Welltower (WELL) 10-Q 30 Jul 21 2021 Q2 Quarterly report Financial data

Cover Page

Cover Page - shares	6 Months Ended
	Jun. 30, 2021	Jul. 23, 2021
Document Information [Line Items]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Jun. 30, 2021
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		422,562,838
Entity Central Index Key	0000766704
Amendment Flag	false
Document Fiscal Year Focus	2021
Document Fiscal Period Focus	Q2
Current Fiscal Year End Date	--12-31
Common stock, $1.00 par value per share
Document Information [Line Items]
Title of 12(b) Security	Common stock, $1.00 par value per share
Trading Symbol	WELL
Security Exchange Name	NYSE
4.800% Notes due 2028
Document Information [Line Items]
Title of 12(b) Security	4.800% Notes due 2028
Trading Symbol	WELL28
Security Exchange Name	NYSE
4.500% Notes due 2034
Document Information [Line Items]
Title of 12(b) Security	4.500% Notes due 2034
Trading Symbol	WELL34
Security Exchange Name	NYSE

CONSOLIDATED BALANCE SHEETS

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Jun. 30, 2021	Dec. 31, 2020	[1]
Real property owned:
Land and land improvements	$ 3,448,542	$ 3,440,650
Buildings and improvements	28,124,236	28,024,971
Acquired lease intangibles	1,516,971	1,500,030
Real property held for sale, net of accumulated depreciation	592,699	216,613
Construction in progress	458,844	487,742
Less accumulated depreciation and amortization	(6,415,676)	(6,104,297)
Net real property owned	27,725,616	27,565,709
Right of use assets, net	453,621	465,866
Real estate loans receivable, net of credit allowance	1,097,299	443,372
Net real estate investments	29,276,536	28,474,947
Other assets:
Investments in unconsolidated entities	1,020,112	946,234
Goodwill	68,321	68,321
Cash and cash equivalents	513,602	1,545,046
Restricted cash	295,102	475,997
Straight-line rent receivable	331,381	344,066
Receivables and other assets	671,062	629,031
Total other assets	2,899,580	4,008,695
Total Assets	32,176,116	32,483,642
Liabilities:
Unsecured credit facility and commercial paper	0	0
Senior unsecured notes	11,157,732	11,420,790
Secured debt	2,304,178	2,377,930
Lease liabilities	409,628	418,266
Accrued expenses and other liabilities	1,061,370	1,041,594
Total liabilities	14,932,908	15,258,580
Redeemable noncontrolling interests	392,379	343,490
Equity:
Common stock	423,933	418,691
Capital in excess of par value	21,161,838	20,823,145
Treasury stock	(108,633)	(104,490)
Cumulative net income	8,425,401	8,327,598
Cumulative dividends	(13,854,145)	(13,343,721)
Accumulated other comprehensive income (loss)	(127,948)	(148,504)
Total Welltower Inc. stockholders’ equity	15,920,446	15,972,719
Noncontrolling interests	930,383	908,853
Total equity	16,850,829	16,881,572
Total liabilities and equity	$ 32,176,116	$ 32,483,642
[1]	Note: The consolidated balance sheet at December 31, 2020 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by U.S. generally accepted accounting principles for complete financial statements.

