 for additional information. Items Measured at Fair Value on a Nonrecurring Basis

Segment Reporting

Segment Reporting	9 Months Ended
	Sep. 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. All intersegment transactions are eliminated. Summary information for the reportable segments (which excludes unconsolidated entities) is as follows (in thousands): Three Months Ended September 30, 2020: Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 740,956 $ — $ — $ — $ 740,956 Rental income — 103,938 171,108 — 275,046 Interest income 113 15,877 760 — 16,750 Other income 996 1,113 836 1,177 4,122 Total revenues 742,065 120,928 172,704 1,177 1,036,874 Property operating expenses 567,704 12,567 52,728 1,718 634,717 Consolidated net operating income 174,361 108,361 119,976 (541) 402,157 Depreciation and amortization 133,224 58,157 64,151 — 255,532 Interest expense 12,728 2,070 4,287 105,766 124,851 General and administrative expenses — — — 31,003 31,003 Loss (gain) on derivatives and financial instruments, net — 1,395 — — 1,395 Loss (gain) on extinguishment of debt, net — — — 33,004 33,004 Provision for loan losses 86 372 2,399 — 2,857 Impairment of assets 12,778 10,535 — — 23,313 Other expenses 6,488 2,805 781 1,470 11,544 Income (loss) from continuing operations before income taxes and other items 9,057 33,027 48,358 (171,784) (81,342) Income tax (expense) benefit — — — (2,003) (2,003) Income (loss) from unconsolidated entities (7,678) (423) 2,120 — (5,981) Gain (loss) on real estate dispositions, net 313,319 (619) 171,604 — 484,304 Income (loss) from continuing operations 314,698 31,985 222,082 (173,787) 394,978 Net income (loss) $ 314,698 $ 31,985 $ 222,082 $ (173,787) $ 394,978 Total assets $ 15,063,405 $ 9,075,910 $ 6,892,502 $ 1,509,780 $ 32,541,597 Three Months Ended September 30, 2019: Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 834,121 $ — $ — $ — $ 834,121 Rental income — 227,499 184,648 — 412,147 Interest income — 15,279 358 — 15,637 Other income 1,375 1,829 183 841 4,228 Total revenues 835,496 244,607 185,189 841 1,266,133 Property operating expenses 581,341 13,922 60,325 — 655,588 Consolidated net operating income 254,155 230,685 124,864 841 610,545 Depreciation and amortization 148,126 57,147 67,172 — 272,445 Interest expense 16,356 3,076 3,363 114,548 137,343 General and administrative expenses — — — 31,019 31,019 Loss (gain) on derivatives and financial instruments, net — 1,244 — — 1,244 Loss (gain) on extinguishment of debt, net 1,450 — — 64,374 65,824 Impairment of assets 2,599 12,314 3,183 — 18,096 Other expenses 4,274 (2,496) 524 3,884 6,186 Income (loss) from continuing operations before income taxes and other items 81,350 159,400 50,622 (212,984) 78,388 Income tax (expense) benefit — — — (3,968) (3,968) Income (loss) from unconsolidated entities (3,859) 5,276 1,845 — 3,262 Gain (loss) on real estate dispositions, net 519,203 51,529 (482) — 570,250 Income (loss) from continuing operations 596,694 216,205 51,985 (216,952) 647,932 Net income (loss) $ 596,694 $ 216,205 $ 51,985 $ (216,952) $ 647,932 Nine Months Ended September 30, 2020 Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 2,360,488 $ — $ — $ — $ 2,360,488 Rental income — 512,815 548,496 — 1,061,311 Interest income 305 46,068 1,687 — 48,060 Other income 6,050 3,393 2,681 1,968 14,092 Total revenues 2,366,843 562,276 552,864 1,968 3,483,951 Property operating expenses 1,771,088 39,432 165,024 1,718 1,977,262 Consolidated net operating income 595,755 522,844 387,840 250 1,506,689 Depreciation and amortization 419,161 173,989 202,554 — 795,704 Interest expense 43,191 7,668 13,421 328,935 393,215 General and administrative expenses — — — 100,546 100,546 Loss (gain) on derivatives and financial instruments, net — 10,480 — — 10,480 Loss (gain) on extinguishment of debt, net (492) — 741 33,004 33,253 Provision for loan losses 86 8,895 2,370 — 11,351 Impairment of assets 91,424 34,867 — — 126,291 Other expenses 13,463 6,818 8,244 8,722 37,247 Income (loss) from continuing operations before income taxes and other items 28,922 280,127 160,510 (470,957) (1,398) Income tax (expense) benefit — — — (9,678) (9,678) Income (loss) from unconsolidated entities (25,489) 11,776 5,372 — (8,341) Gain (loss) on real estate dispositions, net 327,635 51,166 524,190 — 902,991 Income (loss) from continuing operations 331,068 343,069 690,072 (480,635) 883,574 Net income (loss) $ 331,068 $ 343,069 $ 690,072 $ (480,635) $ 883,574 Nine Months Ended September 30, 2019 Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 2,616,491 $ — $ — $ — $ 2,616,491 Rental income — 681,893 496,924 — 1,178,817 Interest income — 47,343 769 — 48,112 Other income 6,920 4,370 322 3,452 15,064 Total revenues 2,623,411 733,606 498,015 3,452 3,858,484 Property operating expenses 1,826,344 41,700 159,478 — 2,027,522 Consolidated net operating income 797,067 691,906 338,537 3,452 1,830,962 Depreciation and amortization 416,252 174,551 173,626 — 764,429 Interest expense 52,179 9,741 10,097 351,894 423,911 General and administrative expenses — — — 100,042 100,042 Loss (gain) on derivatives and financial — 670 — — 670 Loss (gain) on extinguishment of debt, net 1,450 — — 80,093 81,543 Provision for loan losses — 18.69 18,690 — — 18.69 — 18,690 Impairment of assets 2,599 11,374 14,062 — 28,035 Other expenses 19,077 6,093 1,274 10,126 36,570 Income (loss) from continuing operations before income taxes and other items 305,510 470,787 139,478 (538,703) 377,072 Income tax (expense) benefit — — — (7,789) (7,789) Income (loss) from unconsolidated entities (37,892) 17,512 5,394 — (14,986) Gain (loss) on real estate dispositions, net 518,493 217,973 (489) — 735,977 Income (loss) from continuing operations 786,111 706,272 144,383 (546,492) 1,090,274 Net income (loss) $ 786,111 $ 706,272 $ 144,383 $ (546,492) $ 1,090,274 Our portfolio of properties and other investments are located in the United States, the United Kingdom and Canada. Revenues and assets are attributed to the country in which the property is physically located. The following is a summary of geographic information for the periods presented (dollars in thousands): Three Months Ended Nine Months Ended September 30, 2020 September 30, 2019 September 30, 2020 September 30, 2019 Revenues: Amount (1) % Amount % Amount (1) % Amount % United States $ 819,057 79.0 % $ 1,039,016 82.1 % $ 2,820,609 81.0 % $ 3,175,059 82.3 % United Kingdom 110,281 10.6 % 110,303 8.7 % 337,601 9.7 % 335,368 8.7 % Canada 107,536 10.4 % 116,814 9.2 % 325,741 9.3 % 348,057 9.0 % Total $ 1,036,874 100.0 % $ 1,266,133 100.0 % $ 3,483,951 100.0 % $ 3,858,484 100.0 % As of September 30, 2020 December 31, 2019 Assets: Amount % Amount % United States $ 26,988,613 83.0 % $ 27,513,911 82.4 % United Kingdom 3,200,439 9.8 % 3,405,388 10.2 % Canada 2,352,545 7.2 % 2,461,452 7.4 % Total $ 32,541,597 100.0 % $ 33,380,751 100.0 % (1) The United States, United Kingdom and Canada represent 76%, 11% and 13%, respectively, of our resident fees and services revenue stream for the three and nine months ended September 30, 2020.

Income Taxes and Distributions

Income Taxes and Distributions	9 Months Ended
	Sep. 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 nine months ended September 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	9 Months Ended
	Sep. 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): September 30, 2020 December 31, 2019 Assets: Net real estate investments $ 456,006 $ 960,093 Cash and cash equivalents 22,958 27,522 Receivables and other assets 13,169 14,586 Total assets (1) $ 492,133 $ 1,002,201 Liabilities and equity: Secured debt $ 166,122 $ 460,117 Lease liabilities 1,325 1,326 Accrued expenses and other liabilities 18,910 22,215 Total equity 305,776 518,543 Total liabilities and equity $ 492,133 $ 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)	9 Months Ended	12 Months Ended
	Sep. 30, 2020	Dec. 31, 2019
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation The accompanying unaudited consolidated financial statements have been prepared in accordance with U.S. generally accepted accounting principles (“U.S. GAAP”) for interim financial information and with instructions to Quarterly Report on Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all of the information and footnotes required by U.S. GAAP for complete financial statements. In the opinion of management, all adjustments (such as normal recurring accruals) considered necessary for a fair presentation have been included. Operating results for the nine months ended September 30, 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 • 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, certain tenants and operators have requested rent relief, most often in the form of a short-term rent deferral. Not all requests result in modification of agreements, nor do we intend to forgo our contractual rights under our lease agreements. We evaluate each rent relief request on an individual basis. To date, the majority of rent deferral agreements result in two months of full or partial rent relief to repaid by the end of the year and we generally expect this to continue to be the case unless local ordinances mandate otherwise. 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 and Relat_3

Accounting Policies and Related Matters (Tables)	9 Months Ended
	Sep. 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 August September Spot occupancy (1) 85.6 % 84.8 % 82.5 % 80.8 % 79.9 % 79.2 % 78.7 % 78.4 % Sequential occupancy change (0.8) % (2.3) % (1.7) % (0.9) % (0.7) % (0.5) % (0.3) % (1) Spot occupancy represents approximate month end occupancy for properties in operation as of February 29, 2020, including unconsolidated properties but excluding acquisitions, dispositions and development conversions since this date.

Real Property Acquisitions an_2

Real Property Acquisitions and Development (Tables)	9 Months Ended
	Sep. 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): Nine Months Ended September 30, 2020 September 30, 2019 Seniors Housing Operating Triple-net Outpatient Totals Seniors Housing Operating Triple-net Outpatient Totals Land and land improvements $ 15,758 $ — $ 43,252 $ 59,010 $ 107,945 $ 14,172 $ 187,301 $ 309,418 Buildings and improvements 132,481 765 171,630 304,876 1,138,484 125,763 1,324,371 2,588,618 Acquired lease intangibles 10,810 — 23,823 34,633 61,163 — 104,309 165,472 Construction in progress — — — — 36,174 — — 36,174 Real property held for sale — — — — 17,435 — — 17,435 Right of use assets, net — — — — — — 58,377 58,377 Total net real estate assets 159,049 765 238,705 398,519 1,361,201 139,935 1,674,358 3,175,494 Receivables and other assets 257 — 139 396 6,742 — 419 7,161 Total assets acquired (1) 159,306 765 238,844 398,915 1,367,943 139,935 1,674,777 3,182,655 Secured debt — — — — (43,209) — — (43,209) Lease liabilities — — — — — — (47,740) (47,740) Accrued expenses and other liabilities (671) — (2,043) (2,714) (9,639) (100) (23,483) (33,222) Total liabilities acquired (671) — (2,043) (2,714) (52,848) (100) (71,223) (124,171) Noncontrolling interests (2) (2,827) — — (2,827) (39,570) (1,056) (1,201) (41,827) Non-cash acquisition related activity (3) — — — — (11,889) — — (11,889) Cash disbursed for acquisitions 155,808 765 236,801 393,374 1,263,636 138,779 1,602,353 3,004,768 Construction in progress additions 75,617 33,021 33,593 142,231 188,178 37,978 42,316 268,472 Less: Capitalized interest (7,760) (2,569) (2,905) (13,234) (5,972) (1,565) (2,867) (10,404) Accruals (4) (1,376) — (922) (2,298) — — 45 45 Cash disbursed for construction in progress 66,481 30,452 29,766 126,699 182,206 36,413 39,494 258,113 Capital improvements to existing properties 130,465 5,971 46,888 183,324 160,260 10,337 35,816 206,413 Total cash invested in real property, net of cash acquired $ 352,754 $ 37,188 $ 313,455 $ 703,397 $ 1,606,102 $ 185,529 $ 1,677,663 $ 3,469,294 (1) Excludes $580,000 and $1,910,000 of unrestricted and restricted cash acquired during the nine months ended September 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. Nine Months Ended September 30, 2020 September 30, 2019 Development projects: Seniors Housing Operating $ 93,188 $ 28,117 Triple-net 59,201 — Outpatient Medical 43,493 — Total development projects 195,882 28,117 Expansion projects 48,600 — Total construction in progress conversions $ 244,482 $ 28,117

Real Estate Intangibles (Tables

Real Estate Intangibles (Tables)	9 Months Ended
	Sep. 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): September 30, 2020 December 31, 2019 Assets: In place lease intangibles $ 1,410,935 $ 1,513,836 Above market tenant leases 55,437 59,540 Lease commissions 42,681 43,675 Gross historical cost 1,509,053 1,617,051 Accumulated amortization (1,171,721) (1,181,158) Net book value $ 337,332 $ 435,893 Weighted-average amortization period in years 10.9 10.3 Liabilities: Below market tenant leases $ 81,385 $ 99,035 Accumulated amortization (41,662) (49,390) Net book value $ 39,723 $ 49,645 Weighted-average amortization period in years 8.3 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 September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Rental income related to (above)/below market tenant leases, net $ 327 $ 291 $ 1,252 $ 210 Amortization related to in place lease intangibles and lease commissions (28,948) (48,414) (98,241) (101,837)
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 $ 23,561 $ 2,146 2021 63,988 8,135 2022 43,080 7,448 2023 34,711 5,228 2024 27,088 3,082 Thereafter 144,904 13,684 Total $ 337,332 $ 39,723

Dispositions and Assets Held _2

Dispositions and Assets Held for Sale (Tables)	9 Months Ended
	Sep. 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): Nine Months Ended September 30, 2020 2019 Real estate dispositions: Seniors Housing Operating $ 1,093,477 $ 1,204,084 Triple-net 33,445 660,885 Outpatient Medical 1,394,971 482 Total dispositions 2,521,893 1,865,451 Gain (loss) on real estate dispositions, net 902,991 735,977 Net other assets/liabilities disposed 98,065 (357) Proceeds from real estate dispositions $ 3,522,949 $ 2,601,071
Dispositions and Assets Held for Sale	The following represents the activity related to these properties for the periods presented (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Revenues: Total revenues $ 36,820 $ 133,661 $ 207,918 $ 554,744 Expenses: Interest expense 584 4,593 6,579 14,801 Property operating expenses 22,485 68,848 117,069 305,598 Provision for depreciation 5,907 23,627 37,254 94,694 Total expenses 28,976 97,068 160,902 415,093 Income (loss) from real estate dispositions, net $ 7,844 $ 36,593 $ 47,016 $ 139,651

Leases (Tables)

Leases (Tables)	9 Months Ended
	Sep. 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): Nine Months Ended Classification September 30, 2020 September 30, 2019 Operating lease cost: (1) Real estate lease expense Property operating expenses $ 17,397 $ 18,326 Non-real estate investment lease expense General and administrative expenses 3,673 1,286 Finance lease cost: Amortization of leased assets Property operating expenses 6,229 6,549 Interest on lease liabilities Interest expense 4,693 3,497 Sublease income Rental income (3,130) (3,130) Total $ 28,862 $ 26,528 (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 September 30, 2020 December 31, 2019 Right of use assets: Operating leases - real estate Right of use assets, net $ 323,200 $ 374,217 Finance leases - real estate Right of use assets, net 157,661 162,216 Real estate right of use assets, net 480,861 536,433 Operating leases - non-real estate investments Receivables and other assets 10,328 12,474 Total right of use assets, net $ 491,189 $ 548,907 Lease liabilities: Operating leases $ 320,044 $ 364,803 Financing leases 107,798 108,890 Total $ 427,842 $ 473,693

Loans Receivable (Tables)

Loans Receivable (Tables)	9 Months Ended
	Sep. 30, 2020
Receivables [Abstract]
Summary of Loans Receivable	The following is a summary of our loans receivable (in thousands): September 30, 2020 December 31, 2019 Mortgage loans $ 293,351 $ 188,062 Other real estate loans 127,988 124,696 Allowance for credit losses on real estate loans receivable (6,633) (42,376) Real estate loans receivable, net of credit allowance 414,706 270,382 Non-real estate loans 460,411 362,850 Allowance for credit losses on non-real estate loans receivable (78,262) (25,996) Non-real estate loans receivable, net of credit allowance 382,149 336,854 Total loans receivable, net of credit allowance $ 796,855 $ 607,236
Summary of Loan Activity	The following is a summary of our loan activity for the periods presented (in thousands): Nine Months Ended September 30, 2020 September 30, 2019 Advances on loans receivable: Investments in new loans $ 194,942 $ 36,024 Draws on existing loans 21,365 54,832 Net cash advances on loans receivable 216,307 90,856 Receipts on loans receivable: Loan payoffs — 37,686 Principal payments on loans 14,345 19,439 Net cash receipts on loans receivable 14,345 57,125 Net cash advances (receipts) on loans receivable $ 201,962 $ 33,731
Schedule of Credit Loss	The following is a summary of our loans by credit loss category (in thousands): September 30, 2020 Loan category Years of Origination Loan Carrying Value Allowance for Credit Loss Net Loan Balance No. of Loans Deteriorated loans (1) 2007 - 2018 $ 249,314 $ (76,695) $ 172,619 7 Collective loan pool 2007 - 2015 129,949 (1,886) 128,063 15 Collective loan pool 2016 124,599 (1,612) 122,987 4 Collective loan pool 2017 124,840 (1,074) 123,766 7 Collective loan pool 2018 17,314 (251) 17,063 1 Collective loan pool 2019 49,274 (684) 48,590 7 Collective loan pool 2020 186,460 (2,693) 183,767 6 Total loans $ 881,750 $ (84,895) $ 796,855 47 (1) During the three months ended September 30, 2020, two loans receivable originated in 2016 to Genesis Healthcare with an aggregate carrying value of $62,753,000 were transferred to the deteriorated loan pool. The carrying value is exclusive of deferred gains of $62,819,000 recorded in accrued expenses and other liabilities on the Consolidated Balance Sheets. Nine Months Ended September 30, 2020 September 30, 2019 Balance at beginning of period $ 68,372 $ 68,372 Adoption of ASU 2016-13 5,212 — Provision for loan losses 11,351 18,690 Loan write-offs — (18,690) Foreign currency translation (40) — Balance at end of period $ 84,895 $ 68,372
Summary of Impaired Loans	The following is a summary of our deteriorated loans (in thousands): Nine Months Ended September 30, 2020 September 30, 2019 Balance of deteriorated loans at end of period (1) $ 249,314 $ 188,043 Allowance for credit losses (76,695) (68,372) Balance of deteriorated loans not reserved $ 172,619 $ 119,671 Interest recognized on deteriorated loans (2) $ 13,847 $ 12,082 (1) Current year amounts include $10,686,000 and $2,534,000 of loans on non-accrual as of September 30, 2020 and December 31, 2019, respectively. Prior year amounts include $2,534,000 and $2,567,000 as of September 30, 2019 and December 31, 2018, respectively. (2) Represents cash interest recognized in the period.

Investments in Unconsolidated_2

Investments in Unconsolidated Entities (Tables)	9 Months Ended
	Sep. 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) September 30, 2020 December 31, 2019 Seniors Housing Operating 10% to 65% $ 582,378 $ 463,741 Triple-net 10% to 25% 160 7,740 Outpatient Medical 15% to 50% 240,048 111,942 Total $ 822,586 $ 583,423 (1) Excludes ownership of in substance real estate.