CONSOLIDATED STATEMENTS OF COMP

CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (UNAUDITED) - USD ($) shares in Thousands, $ in Thousands		3 Months Ended		6 Months Ended
		Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Revenues:
Rental income		$ 354,723	$ 396,305	$ 657,566	$ 786,265
Total revenues		1,140,992	1,188,475	2,193,054	2,447,077
Expenses:
Property operating expenses		642,657	660,764	1,259,983	1,342,545
Depreciation and amortization		240,885	265,371	485,311	540,172
Interest expense		122,341	126,357	245,483	268,364
General and administrative expenses		31,436	34,062	61,362	69,543
Loss (gain) on derivatives and financial instruments, net		(359)	1,434	1,575	9,085
Loss (gain) on extinguishment of debt, net		55,612	249	50,969	249
Provision for loan losses		6,197	1,422	7,580	8,494
Impairment of assets		23,692	75,151	47,260	102,978
Other expenses		11,687	19,411	22,681	25,703
Total expenses		1,134,148	1,184,221	2,182,204	2,367,133
Income (loss) from continuing operations before income taxes and other items		6,844	4,254	10,850	79,944
Income tax (expense) benefit		2,221	(2,233)	(1,722)	(7,675)
Income (loss) from unconsolidated entities		(7,976)	1,332	5,073	(2,360)
Gain (loss) on real estate dispositions, net		44,668	155,863	103,748	418,687
Income (loss) from continuing operations		45,757	159,216	117,949	488,596
Net income		45,757	159,216	117,949	488,596
Less: Net income (loss) attributable to noncontrolling interests	[1]	19,500	(20,030)	20,146	(934)
Net income (loss) attributable to common stockholders		$ 26,257	$ 179,246	$ 97,803	$ 489,530
Average number of common shares outstanding:
Basic (in shares)		417,452	417,084	417,360	413,696
Diluted (in shares)		419,305	419,121	419,205	415,775
Basic:
Income (loss) from continuing operations (in dollars per share)		$ 0.11	$ 0.38	$ 0.28	$ 1.18
Net income (loss) attributable to common stockholders (in dollars per share)		0.06	0.43	0.23	1.18
Diluted:
Income (loss) from continuing operations (in dollars per share)		0.11	0.38	0.28	1.18
Net income (loss) attributable to common stockholders (in dollars per share)	[2]	0.06	0.42	0.23	1.17
Dividends declared and paid per common share (in dollars per share)		$ 0.61	$ 0.61	$ 1.22	$ 1.48
Other comprehensive income (loss):
Foreign currency translation gain (loss)		$ 12,994	$ 13,015	$ 57,204	$ (252,562)
Derivative and financial instruments designated as hedges gain (loss)		(9,808)	(27,171)	(29,845)	231,941
Total other comprehensive income (loss)		3,186	(14,156)	27,359	(20,621)
Total comprehensive income (loss)		48,943	145,060	145,308	467,975
Less: Total comprehensive income (loss) attributable to noncontrolling interests	[1]	22,498	(13,543)	26,949	(16,856)
Total comprehensive income (loss) attributable to common stockholders		26,445	158,603	118,359	484,831
Resident fees and services
Revenues:
Revenue from contract with customer		740,891	769,560	1,464,355	1,619,532
Interest income
Revenues:
Revenue from contract with customer		38,448	16,069	58,027	31,310
Other income
Revenues:
Revenue from contract with customer		$ 6,930	$ 6,541	$ 13,106	$ 9,970
[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	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	Noncontrolling Interests	Noncontrolling InterestsCumulative effect, period of adoption, adjusted balance
Balances at beginning of period at Dec. 31, 2019	$ 16,506,627		$ (5,212)	$ 16,501,415	$ 411,005	$ 411,005	$ 20,190,119	$ 20,190,119	$ (78,955)	$ (78,955)	$ 7,353,966	$ (5,212)	$ 7,348,754	$ (12,223,534)	$ (12,223,534)	$ (112,157)	$ (112,157)	$ 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		20,818,242		(86,975)		7,659,038			(12,579,535)		(96,213)		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		7,404		832
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		20,836,549		(93,799)		7,838,284			(12,834,381)		(116,856)		888,387
Balances at beginning of period at Dec. 31, 2020	16,881,572	[1]			418,691		20,823,145		(104,490)		8,327,598			(13,343,721)		(148,504)		908,853
Comprehensive income:
Net income (loss)	71,369										71,546							(177)
Other comprehensive income (loss)	24,097															20,368		3,729
Total comprehensive income	95,466
Net change in noncontrolling interests	(34,516)						(14,250)											(20,266)
Amounts related to stock incentive plans, net of forfeitures	3,539				175		5,393		(2,029)
Net proceeds from issuance of common stock	(92)						(92)
Dividends paid:
Common stock dividends	(254,952)													(254,952)
Balances at end of period at Mar. 31, 2021	16,691,017				418,866		20,814,196		(106,519)		8,399,144			(13,598,673)		(128,136)		892,139
Comprehensive income:
Net income (loss)	45,952										26,257							19,695
Other comprehensive income (loss)	3,107															188		2,919
Total comprehensive income	49,059
Net change in noncontrolling interests	(1,747)						(17,377)											15,630
Amounts related to stock incentive plans, net of forfeitures	2,441				51		4,504		(2,114)
Net proceeds from issuance of common stock	365,531				5,016		360,515
Dividends paid:
Common stock dividends	(255,472)													(255,472)
Balances at end of period at Jun. 30, 2021	$ 16,850,829				$ 423,933		$ 21,161,838		$ (108,633)		$ 8,425,401			$ (13,854,145)		$ (127,948)		$ 930,383
[1]	Note: The consolidated balance sheet at December 31, 2020 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by U.S. generally accepted accounting principles for complete financial statements.