Credit Concentration (Tables)

Credit Concentration (Tables)	9 Months Ended
	Sep. 30, 2020
Risks and Uncertainties [Abstract]
Summary of Credit Concentration	The following table summarizes certain information about our credit concentration for the nine months ended September 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 $ 194,952 13% ProMedica 215 159,562 11% Revera (3) 94 81,317 5% Avery Healthcare 59 56,192 4% Sagora Senior Living 31 50,539 3% Remaining portfolio 924 964,127 64% Totals 1,488 $ 1,506,689 100% (1) Sunrise Senior Living and Revera are in our Seniors Housing Operating segment. ProMedica is in our Triple-net segment. Avery Healthcare and Sagora Senior Living are 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)	9 Months Ended
	Sep. 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 September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Balance outstanding at quarter end $ — $ 1,335,000 $ — $ 1,335,000 Maximum amount outstanding at any month end $ — $ 1,335,000 $ 2,100,000 $ 2,880,000 Average amount outstanding (total of daily principal balances divided by days in period) $ — $ 1,296,185 $ 663,895 $ 1,299,963 Weighted average interest rate (actual interest expense divided by average borrowings outstanding) — % 2.82 % 2.09 % 3.02 %

Senior Unsecured Notes and Se_2

Senior Unsecured Notes and Secured Debt (Tables)	9 Months Ended
	Sep. 30, 2020
Debt Disclosure [Abstract]
Annual Principal Payments Due on Debt Obligations	At September 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 $ — $ 75,915 $ 75,915 2021 — 433,616 433,616 2022 (4) 870,000 449,248 1,319,248 2023 (5,6) 1,361,397 329,650 1,691,047 2024 1,350,000 178,285 1,528,285 Thereafter (7,8,9) 7,831,880 1,002,474 8,834,354 Totals $ 11,413,277 $ 2,469,188 $ 13,882,465 (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 0.86% to 6.50%. (3) Annual interest rates range from 0.10% to 12.00%. Carrying value of the properties securing the debt totaled $5,315,000,000 at September 30, 2020. (4) Includes a $860,000,000 unsecured term credit facility. The loan matures on April 1, 2022 and bears interest at LIBOR plus 1.20% (1.34% at September 30, 2020). (5) Includes a $250,000,000 Canadian-denominated unsecured term credit facility (approximately $187,645,000 based on the Canadian/U.S. Dollar exchange rate on September 30, 2020). The loan matures on July 19, 2023 and bears interest at the Canadian Dealer Offered Rate plus 0.9% (1.38% at September 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% (1.06% at September 30, 2020). (7) Includes a $300,000,000 Canadian-denominated 2.95% senior unsecured notes due 2027 (approximately $225,175,000 based on the Canadian/U.S. Dollar exchange rate on September 30, 2020). (8) Includes a £550,000,000 4.80% senior unsecured notes due 2028 (approximately $710,655,000 based on the Sterling/U.S. Dollar exchange rate in effect on September 30, 2020). (9) Includes a £500,000,000 4.50% senior unsecured notes due 2034 (approximately $646,050,000 based on the Sterling/U.S. Dollar exchange rate in effect on September 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): Nine Months Ended September 30, 2020 September 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% 3,260,000 3.47% Debt extinguished (566,248) 3.26% (3,107,500) 4.47% Foreign currency (48,037) 4.14% (35,208) 4.35% Ending balance $ 11,413,277 3.67% $ 9,817,276 4.12% The following is a summary of our secured debt principal activity for the periods presented (dollars in thousands): Nine Months Ended September 30, 2020 September 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% 318,854 3.51% Debt assumed — —% 42,000 4.62% Debt extinguished (491,506) 2.61% (193,604) 4.37% Principal payments (46,585) 3.60% (40,348) 3.69% Foreign currency (30,984) 3.19% 26,402 3.20% Ending balance $ 2,469,188 3.16% $ 2,639,015 3.66%

Derivative Instruments (Tables)

Derivative Instruments (Tables)	9 Months Ended
	Sep. 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): September 30, 2020 December 31, 2019 Derivatives designated as net investment hedges: Denominated in Canadian Dollars $ 650,000 $ 725,000 Denominated in Pound Sterling £ 1,340,708 £ 1,340,708 Financial instruments designated as net investment hedges: Denominated in Canadian Dollars $ 250,000 $ 250,000 Denominated in Pound Sterling £ 1,050,000 £ 1,050,000 Interest rate swaps designated as cash flow hedges: Denominated in U.S Dollars (1) $ 450,000 $ 1,188,250 Derivative instruments not designated: Interest rate caps denominated in U.S. Dollars $ 95,086 $ 405,819 Forward sales contracts denominated in Canadian Dollars $ 80,000 $ — Forward purchase contracts denominated in Pound Sterling £ — £ (125,000) Forward sales contracts denominated in Pound 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 September 30, Nine Months Ended September 30, Description Location 2020 2019 2020 2019 Gain (loss) on derivative instruments designated as hedges recognized in income Interest expense $ 5,724 $ 7,478 $ 16,475 $ 19,945 Gain (loss) on derivative instruments not designated as hedges recognized in income Interest expense $ (1,159) $ 600 $ (3,207) $ (2,065) Gain (loss) on derivative and financial instruments designated as hedges recognized in OCI OCI $ (145,512) $ 78,947 $ 86,429 $ 91,672

Stockholders' Equity (Tables)

Stockholders' Equity (Tables)	9 Months Ended
	Sep. 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: September 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 418,877,323 411,550,857 Outstanding shares 417,305,044 410,256,615 Nine Months Ended September 30, 2020 September 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 nine months ended September 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 4,438,787 $ 75.59 $ 335,535 $ 332,054 2019 Option exercises 10,736 51.32 551 551 2019 Equity shelf program issuances 4,729,045 75.24 355,803 353,500 2019 Preferred stock conversions 12,712,452 — — 2019 Stock incentive plans, net of forfeitures 192,237 — — 2019 Totals 22,083,257 $ 691,889 $ 686,105 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 185,994 — — 2020 Totals 7,250,376 $ 607,189 $ 595,313
Summary of Dividend Payments	The following is a summary of our dividend payments (in thousands, except per share amounts): Nine Months Ended September 30, 2020 September 30, 2019 Per Share Amount Per Share Amount Common stock $ 2.09 $ 865,357 $ 2.61 $ 1,051,687
Summary of Accumulated Other Comprehensive Income (Loss)	The following is a summary of accumulated other comprehensive income (loss) for the periods presented (in thousands): September 30, 2020 December 31, 2019 Foreign currency translation $ (820,555) $ (719,814) Derivative and financial instruments designated as hedges 694,086 607,657 Total accumulated other comprehensive income (loss) $ (126,469) $ (112,157)

Earnings Per Share (Tables)

Earnings Per Share (Tables)	9 Months Ended
	Sep. 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 September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Numerator for basic earnings per share - net income (loss) attributable to common stockholders $ 325,585 $ 589,876 $ 815,115 $ 1,008,108 Adjustment for net income (loss) attributable to OP units (1,716) 492 (4,470) 580 Numerator for diluted earnings per share $ 323,869 $ 590,368 $ 810,645 $ 1,008,688 Denominator for basic earnings per share - weighted average shares 417,027 405,023 414,822 400,441 Effect of dilutive securities: Non-vested restricted shares 542 757 620 860 Redeemable OP units 1,396 1,096 1,396 1,096 Employee stock purchase program 22 15 22 15 Dilutive potential common shares 1,960 1,868 2,038 1,971 Denominator for diluted earnings per share - adjusted weighted average shares 418,987 406,891 416,860 402,412 Basic earnings per share $ 0.78 $ 1.46 $ 1.96 $ 2.52 Diluted earnings per share $ 0.77 $ 1.45 $ 1.94 $ 2.51

Disclosure about Fair Value o_2

Disclosure about Fair Value of Financial Instruments (Tables)	9 Months Ended
	Sep. 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): September 30, 2020 December 31, 2019 Carrying Amount Fair Value Carrying Amount Fair Value Financial assets: Mortgage loans receivable $ 289,082 $ 295,597 $ 145,686 $ 150,217 Other real estate loans receivable 125,624 129,069 124,696 128,512 Equity securities 5,205 5,205 15,685 15,685 Cash and cash equivalents 1,603,740 1,603,740 284,917 284,917 Restricted cash 551,593 551,593 100,849 100,849 Non-real estate loans receivable 382,149 430,558 336,854 379,239 Foreign currency forward contracts, interest rate swaps and cross currency swaps 81,964 81,964 18,554 18,554 Financial liabilities: Borrowings under unsecured credit facility and commercial paper program $ — $ — $ 1,587,597 $ 1,587,597 Senior unsecured notes 11,321,573 12,603,853 10,336,513 11,400,571 Secured debt 2,459,659 2,541,260 2,990,962 3,041,893 Foreign currency forward contracts, interest rate swaps and cross currency swaps 64,100 64,100 53,601 53,601 Redeemable OP unitholder interests $ 100,513 $ 98,335 $ 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 September 30, 2020 Total Level 1 Level 2 Level 3 Equity securities $ 5,205 $ 5,205 $ — $ — Foreign currency forward contracts, interest rate swaps and cross currency swaps, net asset (liability) (1) 17,864 — 17,864 — Totals $ 23,069 $ 5,205 $ 17,864 $ — (1) Please see Note 12 for additional information.