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS (UNAUDITED) - USD ($) $ in Thousands		6 Months Ended
		Jun. 30, 2021	Jun. 30, 2020
Operating activities:
Net income		$ 117,949	$ 488,596
Adjustments to reconcile net income to net cash provided from (used in) operating activities:
Depreciation and amortization		485,311	540,172
Other amortization expenses		8,854	6,947
Provision for loan losses		7,580	8,494
Impairment of assets		47,260	102,978
Stock-based compensation expense		10,333	14,373
Loss (gain) on derivatives and financial instruments, net		1,575	9,085
Loss (gain) on extinguishment of debt, net		50,969	249
Loss (income) from unconsolidated entities		(5,073)	2,360
Rental income less than (in excess of) cash received		9,688	(25,959)
Amortization related to above (below) market leases, net		(926)	(1,008)
Loss (gain) on real estate dispositions, net		(103,748)	(418,687)
Distributions by unconsolidated entities		4,841	6,795
Increase (decrease) in accrued expenses and other liabilities		18,569	22,348
Decrease (increase) in receivables and other assets		(14,269)	54,873
Net cash provided from (used in) operating activities		638,913	811,616
Investing activities:
Cash disbursed for acquisitions, net of cash acquired		(661,285)	(390,802)
Cash disbursed for capital improvements to existing properties		(94,483)	(122,103)
Cash disbursed for construction in progress		(144,344)	(93,031)
Capitalized interest		(9,358)	(9,287)
Investment in loans receivable		(918,407)	(19,538)
Principal collected on loans receivable		248,841	12,796
Other investments, net of payments		3,030
Other investments, net of payments			(3,695)
Contributions to unconsolidated entities		(233,296)	(225,739)
Distributions by unconsolidated entities		171,250	8,811
Proceeds from (payments on) derivatives		(13,762)	(13,319)
Proceeds from sales of real property		446,680	1,998,087
Net cash provided from (used in) investing activities		(1,205,134)	1,142,180
Financing activities:
Net increase (decrease) under unsecured credit facility and commercial paper		0	(1,587,597)
Net proceeds from issuance of senior unsecured notes		1,208,241	1,588,549
Payments to extinguish senior unsecured notes		(1,533,752)	0
Net proceeds from the issuance of secured debt		0	44,921
Payments on secured debt		(98,263)	(345,340)
Net proceeds from the issuance of common stock		366,464	595,313
Repurchase of common stock		0	(7,656)
Payments for deferred financing costs and prepayment penalties		(72,251)	(4,725)
Contributions by noncontrolling interests	[1]	65,982	13,764
Distributions to noncontrolling interests	[1]	(67,242)	(180,875)
Cash distributions to stockholders		(509,665)	(610,847)
Other financing activities		(7,628)	(9,816)
Net cash provided from (used in) financing activities		(648,114)	(504,309)
Effect of foreign currency translation on cash and cash equivalents and restricted cash		1,996	(9,010)
Increase (decrease) in cash, cash equivalents and restricted cash		(1,212,339)	1,440,477
Cash, cash equivalents and restricted cash at beginning of period		2,021,043	385,766
Cash, cash equivalents and restricted cash at end of period		808,704	1,826,243
Supplemental cash flow information:
Interest paid		221,294	227,632
Income taxes paid (received), net		$ 1,922	$ (1,142)
[1]	(1) Includes amounts attributable to redeemable noncontrolling interests.

Business

Business	6 Months Ended
	Jun. 30, 2021
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Business	BusinessWelltower Inc. (the "Company"), an S&P 500 company headquartered in Toledo, Ohio, is driving the transformation of health care infrastructure. The Company invests with leading seniors housing operators, post-acute providers and health systems to fund the real estate and infrastructure needed to scale innovative care delivery models and improve people’s wellness and overall health care experience. Welltower™, a real estate investment trust (“REIT”), owns interests in properties concentrated in major, high-growth markets in the United States (“U.S.”), Canada and the United Kingdom (“U.K.”), consisting of seniors housing and post-acute communities and outpatient medical properties.

Accounting Policies and Related

Accounting Policies and Related Matters	6 Months Ended
	Jun. 30, 2021
Accounting Policies [Abstract]
Accounting Policies and Related Matters	Accounting Policies and Related Matters Basis of Presentation The accompanying unaudited consolidated financial statements have been prepared in accordance with U.S. generally accepted accounting principles (“U.S. GAAP”) for interim financial information and with instructions to Quarterly Report on Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all of the information and footnotes required by U.S. GAAP for complete financial statements. In the opinion of management, all adjustments (such as normal recurring accruals) considered necessary for a fair presentation have been included. Operating results for the six months ended June 30, 2021 are not necessarily an indication of the results that may be expected for the year ending December 31, 2021. 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, 2020. 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, the direct and indirect economic effects of the pandemic and containment measures, the impact of new variants, the effectiveness of vaccines, the overall pace of recovery, 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. Our Seniors Housing Operating revenues are dependent on occupancy. Spot occupancy declined since the beginning of the pandemic, reaching a low of 72.3% on March 12, 2021. As of June 30, 2021, virtually all communities are now accepting new residents, resulting in an increase in move-in activity and occupancy rates of approximately 230 basis points since the low point to 74.6% on June 30, 2021. Additionally, rapid distribution and a high acceptance rate of COVID-19 vaccinations by residents within assisted living and memory care facilities in the U.S. and U.K. has resulted in a significant decrease in total resident case counts since mid-January across the portfolio. Monthly spot occupancy rates through June 30, 2021 are as follows: December 2020 January 2021 February 2021 March 2021 April 2021 May 2021 June 2021 Spot occupancy (1) 74.7 % 73.3 % 72.5 % 72.6 % 73.2 % 73.6 % 74.6 % Sequential occupancy change (2) (1.4) % (0.8) % 0.1 % 0.5 % 0.5 % 0.9 % (1) Spot occupancy represents approximate month end occupancy at our share for 592 properties in operation as of December 31, 2020, including unconsolidated properties but excluding acquisitions, dispositions and development conversions since this date. (2) Sequential occupancy changes are based on actual spot occupancy and may not recalculate due to rounding. On a month-to-date basis, as of July 23, 2021, Seniors Housing Operating occupancy has increased approximately 40 basis points. Occupancy continued to strengthen in the U.S. and U.K. with gains of approximately 60 basis points and 30 basis points, respectively, while occupancy in Canada remained flat over the same period. Property-level operating expenses associated with the COVID-19 pandemic relating to our Seniors Housing Operating portfolio, net of reimbursements including Provider Relief Funds and similar programs in the U.K. and Canada, resulted in a net benefit of approximately $1,535,000 and $22,792,000 for the three and six months ended June 30, 2021, respectively, as compared to a net expense of $40,127,000 and $47,421,000 during the three and six months ended June 30, 2020, respectively. 