Segment Reporting (Tables)

Segment Reporting (Tables)	9 Months Ended
	Sep. 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 September 30, 2020: Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 740,956 $ — $ — $ — $ 740,956 Rental income — 103,938 171,108 — 275,046 Interest income 113 15,877 760 — 16,750 Other income 996 1,113 836 1,177 4,122 Total revenues 742,065 120,928 172,704 1,177 1,036,874 Property operating expenses 567,704 12,567 52,728 1,718 634,717 Consolidated net operating income 174,361 108,361 119,976 (541) 402,157 Depreciation and amortization 133,224 58,157 64,151 — 255,532 Interest expense 12,728 2,070 4,287 105,766 124,851 General and administrative expenses — — — 31,003 31,003 Loss (gain) on derivatives and financial instruments, net — 1,395 — — 1,395 Loss (gain) on extinguishment of debt, net — — — 33,004 33,004 Provision for loan losses 86 372 2,399 — 2,857 Impairment of assets 12,778 10,535 — — 23,313 Other expenses 6,488 2,805 781 1,470 11,544 Income (loss) from continuing operations before income taxes and other items 9,057 33,027 48,358 (171,784) (81,342) Income tax (expense) benefit — — — (2,003) (2,003) Income (loss) from unconsolidated entities (7,678) (423) 2,120 — (5,981) Gain (loss) on real estate dispositions, net 313,319 (619) 171,604 — 484,304 Income (loss) from continuing operations 314,698 31,985 222,082 (173,787) 394,978 Net income (loss) $ 314,698 $ 31,985 $ 222,082 $ (173,787) $ 394,978 Total assets $ 15,063,405 $ 9,075,910 $ 6,892,502 $ 1,509,780 $ 32,541,597 Three Months Ended September 30, 2019: Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 834,121 $ — $ — $ — $ 834,121 Rental income — 227,499 184,648 — 412,147 Interest income — 15,279 358 — 15,637 Other income 1,375 1,829 183 841 4,228 Total revenues 835,496 244,607 185,189 841 1,266,133 Property operating expenses 581,341 13,922 60,325 — 655,588 Consolidated net operating income 254,155 230,685 124,864 841 610,545 Depreciation and amortization 148,126 57,147 67,172 — 272,445 Interest expense 16,356 3,076 3,363 114,548 137,343 General and administrative expenses — — — 31,019 31,019 Loss (gain) on derivatives and financial instruments, net — 1,244 — — 1,244 Loss (gain) on extinguishment of debt, net 1,450 — — 64,374 65,824 Impairment of assets 2,599 12,314 3,183 — 18,096 Other expenses 4,274 (2,496) 524 3,884 6,186 Income (loss) from continuing operations before income taxes and other items 81,350 159,400 50,622 (212,984) 78,388 Income tax (expense) benefit — — — (3,968) (3,968) Income (loss) from unconsolidated entities (3,859) 5,276 1,845 — 3,262 Gain (loss) on real estate dispositions, net 519,203 51,529 (482) — 570,250 Income (loss) from continuing operations 596,694 216,205 51,985 (216,952) 647,932 Net income (loss) $ 596,694 $ 216,205 $ 51,985 $ (216,952) $ 647,932 Nine Months Ended September 30, 2020 Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 2,360,488 $ — $ — $ — $ 2,360,488 Rental income — 512,815 548,496 — 1,061,311 Interest income 305 46,068 1,687 — 48,060 Other income 6,050 3,393 2,681 1,968 14,092 Total revenues 2,366,843 562,276 552,864 1,968 3,483,951 Property operating expenses 1,771,088 39,432 165,024 1,718 1,977,262 Consolidated net operating income 595,755 522,844 387,840 250 1,506,689 Depreciation and amortization 419,161 173,989 202,554 — 795,704 Interest expense 43,191 7,668 13,421 328,935 393,215 General and administrative expenses — — — 100,546 100,546 Loss (gain) on derivatives and financial instruments, net — 10,480 — — 10,480 Loss (gain) on extinguishment of debt, net (492) — 741 33,004 33,253 Provision for loan losses 86 8,895 2,370 — 11,351 Impairment of assets 91,424 34,867 — — 126,291 Other expenses 13,463 6,818 8,244 8,722 37,247 Income (loss) from continuing operations before income taxes and other items 28,922 280,127 160,510 (470,957) (1,398) Income tax (expense) benefit — — — (9,678) (9,678) Income (loss) from unconsolidated entities (25,489) 11,776 5,372 — (8,341) Gain (loss) on real estate dispositions, net 327,635 51,166 524,190 — 902,991 Income (loss) from continuing operations 331,068 343,069 690,072 (480,635) 883,574 Net income (loss) $ 331,068 $ 343,069 $ 690,072 $ (480,635) $ 883,574 Nine Months Ended September 30, 2019 Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 2,616,491 $ — $ — $ — $ 2,616,491 Rental income — 681,893 496,924 — 1,178,817 Interest income — 47,343 769 — 48,112 Other income 6,920 4,370 322 3,452 15,064 Total revenues 2,623,411 733,606 498,015 3,452 3,858,484 Property operating expenses 1,826,344 41,700 159,478 — 2,027,522 Consolidated net operating income 797,067 691,906 338,537 3,452 1,830,962 Depreciation and amortization 416,252 174,551 173,626 — 764,429 Interest expense 52,179 9,741 10,097 351,894 423,911 General and administrative expenses — — — 100,042 100,042 Loss (gain) on derivatives and financial — 670 — — 670 Loss (gain) on extinguishment of debt, net 1,450 — — 80,093 81,543 Provision for loan losses — 18.69 18,690 — — 18.69 — 18,690 Impairment of assets 2,599 11,374 14,062 — 28,035 Other expenses 19,077 6,093 1,274 10,126 36,570 Income (loss) from continuing operations before income taxes and other items 305,510 470,787 139,478 (538,703) 377,072 Income tax (expense) benefit — — — (7,789) (7,789) Income (loss) from unconsolidated entities (37,892) 17,512 5,394 — (14,986) Gain (loss) on real estate dispositions, net 518,493 217,973 (489) — 735,977 Income (loss) from continuing operations 786,111 706,272 144,383 (546,492) 1,090,274 Net income (loss) $ 786,111 $ 706,272 $ 144,383 $ (546,492) $ 1,090,274
Summary of Geographic Information	The following is a summary of geographic information for the periods presented (dollars in thousands): Three Months Ended Nine Months Ended September 30, 2020 September 30, 2019 September 30, 2020 September 30, 2019 Revenues: Amount (1) % Amount % Amount (1) % Amount % United States $ 819,057 79.0 % $ 1,039,016 82.1 % $ 2,820,609 81.0 % $ 3,175,059 82.3 % United Kingdom 110,281 10.6 % 110,303 8.7 % 337,601 9.7 % 335,368 8.7 % Canada 107,536 10.4 % 116,814 9.2 % 325,741 9.3 % 348,057 9.0 % Total $ 1,036,874 100.0 % $ 1,266,133 100.0 % $ 3,483,951 100.0 % $ 3,858,484 100.0 % As of September 30, 2020 December 31, 2019 Assets: Amount % Amount % United States $ 26,988,613 83.0 % $ 27,513,911 82.4 % United Kingdom 3,200,439 9.8 % 3,405,388 10.2 % Canada 2,352,545 7.2 % 2,461,452 7.4 % Total $ 32,541,597 100.0 % $ 33,380,751 100.0 % (1) The United States, United Kingdom and Canada represent 76%, 11% and 13%, respectively, of our resident fees and services revenue stream for the three and nine months ended September 30, 2020.

Variable Interest Entities (Tab

Variable Interest Entities (Tables)	9 Months Ended
	Sep. 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): September 30, 2020 December 31, 2019 Assets: Net real estate investments $ 456,006 $ 960,093 Cash and cash equivalents 22,958 27,522 Receivables and other assets 13,169 14,586 Total assets (1) $ 492,133 $ 1,002,201 Liabilities and equity: Secured debt $ 166,122 $ 460,117 Lease liabilities 1,325 1,326 Accrued expenses and other liabilities 18,910 22,215 Total equity 305,776 518,543 Total liabilities and equity $ 492,133 $ 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_4

Accounting Policies and Related Matters - Spot Occupancy (Details) - Seniors Housing Operating - COVID-19	Sep. 30, 2020	Aug. 31, 2020	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	78.40%	78.70%	79.20%	79.90%	80.80%	82.50%	84.80%	85.60%
Sequential occupancy change	(0.30%)	(0.50%)	(0.70%)	(0.90%)	(1.70%)	(2.30%)	(0.80%)

Accounting Policies and Relat_5

Accounting Policies and Related Matters - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended	9 Months Ended	12 Months Ended
	Sep. 30, 2020	Sep. 30, 2020	Dec. 31, 2019	Sep. 30, 2019	Dec. 31, 2018
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Increase in operational cost	$ 18,192	$ 68,628
Cost of property operating expense		46,000
Allowance for credit loss on loans receivable	$ 84,895	$ 84,895	$ 68,372	$ 68,372	$ 68,372
Accounting Standards Update [Extensible List]		us-gaap:AccountingStandardsUpdate201613Member	us-gaap:AccountingStandardsUpdate201613Member
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
COVID-19
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Rent collected percentage	99.00%
Percentage of rent cash collection	97.00%
Percentage of rent approved for deferral	2.00%
Percentage of deferred rent collected	99.00%

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	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019
Business Acquisition [Line Items]
Land and land improvements	$ 59,010	$ 309,418
Buildings and improvements	304,876	2,588,618
Acquired lease intangibles	34,633	165,472
Construction in progress	0	36,174
Real property held for sale	0	17,435
Right of use assets, net	0	58,377
Total net real estate assets	398,519	3,175,494
Receivables and other assets	396	7,161
Total assets acquired	398,915	3,182,655
Secured debt	0	(43,209)
Lease liabilities	0	(47,740)
Accrued expenses and other liabilities	(2,714)	(33,222)
Total liabilities acquired	(2,714)	(124,171)
Noncontrolling interests	(2,827)	(41,827)
Non-cash acquisition related activity	0	(11,889)
Cash disbursed for acquisitions	393,374	3,004,768
Construction in progress additions	142,231	268,472
Less: Capitalized interest	(13,234)	(10,404)
Accruals	(2,298)	45
Cash disbursed for construction in progress	126,699	258,113
Capital improvements to existing properties	183,324	206,413
Total cash invested in real property, net of cash acquired	703,397	3,469,294
Cash acquired from acquisition	580	1,910
Seniors Housing Operating
Business Acquisition [Line Items]
Land and land improvements	15,758	107,945
Buildings and improvements	132,481	1,138,484
Acquired lease intangibles	10,810	61,163
Construction in progress	0	36,174
Real property held for sale	0	17,435
Right of use assets, net	0	0
Total net real estate assets	159,049	1,361,201
Receivables and other assets	257	6,742
Total assets acquired	159,306	1,367,943
Secured debt	0	(43,209)
Lease liabilities	0	0
Accrued expenses and other liabilities	(671)	(9,639)
Total liabilities acquired	(671)	(52,848)
Noncontrolling interests	(2,827)	(39,570)
Non-cash acquisition related activity	0	(11,889)
Cash disbursed for acquisitions	155,808	1,263,636
Construction in progress additions	75,617	188,178
Less: Capitalized interest	(7,760)	(5,972)
Accruals	(1,376)	0
Cash disbursed for construction in progress	66,481	182,206
Capital improvements to existing properties	130,465	160,260
Total cash invested in real property, net of cash acquired	352,754	1,606,102
Triple-net
Business Acquisition [Line Items]
Land and land improvements	0	14,172
Buildings and improvements	765	125,763
Acquired lease intangibles	0	0
Construction in progress	0	0
Real property held for sale	0	0
Right of use assets, net	0	0
Total net real estate assets	765	139,935
Receivables and other assets	0	0
Total assets acquired	765	139,935
Secured debt	0	0
Lease liabilities	0	0
Accrued expenses and other liabilities	0	(100)
Total liabilities acquired	0	(100)
Noncontrolling interests	0	(1,056)
Non-cash acquisition related activity	0	0
Cash disbursed for acquisitions	765	138,779
Construction in progress additions	33,021	37,978
Less: Capitalized interest	(2,569)	(1,565)
Accruals	0	0
Cash disbursed for construction in progress	30,452	36,413
Capital improvements to existing properties	5,971	10,337
Total cash invested in real property, net of cash acquired	37,188	185,529
Outpatient Medical
Business Acquisition [Line Items]
Land and land improvements	43,252	187,301
Buildings and improvements	171,630	1,324,371
Acquired lease intangibles	23,823	104,309
Construction in progress	0	0
Real property held for sale	0	0
Right of use assets, net	0	58,377
Total net real estate assets	238,705	1,674,358
Receivables and other assets	139	419
Total assets acquired	238,844	1,674,777
Secured debt	0	0
Lease liabilities	0	(47,740)
Accrued expenses and other liabilities	(2,043)	(23,483)
Total liabilities acquired	(2,043)	(71,223)
Noncontrolling interests	0	(1,201)
Non-cash acquisition related activity	0	0
Cash disbursed for acquisitions	236,801	1,602,353
Construction in progress additions	33,593	42,316
Less: Capitalized interest	(2,905)	(2,867)
Accruals	(922)	45
Cash disbursed for construction in progress	29,766	39,494
Capital improvements to existing properties	46,888	35,816
Total cash invested in real property, net of cash acquired	$ 313,455	$ 1,677,663