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 2020 applications were made for amounts under Phase 2 and Phase 3 of the Provider Relief Fund related to our Seniors Housing Operating portfolio. During the six months ended June 30, 2021, we received total Provider Relief Funds of approximately $40,976,000, which was recognized as a reduction to COVID-19 costs within property operating expenses. Our Triple-net operators have experienced similar occupancy declines and operating costs as described above with respect to our Seniors Housing Operating properties. Additionally, long-term/post-acute care facilities are generally experiencing a higher degree of occupancy declines. These factors may continue to impact the ability of our Triple-net operators to make contractual rent payments to us in the future. Many of our Triple-net operators received funds under the Coronavirus Aid Relief and Economic Security Act (“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 have generally received funds from Phases 2 and 3 of the Provider Relief Fund. During the six months ended June 30, 2021, we collected approximately 95% of rent due from operators under Triple-net lease agreements (primarily seniors housing and post-acute care facilities). No significant rent deferrals or rent concessions have been made. We evaluate leases individually and recognize rent on a cash basis if collectibility of substantially all contractual rent payments is not probable. To the extent 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. New Accounting Standards • In August 2020, the FASB issued ASU 2020-06, “Debt-Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging-Contracts in Entity’s Own Equity (Subtopic 815-40) Accounting for Convertible Instruments and Contracts in an Entity’s Own Equity”. This ASU simplifies accounting for convertible instruments and removes certain settlement conditions that are required for equity contracts to qualify for the derivative scope exception. This ASU also simplifies the diluted earnings per share calculation in certain areas and provides updated disclosure requirements. The ASU is effective for public business entities beginning after December 15, 2021 including interim periods within those fiscal years. Early adoption is permitted. We are currently evaluating the guidance and the impact it may have on our consolidated financial statements. • In March 2020, the FASB issued an amendment to the reference rate reform standard which provides the option for a limited period of time to ease the potential burden in accounting for, or recognizing the effects of, reference rate reform on contract modifications and hedge accounting. An example of such reform is the expected market transition from the London Interbank Offered Rate ("LIBOR") and other interbank offered rates to alternative reference rates. Entities that make this optional expedient election would not have to remeasure the contracts at the modification date or reassess the accounting treatment if certain criteria are met and would continue applying hedge accounting for relationships affected by reference rate reform. The new standard was effective for us upon issuance and elections can be made through December 31, 2022. We are currently evaluating our options with regards to existing contracts and hedging relationships and the impact of adopting this update on our consolidated financial statements.