Real Property Acquisitions an_4

Real Property Acquisitions and Development - Construction Activity (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019
Segment Reporting Information [Line Items]
Total development projects	$ 195,882	$ 28,117
Expansion projects	48,600	0
Total construction in progress conversions	244,482	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	59,201	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	9 Months Ended	12 Months Ended
	Sep. 30, 2020	Dec. 31, 2019
Assets:
Gross historical cost	$ 1,509,053	$ 1,617,051
Accumulated amortization	(1,171,721)	(1,181,158)
Net book value	$ 337,332	$ 435,893
Weighted-average amortization period in years	10 years 10 months 24 days	10 years 3 months 18 days
Liabilities:
Below market tenant leases	$ 81,385	$ 99,035
Accumulated amortization	(41,662)	(49,390)
Net book value	$ 39,723	$ 49,645
Weighted-average amortization period in years	8 years 3 months 18 days	8 years 7 months 6 days
In place lease intangibles
Assets:
Gross historical cost	$ 1,410,935	$ 1,513,836
Above market tenant leases
Assets:
Gross historical cost	55,437	59,540
Lease commissions
Assets:
Gross historical cost	$ 42,681	$ 43,675

Real Estate Intangibles - Sum_2

Real Estate Intangibles - Summary of Real Estate Intangible Amortization (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Goodwill and Intangible Assets Disclosure [Abstract]
Rental income related to (above)/below market tenant leases, net	$ 327	$ 291	$ 1,252	$ 210
Amortization related to in place lease intangibles and lease commissions	$ (28,948)	$ (48,414)	$ (98,241)	$ (101,837)

Real Estate Intangibles - Sched

Real Estate Intangibles - Schedule of Future Estimated Aggregate Amortization of Intangible Assets and Liabilities (Details) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Assets
2020	$ 23,561
2021	63,988
2022	43,080
2023	34,711
2024	27,088
Thereafter	144,904
Net book value	337,332	$ 435,893
Liabilities
2020	2,146
2021	8,135
2022	7,448
2023	5,228
2024	3,082
Thereafter	13,684
Net book value	$ 39,723	$ 49,645

Dispositions and Assets Held _3

Dispositions and Assets Held for Sale - Narrative (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2020USD ($)property	Dec. 31, 2019USD ($)
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Real property held for sale | $	$ 362,886	$ 1,253,008
Expected proceeds from properties held for sale | $	437,116
Impairment of assets held for sale | $	79,905
Impairment of assets held for use | $	46,386
Held for sale
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Secured debt | $	12,737
Net other assets and liabilities | $	$ 21,063
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	8
Number of properties subject to asset impairment	13
Number of properties held for use	4
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	2
Number of properties subject to asset impairment	1
Number of properties held for use	4
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	11

Dispositions and Assets Held _4

Dispositions and Assets Held for Sale - Summary of Real Property Disposition Activity (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Real estate dispositions:
Total dispositions			$ 2,521,893	$ 1,865,451
Gain (loss) on real estate dispositions, net	$ 484,304	$ 570,250	902,991	735,977
Net other assets/liabilities disposed			98,065	(357)
Proceeds from real estate dispositions			3,522,949	2,601,071
Seniors Housing Operating
Real estate dispositions:
Total dispositions			1,093,477	1,204,084
Triple-net
Real estate dispositions:
Total dispositions			33,445	660,885
Outpatient Medical
Real estate dispositions:
Total dispositions			$ 1,394,971	$ 482

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		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Revenues:
Total revenues	$ 36,820	$ 133,661	$ 207,918	$ 554,744
Expenses:
Interest expense	584	4,593	6,579	14,801
Property operating expenses	22,485	68,848	117,069	305,598
Provision for depreciation	5,907	23,627	37,254	94,694
Total expenses	28,976	97,068	160,902	415,093
Income (loss) from real estate dispositions, net	$ 7,844	$ 36,593	$ 47,016	$ 139,651

Leases - Narrative (Details)

Leases - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Lessee, Lease, Description [Line Items]
Straight line rent adjustment	$ 112,398		$ 146,508
Rental and other revenues related to operating lease payments	$ 275,046	$ 412,147	1,061,311	$ 1,178,817
Rental and other revenues related to operating lease payments, variable leases			153,217	$ 147,815
Genesis Health Care
Lessee, Lease, Description [Line Items]
Straight line rent adjustment			$ 91,025
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	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019
Finance lease cost:
Amortization of leased assets	$ 6,229	$ 6,549
Interest on lease liabilities	4,693	3,497
Sublease income	(3,130)	(3,130)
Total	28,862	26,528
Property operating expenses
Operating lease cost:
Lease expense	17,397	18,326
General and administrative expenses
Operating lease cost:
Lease expense	$ 3,673	$ 1,286

Leases - Supplemental Balance S

Leases - Supplemental Balance Sheet Information Related to Leases (Details) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Right of use assets:
Total right of use assets, net	$ 480,861	$ 536,433
Lease liabilities:
Operating leases	320,044	364,803
Financing leases	107,798	108,890
Total	$ 427,842	$ 473,693
Operating lease, right-of-use asset, statement of financial position	well:LeaseRightOfUseAsset	well:LeaseRightOfUseAsset
Finance lease, right-of-use asset, statement of financial position	well:LeaseRightOfUseAsset	well:LeaseRightOfUseAsset
Operating lease, liability, statement of financial position	well:LeaseLiability	well:LeaseLiability
Finance lease, liability, statement of financial position	well:LeaseLiability	well:LeaseLiability
Real estate
Right of use assets:
Operating leases	$ 323,200	$ 374,217
Finance leases	157,661	162,216
Corporate
Right of use assets:
Operating leases	$ 10,328	$ 12,474
Lease liabilities:
Operating lease, right-of-use asset, statement of financial position	well:ReceivablesAndOtherAssets	well:ReceivablesAndOtherAssets
Real estate and Corporate
Right of use assets:
Total right of use assets, net	$ 491,189	$ 548,907

Loans Receivable - Narrative (D

Loans Receivable - Narrative (Details) - USD ($) $ in Thousands	1 Months Ended	3 Months Ended		9 Months Ended
	Mar. 31, 2019	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019	Dec. 31, 2019
Financing Receivable, Troubled Debt Restructuring [Line Items]
Interest receivable		$ 12,039		$ 12,039		$ 6,897
Non-real estate loans		460,411		460,411		362,850
Allowance for credit losses on non-real estate loans receivable		78,262		78,262		$ 25,996
Provision for loan losses	$ 18,690	2,857	$ 0	11,351	$ 18,690
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	Sep. 30, 2020	Dec. 31, 2019	Sep. 30, 2019	Dec. 31, 2018
Accounts, Notes, Loans and Financing Receivable [Line Items]
Loan Carrying Value	$ 881,750
Allowance for credit losses on real estate loans receivable	(84,895)	$ (68,372)	$ (68,372)	$ (68,372)
Real estate loans receivable, net of credit allowance	414,706	270,382
Non-real estate loans	460,411	362,850
Allowance for credit losses on non-real estate loans receivable	(78,262)	(25,996)
Non-real estate loans receivable, net of credit allowance	382,149	336,854
Total loans receivable, net of credit allowance	796,855	607,236
Mortgage loans
Accounts, Notes, Loans and Financing Receivable [Line Items]
Loan Carrying Value	293,351	188,062
Other real estate loans
Accounts, Notes, Loans and Financing Receivable [Line Items]
Loan Carrying Value	127,988	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	$ (6,633)	$ (42,376)

Loans Receivable - Summary of_2

Loans Receivable - Summary of Real Estate Loan Activity (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019
Advances on loans receivable:
Net cash advances on loans receivable	$ 216,307	$ 90,856
Receipts on loans receivable:
Net cash receipts on loans receivable	14,345	57,125
Seniors Housing Operating
Advances on loans receivable:
Investments in new loans	194,942	36,024
Draws on existing loans	21,365	54,832
Net cash advances on loans receivable	216,307	90,856
Receipts on loans receivable:
Loan payoffs	0	37,686
Principal payments on loans	14,345	19,439
Net cash receipts on loans receivable	14,345	57,125
Net cash advances (receipts) on loans receivable	$ 201,962	$ 33,731