Real Property Acquisitions and

Real Property Acquisitions and Development	6 Months Ended
	Jun. 30, 2021
Real Estate [Abstract]
Real Property Acquisitions and Development	Real Property Acquisitions and Development The total purchase price for all properties acquired has been allocated to the tangible and identifiable intangible assets and liabilities at cost on a relative fair value basis. Liabilities assumed and any associated noncontrolling interests are reflected at fair value. The results of operations for these acquisitions have been included in our consolidated results of operations since the date of acquisition and are a component of the appropriate segments. Transaction costs primarily represent costs incurred with acquisitions, including due diligence costs, fees for legal and valuation services, termination of pre-existing relationships computed based on the fair value of the assets acquired, lease termination fees and other acquisition-related costs. Transaction costs related to asset acquisitions are capitalized as a component of purchase price and all other non-capitalizable costs are reflected in other expenses on our Consolidated Statements of Comprehensive Income. The following is a summary of our real property investment activity by segment for the periods presented (in thousands): Six Months Ended June 30, 2021 June 30, 2020 Seniors Housing Operating Triple-net Outpatient Totals Seniors Housing Operating Triple-net Outpatient Totals Land and land improvements $ 25,636 $ 30,849 $ 29,735 $ 86,220 $ 15,758 $ — $ 40,847 $ 56,605 Buildings and improvements 167,791 268,210 152,737 588,738 132,480 765 171,457 304,702 Acquired lease intangibles 10,679 — 6,274 16,953 10,810 — 23,823 34,633 Receivables and other assets 634 — 8 642 257 — 139 396 Total assets acquired (1) 204,740 299,059 188,754 692,553 159,305 765 236,266 396,336 Accrued expenses and other liabilities (2,923) (8,703) (266) (11,892) (671) — (2,036) (2,707) Total liabilities acquired (2,923) (8,703) (266) (11,892) (671) — (2,036) (2,707) Noncontrolling interests (2) (2,597) (2,056) (14,723) (19,376) (2,827) — — (2,827) Cash disbursed for acquisitions 199,220 288,300 173,765 661,285 155,807 765 234,230 390,802 Construction in progress additions 93,108 46,904 13,371 153,383 53,705 26,262 26,677 106,644 Less: Capitalized interest (6,014) (1,238) (2,106) (9,358) (5,470) (1,826) (1,991) (9,287) Accruals (3) 8 — 311 319 (1,343) — (2,983) (4,326) Cash disbursed for construction in progress 87,102 45,666 11,576 144,344 46,892 24,436 21,703 93,031 Capital improvements to existing properties 64,438 15,568 14,477 94,483 87,002 4,700 30,401 122,103 Total cash invested in real property, net of cash acquired $ 350,760 $ 349,534 $ 199,818 $ 900,112 $ 289,701 $ 29,901 $ 286,334 $ 605,936 (1) Excludes $301,000 and $580,000 of unrestricted and restricted cash acquired during the six months ended June 30, 2021 and June 30, 2020, respectively. (2) Includes amounts attributable to both redeemable noncontrolling interests and noncontrolling interests. (3) R epresents non-cash accruals for amounts to be paid in future periods for properties that converted, off-set by amounts paid in the current period. On June 21, 2021, we entered into a definitive agreement to acquire a portfolio of 86 seniors housing properties owned by Holiday Retirement for a total purchase price of $1,576,800,000, which will be included in our Seniors Housing Operating segment. Atria Senior Living will assume operations of the portfolio following its acquisition of the Holiday Retirement management company pursuant to an incentive-based management agreement. We expect to close the transaction during the third quarter. Construction Activity The following is a summary of the construction projects that were placed into service and began generating revenues during the periods presented (in thousands): Six Months Ended June 30, 2021 June 30, 2020 Development projects: Seniors Housing Operating $ 58,844 $ 93,188 Triple-net 22,990 33,627 Outpatient Medical 101,867 43,493 Total development projects 183,701 170,308 Expansion projects — 35,637 Total construction in progress conversions $ 183,701 $ 205,945

Real Estate Intangibles

Real Estate Intangibles	6 Months Ended
	Jun. 30, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
Real Estate Intangibles	Real Estate Intangibles The following is a summary of our real estate intangibles, excluding those related to ground leases or classified as held for sale, as of the dates indicated (dollars in thousands): June 30, 2021 December 31, 2020 Assets: In place lease intangibles $ 1,416,212 $ 1,406,705 Above market tenant leases 53,066 52,621 Lease commissions 47,693 40,704 Gross historical cost 1,516,971 1,500,030 Accumulated amortization (1,223,550) (1,177,513) Net book value $ 293,421 $ 322,517 Weighted-average amortization period in years 10.7 10.5 Liabilities: Below market tenant leases $ 74,183 $ 77,851 Accumulated amortization (41,552) (40,871) Net book value $ 32,631 $ 36,980 Weighted-average amortization period in years 8.3 8.3 The following is a summary of real estate intangible amortization income (expense) for the periods presented (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2021 2020 2021 2020 Rental income related to (above)/below market tenant leases, net $ 432 $ 402 $ 857 $ 925 Amortization related to in place lease intangibles and lease commissions (20,432) (33,316) (43,211) (69,293) The future estimated aggregate amortization of intangible assets and liabilities is as follows for the periods presented (in thousands): Assets Liabilities 2021 $ 40,278 $ 3,904 2022 48,245 7,234 2023 34,780 5,092 2024 27,176 2,976 2025 21,943 2,447 Thereafter 120,999 10,978 Total $ 293,421 $ 32,631

Dispositions, Real Property Hel

Dispositions, Real Property Held for Sale and Impairment	6 Months Ended
	Jun. 30, 2021
Discontinued Operations and Disposal Groups [Abstract]
Dispositions, Real Property Held for Sale and Impairment	Dispositions, Real Property Held for Sale and Impairment We periodically sell properties for various reasons, including favorable market conditions, the exercise of tenant purchase options or reduction of concentrations (i.e., property type, relationship or geography). At June 30, 2021, two Seniors Housing Operating, 54 Triple-net, and two Outpatient Medical properties with an aggregate real estate balance of $592,699,000 were classified as held for sale. In addition to the real property balances held for sale, net other assets and (liabilities) of $20,382,000 are included in the Consolidated Balance Sheets related to the held for sale properties. Expected gross sales proceeds related to the held for sale properties is approximately $747,153,000. During the six months ended June 30, 2021, we recorded $18,077,000 of impairment charges related to three Triple-net properties and one Outpatient Medical property which were classified as held for sale for which the carrying value exceeded the estimated fair value less cost to sell. Additionally, during the six months ended June 30, 2021, we recorded $29,183,000 of impairment charges related to two Seniors Housing Operating properties and two Triple-net properties that were held for use in which the carrying value exceeded the estimated fair value. During the six months ended June 30, 2020, we recorded $75,151,000 of impairment charges related to 12 Seniors Housing Operating properties which were classified as held for sale for which the carrying value exceeded the estimated fair value less cost to sell. Additionally, during the six months ended June 30, 2020, we recorded $27,827,000 of impairment charges related to one Seniors Housing Operating property and one Triple-net property 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): Six Months Ended June 30, 2021 2020 Real estate dispositions: Seniors Housing Operating $ 112,809 $ 706,964 Triple-net 88,367 33,445 Outpatient Medical 137,890 808,992 Total dispositions 339,066 1,549,401 Gain (loss) on real estate dispositions, net 103,748 418,687 Net other assets/liabilities disposed 3,866 29,999 Proceeds from real estate dispositions $ 446,680 $ 1,998,087 Operating results attributable to properties sold or classified as held for sale which do not meet the definition of discontinued operations are not reclassified on our Consolidated Statements of Comprehensive Income. The following represents the activity related to these properties for the periods presented (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2021 2020 2021 2020 Revenues: Total revenues $ 19,441 $ 107,997 $ 48,943 $ 253,500 Expenses: Interest expense 323 3,395 1,438 8,302 Property operating expenses 3,034 50,297 6,203 116,515 Provision for depreciation 1,397 28,090 7,396 54,004 Total expenses 4,754 81,782 15,037 178,821 Income (loss) from real estate dispositions, net $ 14,687 $ 26,215 $ 33,906 $ 74,679