Loans Receivable - Collective P

Loans Receivable - Collective Pool Basis (Details) $ in Thousands	3 Months Ended
	Sep. 30, 2020USD ($)loan	Dec. 31, 2019USD ($)	Sep. 30, 2019USD ($)	Dec. 31, 2018USD ($)
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan Carrying Value	$ 881,750
Allowance for Credit Loss	(84,895)	$ (68,372)	$ (68,372)	$ (68,372)
Real estate loans receivable, net of credit allowance	$ 796,855
No. of Loans | loan	47
Deferred gains	$ 62,819
Deteriorated loans
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan Carrying Value	249,314
Allowance for Credit Loss	(76,695)
Real estate loans receivable, net of credit allowance	$ 172,619
No. of Loans | loan	7
Collective loan pool
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan Carrying Value	$ 129,949
Allowance for Credit Loss	(1,886)
Real estate loans receivable, net of credit allowance	$ 128,063
No. of Loans | loan	15
Collective loan pool
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan Carrying Value	$ 124,599
Allowance for Credit Loss	(1,612)
Real estate loans receivable, net of credit allowance	$ 122,987
No. of Loans | loan	4
Collective loan pool
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan Carrying Value	$ 124,840
Allowance for Credit Loss	(1,074)
Real estate loans receivable, net of credit allowance	$ 123,766
No. of Loans | loan	7
Collective loan pool
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan Carrying Value	$ 17,314
Allowance for Credit Loss	(251)
Real estate loans receivable, net of credit allowance	$ 17,063
No. of Loans | loan	1
Collective loan pool
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan Carrying Value	$ 49,274
Allowance for Credit Loss	(684)
Real estate loans receivable, net of credit allowance	$ 48,590
No. of Loans | loan	7
Collective loan pool
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan Carrying Value	$ 186,460
Allowance for Credit Loss	(2,693)
Real estate loans receivable, net of credit allowance	$ 183,767
No. of Loans | loan	6
Genesis healthcare receivable
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan Carrying Value	$ 62,753
No. of Loans | loan	2

Loans Receivable - Credit Loss

Loans Receivable - Credit Loss Roll Forward (Details) - USD ($) $ in Thousands	9 Months Ended		12 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Dec. 31, 2019
Financing Receivable, Allowance for Credit Loss [Roll Forward]
Balance at beginning of period	$ 68,372	$ 68,372	$ 68,372
Provision for loan losses	11,351	18,690
Loan write-offs	0	(18,690)
Foreign currency translation	(40)	0
Balance at end of period	$ 84,895	68,372	$ 68,372
Accounting Standards Update [Extensible List]	us-gaap:AccountingStandardsUpdate201613Member		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	$ 0
Balance at end of period			$ 5,212

Loans Receivable - Summary of I

Loans Receivable - Summary of Impaired Loans (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Dec. 31, 2019	Dec. 31, 2018
Receivables [Abstract]
Balance of impaired loans at end of period	$ 249,314	$ 188,043
Allowance for credit losses	(76,695)	(68,372)
Balance of deteriorated loans not reserved	172,619	119,671
Interest recognized on impaired loans	13,847	12,082
Carrying value of nonaccrual status	$ 10,686	$ 2,534	$ 2,534	$ 2,567

Investments in Unconsolidated_3

Investments in Unconsolidated Entities - Summary of Investments in Unconsolidated Entities (Details) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated entities	$ 822,586	$ 583,423
Seniors Housing Operating
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated entities	$ 582,378	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	65.00%
Triple-net
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated entities	$ 160	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	$ 240,048	$ 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	9 Months Ended
	Sep. 30, 2020USD ($)property
Schedule of Equity Method Investments [Line Items]
Aggregate unamortized basis difference of joint venture investments	$ 113,217
Total loans made	285,369
Expected additional funding for investments	$ 172,169
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		9 Months Ended
	Sep. 30, 2020USD ($)property	Sep. 30, 2019USD ($)	Sep. 30, 2020USD ($)property	Sep. 30, 2019USD ($)	Dec. 31, 2019
Concentration Risk [Line Items]
Total NOI	$ 402,157	$ 610,545	$ 1,506,689	$ 1,830,962
Percentage total investments with top five customers					37.00%
Net operating income
Concentration Risk [Line Items]
Number of Properties | property	1,488		1,488
Total NOI			$ 1,506,689
Percent of NOI			100.00%
Net operating income | Sunrise Senior Living
Concentration Risk [Line Items]
Number of Properties | property	165		165
Total NOI			$ 194,952
Percent of NOI			13.00%
Net operating income | ProMedica
Concentration Risk [Line Items]
Number of Properties | property	215		215
Total NOI			$ 159,562
Percent of NOI			11.00%
Net operating income | Revera
Concentration Risk [Line Items]
Number of Properties | property	94		94
Total NOI			$ 81,317
Percent of NOI			5.00%
Net operating income | Avery Healthcare
Concentration Risk [Line Items]
Number of Properties | property	59		59
Total NOI			$ 56,192
Percent of NOI			4.00%
Net operating income | Sagora Senior Living
Concentration Risk [Line Items]
Number of Properties | property	31		31
Total NOI			$ 50,539
Percent of NOI			3.00%
Net operating income | Remaining portfolio
Concentration Risk [Line Items]
Number of Properties | property	924		924
Total NOI			$ 964,127
Percent of NOI			64.00%

Borrowings Under Credit Facil_3

Borrowings Under Credit Facilities and Commercial Paper Program - Narrative (Details)	1 Months Ended	9 Months Ended
	Jan. 31, 2019USD ($)	Sep. 30, 2020USD ($)termbank	Dec. 31, 2019USD ($)
Line of Credit Facility [Line Items]
Number of banks in consortium | bank		31
Borrowings outstanding		$ 0	$ 1,587,597,000
Unsecured revolving credit facility
Line of Credit Facility [Line Items]
Unsecured line of credit arrangement		3,000,000,000
Borrowings outstanding		0
Available to borrow in alternate currencies		$ 1,000,000,000
Facility fee		0.15%
Number of successive terms | term		2
Successive term		6 months
Unsecured revolving credit facility | LIBOR
Line of Credit Facility [Line Items]
Debt instrument, basis spread on variable rate		0.825%
Unsecured revolving credit facility | Accordion feature
Line of Credit Facility [Line Items]
Unsecured line of credit arrangement		$ 1,000,000,000
Term credit facility
Line of Credit Facility [Line Items]
Unsecured line of credit arrangement		500,000,000
Term credit facility, CAD denominated
Line of Credit Facility [Line Items]
Unsecured line of credit arrangement		250,000,000
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
Borrowings outstanding		$ 0
Commercial paper note program | Maximum
Line of Credit Facility [Line Items]
Debt instrument, term	397 days

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		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019	Jun. 30, 2020	Dec. 31, 2019	Jun. 30, 2019	Dec. 31, 2018
Debt Disclosure [Abstract]
Balance outstanding at quarter end					$ 0	$ 0	$ 1,335,000	$ 1,335,000
Maximum amount outstanding at any month end	$ 0	$ 1,335,000	$ 2,100,000	$ 2,880,000
Average amount outstanding (total of daily principal balances divided by days in period)	$ 0	$ 1,296,185	$ 663,895	$ 1,299,963
Weighted average interest rate (actual interest expense divided by average borrowings outstanding)	0.00%	2.82%	2.09%	3.02%

Senior Unsecured Notes and Se_3

Senior Unsecured Notes and Secured Debt - Annual Principal Payments Due on Debt Obligations (Details)	9 Months Ended
	Sep. 30, 2020USD ($)	Sep. 30, 2020CAD ($)	Sep. 30, 2020GBP (£)	Dec. 31, 2019USD ($)	Sep. 30, 2019USD ($)	Dec. 31, 2018USD ($)
Annual principal payments due
2020	$ 75,915,000
2021	433,616,000
2022	1,319,248,000
2023	1,691,047,000
2024	1,528,285,000
Thereafter	8,834,354,000
Totals	13,882,465,000
Senior unsecured notes
Annual principal payments due
2020	0
2021	0
2022	870,000,000
2023	1,361,397,000
2024	1,350,000,000
Thereafter	7,831,880,000
Totals	$ 11,413,277,000			$ 10,427,562,000	$ 9,817,276,000	$ 9,699,984,000
Senior unsecured notes | Minimum
Annual principal payments due
Interest rate	0.86%	0.86%	0.86%
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		$ 860,000,000
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	1.34%	1.34%	1.34%
Senior unsecured notes | Canadian-denominated unsecured term credit facility
Annual principal payments due
Face amount	$ 187,645,000	$ 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	1.38%	1.38%	1.38%
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	1.06%	1.06%	1.06%
Senior unsecured notes | 2.95% Senior unsecured notes due 2023
Annual principal payments due
Interest rate	2.95%	2.95%	2.95%
Face amount	$ 225,175,000	$ 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	$ 710,655,000		£ 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	$ 646,050,000		£ 500,000,000
Secured debt
Annual principal payments due
2020	75,915,000
2021	433,616,000
2022	449,248,000
2023	329,650,000
2024	178,285,000
Thereafter	1,002,474,000
Totals	2,469,188,000			$ 2,993,342,000	$ 2,639,015,000	$ 2,485,711,000
Carrying values of properties securing the debt	$ 5,315,000
Secured debt | Minimum
Annual principal payments due
Interest rate	0.10%	0.10%	0.10%
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	9 Months Ended
	Sep. 30, 2020USD ($)	Sep. 30, 2019USD ($)
Amount
Beginning balance
Debt issued	$ 1,588,549	$ 3,253,516
Debt issued	44,921	318,854
Ending balance	13,882,465
Senior unsecured notes
Amount
Beginning balance	10,427,562	9,699,984
Debt issued	1,600,000	3,260,000
Debt extinguished	(566,248)	(3,107,500)
Foreign currency	(48,037)	(35,208)
Ending balance	$ 11,413,277	$ 9,817,276
Weighted Avg. Interest Rate
Beginning balance	4.03%	4.48%
Debt issued	0.0189	0.0347
Debt extinguished	0.0326	0.0447
Foreign currency	0.0414	0.0435
Ending balance	3.67%	4.12%
Secured debt
Amount
Beginning balance	$ 2,993,342	$ 2,485,711
Debt issued	44,921	318,854
Debt assumed	0	42,000
Debt extinguished	(491,506)	(193,604)
Principal payments	(46,585)	(40,348)
Foreign currency	(30,984)	26,402
Ending balance	$ 2,469,188	$ 2,639,015
Weighted Avg. Interest Rate
Beginning balance	3.63%	3.90%
Debt issued	0.0258	0.0351
Debt assumed	0	0.0462
Debt extinguished	0.0261	0.0437
Principal payments	0.0360	0.0369
Foreign currency	0.0319	0.0320
Ending balance	3.16%	3.66%

Senior Unsecured Notes and Se_5

Senior Unsecured Notes and Secured Debt - Narrative (Details) - USD ($) $ in Thousands	1 Months Ended	3 Months Ended		9 Months Ended
	Oct. 29, 2020	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Debt Instrument [Line Items]
Loss (gain) on extinguishment of debt, net		$ 33,004	$ 65,824	$ 33,253	$ 81,543
Subsequent event
Debt Instrument [Line Items]
Loss (gain) on extinguishment of debt, net	$ 12,204
Secured bond
Debt Instrument [Line Items]
Debt extinguished				$ 491,506	$ 193,604
Secured bond | Secured bonds due 2038 | Subsequent event
Debt Instrument [Line Items]
Debt extinguished	20,790
Secured bond | Secured bond due 2040 | Subsequent event
Debt Instrument [Line Items]
Debt extinguished	17,640
Secured bond | Secured bond due 2041 | Subsequent event
Debt Instrument [Line Items]
Debt extinguished	$ 73,140

Derivative Instruments - Narrat

Derivative Instruments - Narrative (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Cash flow hedges to be reclassified within the next twelve months	$ 1,557
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	9 Months Ended		12 Months Ended
	Sep. 30, 2020CAD ($)	Sep. 30, 2020GBP (£)	Dec. 31, 2019CAD ($)	Dec. 31, 2019GBP (£)	Sep. 30, 2020GBP (£)	Sep. 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 Pound 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 Pound Sterling | Derivative Instruments Not Designated | Purchase Contracts
Derivatives, Fair Value [Line Items]
Derivative asset | £					0		125,000
Denominated in Pound 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						$ 450,000		$ 1,188,250
Denominated in U.S Dollars | Derivative Instruments Not Designated
Derivatives, Fair Value [Line Items]
Derivative asset						$ 95,086		$ 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		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Derivative [Line Items]
Gain (loss) on derivative instruments designated as hedges recognized in income	$ (1,395)	$ (1,244)	$ (10,480)	$ (670)
Gain (loss) on derivative and financial instruments designated as hedges recognized in OCI	(145,512)	78,947	86,429	91,672
Foreign Exchange Contract
Derivative [Line Items]
Gain (loss) on derivative and financial instruments designated as hedges recognized in OCI		78,947		91,672
Designated as Hedging Instrument
Derivative [Line Items]
Gain (loss) on derivative instruments designated as hedges recognized in income	5,724	7,478	16,475	19,945
Derivative Instruments Not Designated
Derivative [Line Items]
Gain (loss) on derivative instruments designated as hedges recognized in income	$ (1,159)	$ 600	$ (3,207)	$ (2,065)

Commitments and Contingencies (

Commitments and Contingencies (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2020USD ($)obligation	Dec. 31, 2019USD ($)
Commitments and Contingencies Disclosure [Abstract]
Number of outstanding credit obligations | obligation	8
Letter of credit obligation	$ 14,200
Outstanding construction financings for leased properties	414,833	$ 507,931
Additional financing to complete construction	342,232
Total loans made	285,369
Expected additional funding for investments	172,169
Total contingent purchase obligations	$ 18,488

Stockholders' Equity - Summary

Stockholders' Equity - Summary of Stockholders' Equity Capital Accounts (Details) - $ / shares	Sep. 30, 2020	Dec. 31, 2019	Sep. 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:
Common stock, par value (in dollars per share)	$ 1	$ 1
Authorized shares	700,000,000	700,000,000
Issued shares	418,877,323	411,550,857
Outstanding shares	417,305,044	410,256,615

Stockholders' Equity - Preferre

Stockholders' Equity - Preferred Stock (Details) - shares	9 Months Ended		12 Months Ended
	Sep. 30, 2020	Sep. 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 ($)	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	May 01, 2020	Feb. 28, 2019
Class of Stock [Line Items]
Equity shelf plan issuances	$ 576,196,000	$ 353,500,000
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	9 Months Ended
	Sep. 30, 2020USD ($)shares	Sep. 30, 2019USD ($)shares
Shares Issued
Dividend reinvestment plan issuances (in shares) | shares	264,153	4,438,787
Option exercises (in shares) | shares	251	10,736
Equity shelf program issuances (in shares) | shares	6,799,978	4,729,045
Preferred stock conversions (in shares) | shares		12,712,452
Stock incentive plans, net of forfeitures (in shares) | shares	185,994	192,237
Totals (in shares) | shares	7,250,376	22,083,257
Average Price
Dividend reinvestment plan issuances (in dollars per share)	72.33	75.59
Option exercises (in dollars per share)	47.81	51.32
Equity shelf plan issuances (in dollars per share)	86.48	75.24
Gross Proceeds
Dividend reinvestment plan issuances	$ 19,105	$ 335,535
Option exercises	12	551
Equity shelf plan issuances	588,072	355,803
Totals	607,189	691,889
Net Proceeds
Dividend reinvestment plan issuances	19,105	332,054
Option exercises	12	551
Equity shelf plan issuances	576,196	353,500
Totals	$ 595,313	$ 686,105

Stockholders' Equity - Dividend

Stockholders' Equity - Dividends (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Per Share
Common Stock (in dollars per share)	$ 0.61	$ 0.87	$ 2.09	$ 2.61
Amount
Common stock			$ 865,357	$ 1,051,687

Stockholders' Equity - Accumula

Stockholders' Equity - Accumulated Other Comprehensive Income (Details) - USD ($) $ in Thousands	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2019	Sep. 30, 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)	$ 16,961,102	$ 16,936,527	$ 17,066,337	$ 16,506,627	$ 16,225,729	$ 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)	(820,555)			(719,814)
Derivative and financial instruments designated as hedges
Summary of accumulated other comprehensive income/(loss) [Line Items]
Total accumulated other comprehensive income (loss)	694,086			607,657
Total accumulated other comprehensive income (loss)
Summary of accumulated other comprehensive income/(loss) [Line Items]
Total accumulated other comprehensive income (loss)	$ (126,469)	$ (116,856)	$ (96,213)	$ (112,157)	$ (117,676)	$ (100,622)	$ (144,618)	$ (129,769)

Stock Incentive Plans (Details)

Stock Incentive Plans (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 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	$ 6,565	$ 5,309	$ 20,938	$ 20,501
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		9 Months Ended
		Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Earnings Per Share [Abstract]
Numerator for basic and diluted earnings per share - net income (loss) attributable to common stockholders		$ 325,585	$ 589,876	$ 815,115	$ 1,008,108
Adjustment for net income (loss) attributable to OP units		(1,716)	492	(4,470)	580
Numerator for diluted earnings per share		$ 323,869	$ 590,368	$ 810,645	$ 1,008,688
Denominator for basic earnings per share - weighted average shares (in shares)		417,027	405,023	414,822	400,441
Effect of dilutive securities:
Non-vested restricted shares (in shares)		542	757	620	860
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)		1,960	1,868	2,038	1,971
Denominator for diluted earnings per share - adjusted weighted average shares (in shares)		418,987	406,891	416,860	402,412
Basic earnings per share (in dollars per share)		$ 0.78	$ 1.46	$ 1.96	$ 2.52
Diluted earnings per share (in dollars per share)	[1]	$ 0.77	$ 1.45	$ 1.94	$ 2.51
[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	Sep. 30, 2020	Dec. 31, 2019
Financial assets:
Equity securities	$ 5,205
Restricted cash	551,593	$ 100,849
Carrying Amount
Financial assets:
Equity securities	5,205	15,685
Cash and cash equivalents	1,603,740	284,917
Restricted cash	551,593	100,849
Foreign currency forward contracts, interest rate swaps and cross currency swaps	81,964	18,554
Financial liabilities:
Borrowings under unsecured credit facility and commercial paper program	0	1,587,597
Senior unsecured notes	11,321,573	10,336,513
Secured debt	2,459,659	2,990,962
Foreign currency forward contracts, interest rate swaps and cross currency swaps	64,100	53,601
Redeemable OP unitholder interests	100,513	121,440
Carrying Amount | Mortgage loans receivable
Financial assets:
Loans receivable	289,082	145,686
Carrying Amount | Other real estate loans receivable
Financial assets:
Loans receivable	125,624	124,696
Carrying Amount | Non-real estate loans receivable
Financial assets:
Loans receivable	382,149	336,854
Fair Value
Financial assets:
Equity securities	5,205	15,685
Cash and cash equivalents	1,603,740	284,917
Restricted cash	551,593	100,849
Foreign currency forward contracts, interest rate swaps and cross currency swaps	81,964	18,554
Financial liabilities:
Borrowings under unsecured credit facility and commercial paper program	0	1,587,597
Senior unsecured notes	12,603,853	11,400,571
Secured debt	2,541,260	3,041,893
Foreign currency forward contracts, interest rate swaps and cross currency swaps	64,100	53,601
Redeemable OP unitholder interests	98,335	121,440
Fair Value | Mortgage loans receivable
Financial assets:
Loans receivable	295,597	150,217
Fair Value | Other real estate loans receivable
Financial assets:
Loans receivable	129,069	128,512
Fair Value | Non-real estate loans receivable
Financial assets:
Loans receivable	$ 430,558	$ 379,239

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	Sep. 30, 2020USD ($)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Equity securities	$ 5,205
Foreign currency forward contracts, interest rate swaps and cross currency swaps, net asset (liability)	17,864
Totals	23,069
Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Equity securities	5,205
Foreign currency forward contracts, interest rate swaps and cross currency swaps, net asset (liability)	0
Totals	5,205
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)	17,864
Totals	17,864
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		9 Months Ended
	Mar. 31, 2019USD ($)	Sep. 30, 2020USD ($)	Sep. 30, 2019USD ($)	Sep. 30, 2020USD ($)segment	Sep. 30, 2019USD ($)	Dec. 31, 2019USD ($)
Segment Reporting [Abstract]
Number of operating segments | segment				3
Segment Reporting Information [Line Items]
Rental income		$ 275,046	$ 412,147	$ 1,061,311	$ 1,178,817
Total revenues		1,036,874	1,266,133	3,483,951	3,858,484
Property operating expenses		634,717	655,588	1,977,262	2,027,522
Consolidated net operating income		402,157	610,545	1,506,689	1,830,962
Depreciation and amortization		255,532	272,445	795,704	764,429
Interest expense		124,851	137,343	393,215	423,911
General and administrative expenses		31,003	31,019	100,546	100,042
Loss (gain) on derivatives and financial instruments, net		1,395	1,244	10,480	670
Loss (gain) on extinguishment of debt, net		33,004	65,824	33,253	81,543
Provision for loan losses	$ 18,690	2,857	0	11,351	18,690
Impairment of assets		23,313	18,096	126,291	28,035
Other expenses		11,544	6,186	37,247	36,570
Income (loss) from continuing operations before income taxes and other items		(81,342)	78,388	(1,398)	377,072
Income tax (expense) benefit		(2,003)	(3,968)	(9,678)	(7,789)
Income (loss) from unconsolidated entities		(5,981)	3,262	(8,341)	(14,986)
Gain (loss) on real estate dispositions, net		484,304	570,250	902,991	735,977
Income (loss) from continuing operations		394,978	647,932	883,574	1,090,274
Net income (loss)		394,978	647,932	883,574	1,090,274
Total assets		32,541,597		32,541,597		$ 33,380,751
Resident fees and services
Segment Reporting Information [Line Items]
Revenue from contract with customer		740,956	834,121	2,360,488	2,616,491
Interest income
Segment Reporting Information [Line Items]
Revenue from contract with customer		16,750	15,637	48,060	48,112
Other income
Segment Reporting Information [Line Items]
Revenue from contract with customer		4,122	4,228	14,092	15,064
Operating Segments | Seniors Housing Operating
Segment Reporting Information [Line Items]
Rental income		0	0	0	0
Total revenues		742,065	835,496	2,366,843	2,623,411
Property operating expenses		567,704	581,341	1,771,088	1,826,344
Consolidated net operating income		174,361	254,155	595,755	797,067
Depreciation and amortization		133,224	148,126	419,161	416,252
Interest expense		12,728	16,356	43,191	52,179
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		0	1,450	(492)	1,450
Provision for loan losses		86		86	0
Impairment of assets		12,778	2,599	91,424	2,599
Other expenses		6,488	4,274	13,463	19,077
Income (loss) from continuing operations before income taxes and other items		9,057	81,350	28,922	305,510
Income tax (expense) benefit		0	0	0	0
Income (loss) from unconsolidated entities		(7,678)	(3,859)	(25,489)	(37,892)
Gain (loss) on real estate dispositions, net		313,319	519,203	327,635	518,493
Income (loss) from continuing operations		314,698	596,694	331,068	786,111
Net income (loss)		314,698	596,694	331,068	786,111
Total assets		15,063,405		15,063,405
Operating Segments | Seniors Housing Operating | Resident fees and services
Segment Reporting Information [Line Items]
Revenue from contract with customer		740,956	834,121	2,360,488	2,616,491
Operating Segments | Seniors Housing Operating | Interest income
Segment Reporting Information [Line Items]
Revenue from contract with customer		113	0	305	0
Operating Segments | Seniors Housing Operating | Other income
Segment Reporting Information [Line Items]
Revenue from contract with customer		996	1,375	6,050	6,920
Operating Segments | Triple-net
Segment Reporting Information [Line Items]
Rental income		103,938	227,499	512,815	681,893
Total revenues		120,928	244,607	562,276	733,606
Property operating expenses		12,567	13,922	39,432	41,700
Consolidated net operating income		108,361	230,685	522,844	691,906
Depreciation and amortization		58,157	57,147	173,989	174,551
Interest expense		2,070	3,076	7,668	9,741
General and administrative expenses		0	0	0	0
Loss (gain) on derivatives and financial instruments, net		1,395	1,244	10,480	670
Loss (gain) on extinguishment of debt, net		0	0	0	0
Provision for loan losses		372		8,895	18,690
Impairment of assets		10,535	12,314	34,867	11,374
Other expenses		2,805	(2,496)	6,818	6,093
Income (loss) from continuing operations before income taxes and other items		33,027	159,400	280,127	470,787
Income tax (expense) benefit		0	0	0	0
Income (loss) from unconsolidated entities		(423)	5,276	11,776	17,512
Gain (loss) on real estate dispositions, net		(619)	51,529	51,166	217,973
Income (loss) from continuing operations		31,985	216,205	343,069	706,272
Net income (loss)		31,985	216,205	343,069	706,272
Total assets		9,075,910		9,075,910
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		15,877	15,279	46,068	47,343
Operating Segments | Triple-net | Other income
Segment Reporting Information [Line Items]
Revenue from contract with customer		1,113	1,829	3,393	4,370
Operating Segments | Outpatient Medical
Segment Reporting Information [Line Items]
Rental income		171,108	184,648	548,496	496,924
Total revenues		172,704	185,189	552,864	498,015
Property operating expenses		52,728	60,325	165,024	159,478
Consolidated net operating income		119,976	124,864	387,840	338,537
Depreciation and amortization		64,151	67,172	202,554	173,626
Interest expense		4,287	3,363	13,421	10,097
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		0	0	741	0
Provision for loan losses		2,399		2,370	0
Impairment of assets		0	3,183	0	14,062
Other expenses		781	524	8,244	1,274
Income (loss) from continuing operations before income taxes and other items		48,358	50,622	160,510	139,478
Income tax (expense) benefit		0	0	0	0
Income (loss) from unconsolidated entities		2,120	1,845	5,372	5,394
Gain (loss) on real estate dispositions, net		171,604	(482)	524,190	(489)
Income (loss) from continuing operations		222,082	51,985	690,072	144,383
Net income (loss)		222,082	51,985	690,072	144,383
Total assets		6,892,502		6,892,502
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		760	358	1,687	769
Operating Segments | Outpatient Medical | Other income
Segment Reporting Information [Line Items]
Revenue from contract with customer		836	183	2,681	322
Non-segment / Corporate
Segment Reporting Information [Line Items]
Rental income		0	0	0	0
Total revenues		1,177	841	1,968	3,452
Property operating expenses		1,718	0	1,718	0
Consolidated net operating income		(541)	841	250	3,452
Depreciation and amortization		0	0	0	0
Interest expense		105,766	114,548	328,935	351,894
General and administrative expenses		31,003	31,019	100,546	100,042
Loss (gain) on derivatives and financial instruments, net		0	0	0	0
Loss (gain) on extinguishment of debt, net		33,004	64,374	33,004	80,093
Provision for loan losses		0		0	0
Impairment of assets		0	0	0	0
Other expenses		1,470	3,884	8,722	10,126
Income (loss) from continuing operations before income taxes and other items		(171,784)	(212,984)	(470,957)	(538,703)
Income tax (expense) benefit		(2,003)	(3,968)	(9,678)	(7,789)
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		(173,787)	(216,952)	(480,635)	(546,492)
Net income (loss)		(173,787)	(216,952)	(480,635)	(546,492)
Total assets		1,509,780		1,509,780
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		$ 1,177	$ 841	$ 1,968	$ 3,452

Segment Reporting - Summary of

Segment Reporting - Summary of Geographic Information (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019	Dec. 31, 2019
Revenues from External Customers and Long-Lived Assets [Line Items]
Total revenues	$ 1,036,874	$ 1,266,133	$ 3,483,951	$ 3,858,484
Total assets	32,541,597		32,541,597		$ 33,380,751
United States
Revenues from External Customers and Long-Lived Assets [Line Items]
Total revenues	819,057	1,039,016	2,820,609	3,175,059
Total assets	26,988,613		26,988,613		27,513,911
United Kingdom
Revenues from External Customers and Long-Lived Assets [Line Items]
Total revenues	110,281	110,303	337,601	335,368
Total assets	3,200,439		3,200,439		3,405,388
Canada
Revenues from External Customers and Long-Lived Assets [Line Items]
Total revenues	107,536	$ 116,814	325,741	$ 348,057
Total assets	$ 2,352,545		$ 2,352,545		$ 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	79.00%	82.10%	81.00%	82.30%
Revenue | United Kingdom
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage	10.60%	8.70%	9.70%	8.70%
Revenue | Canada
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage	10.40%	9.20%	9.30%	9.00%
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			83.00%		82.40%
Assets | United Kingdom
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage			9.80%		10.20%
Assets | Canada
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage			7.20%		7.40%
Resident fees and services | Revenue | United States
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage	76.00%		76.00%
Resident fees and services | Revenue | United Kingdom
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage	11.00%		11.00%
Resident fees and services | Revenue | Canada
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage	13.00%		13.00%

Variable Interest Entities (Det

Variable Interest Entities (Details) - USD ($) $ in Thousands	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018
Assets:
Net real estate investments	$ 28,348,107			$ 31,119,271
Cash and cash equivalents	1,603,740			284,917
Receivables and other assets	813,047			757,748
Total Assets	32,541,597			33,380,751
Liabilities and equity:
Secured debt	2,459,659			2,990,962
Lease liabilities	427,842			473,693
Total equity	16,961,102	$ 16,936,527	$ 17,066,337	16,506,627	$ 16,225,729	$ 15,969,572	$ 16,047,831	$ 15,586,599
Total liabilities and equity	32,541,597			33,380,751
VIE, Primary Beneficiary
Assets:
Net real estate investments	456,006			960,093
Cash and cash equivalents	22,958			27,522
Receivables and other assets	13,169			14,586
Total Assets	492,133			1,002,201
Liabilities and equity:
Secured debt	166,122			460,117
Lease liabilities	1,325			1,326
Accrued expenses and other liabilities	18,910			22,215
Total equity	305,776			518,543
Total liabilities and equity	$ 492,133			$ 1,002,201