Leases

Leases	6 Months Ended
	Jun. 30, 2021
Leases [Abstract]
Leases	Leases We lease land, buildings, office space and certain equipment. Many of our leases include a renewal option to extend the term from one The components of lease expense were as follows for the period presented (in thousands): Six Months Ended Classification June 30, 2021 June 30, 2020 Operating lease cost: (1) Real estate lease expense Property operating expenses $ 10,538 $ 12,516 Non-real estate investment lease expense General and administrative expenses 2,354 2,549 Finance lease cost: Amortization of leased assets Property operating expenses 4,111 4,043 Interest on lease liabilities Interest expense 3,310 2,695 Sublease income Rental income (1,267) (2,087) Total $ 19,046 $ 19,716 (1) Includes short-term leases which are immaterial. Supplemental balance sheet information related to leases is as follows (in thousands): Classification June 30, 2021 December 31, 2020 Right of use assets: Operating leases - real estate Right of use assets, net $ 296,150 $ 310,017 Finance leases - real estate Right of use assets, net 157,471 155,849 Real estate right of use assets, net 453,621 465,866 Operating leases - non-real estate investments Receivables and other assets 7,248 9,624 Total right of use assets, net $ 460,869 $ 475,490 Lease liabilities: Operating leases $ 298,722 $ 311,164 Financing leases 110,906 107,102 Total $ 409,628 $ 418,266 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 six months ended June 30, 2021 and 2020, we reserved for straight-line rent receivable balances of $49,241,000 and $34,110,000 through rental income, relating to leases for which collection of substantially all contractual lease payments was no longer deemed probable. Leases in our Triple-net and Outpatient Medical portfolios typically include some form of operating expense reimbursement by the tenant. For the six months ended June 30, 2021, we recognized $657,566,000 of rental income related to operating leases, of which $89,890,000 was for variable lease payments which primarily represents the reimbursement of operating costs such as common area maintenance expenses, utilities, insurance and real estate taxes. For the six months ended June 30, 2020, we recognized $786,265,000 of rental income related to operating leases, of which $104,605,000 was for variable lease payments.
Leases	Leases We lease land, buildings, office space and certain equipment. Many of our leases include a renewal option to extend the term from one The components of lease expense were as follows for the period presented (in thousands): Six Months Ended Classification June 30, 2021 June 30, 2020 Operating lease cost: (1) Real estate lease expense Property operating expenses $ 10,538 $ 12,516 Non-real estate investment lease expense General and administrative expenses 2,354 2,549 Finance lease cost: Amortization of leased assets Property operating expenses 4,111 4,043 Interest on lease liabilities Interest expense 3,310 2,695 Sublease income Rental income (1,267) (2,087) Total $ 19,046 $ 19,716 (1) Includes short-term leases which are immaterial. Supplemental balance sheet information related to leases is as follows (in thousands): Classification June 30, 2021 December 31, 2020 Right of use assets: Operating leases - real estate Right of use assets, net $ 296,150 $ 310,017 Finance leases - real estate Right of use assets, net 157,471 155,849 Real estate right of use assets, net 453,621 465,866 Operating leases - non-real estate investments Receivables and other assets 7,248 9,624 Total right of use assets, net $ 460,869 $ 475,490 Lease liabilities: Operating leases $ 298,722 $ 311,164 Financing leases 110,906 107,102 Total $ 409,628 $ 418,266 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 six months ended June 30, 2021 and 2020, we reserved for straight-line rent receivable balances of $49,241,000 and $34,110,000 through rental income, relating to leases for which collection of substantially all contractual lease payments was no longer deemed probable. Leases in our Triple-net and Outpatient Medical portfolios typically include some form of operating expense reimbursement by the tenant. For the six months ended June 30, 2021, we recognized $657,566,000 of rental income related to operating leases, of which $89,890,000 was for variable lease payments which primarily represents the reimbursement of operating costs such as common area maintenance expenses, utilities, insurance and real estate taxes. For the six months ended June 30, 2020, we recognized $786,265,000 of rental income related to operating leases, of which $104,605,000 was for variable lease payments.
Leases	Leases We lease land, buildings, office space and certain equipment. Many of our leases include a renewal option to extend the term from one The components of lease expense were as follows for the period presented (in thousands): Six Months Ended Classification June 30, 2021 June 30, 2020 Operating lease cost: (1) Real estate lease expense Property operating expenses $ 10,538 $ 12,516 Non-real estate investment lease expense General and administrative expenses 2,354 2,549 Finance lease cost: Amortization of leased assets Property operating expenses 4,111 4,043 Interest on lease liabilities Interest expense 3,310 2,695 Sublease income Rental income (1,267) (2,087) Total $ 19,046 $ 19,716 (1) Includes short-term leases which are immaterial. Supplemental balance sheet information related to leases is as follows (in thousands): Classification June 30, 2021 December 31, 2020 Right of use assets: Operating leases - real estate Right of use assets, net $ 296,150 $ 310,017 Finance leases - real estate Right of use assets, net 157,471 155,849 Real estate right of use assets, net 453,621 465,866 Operating leases - non-real estate investments Receivables and other assets 7,248 9,624 Total right of use assets, net $ 460,869 $ 475,490 Lease liabilities: Operating leases $ 298,722 $ 311,164 Financing leases 110,906 107,102 Total $ 409,628 $ 418,266 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 six months ended June 30, 2021 and 2020, we reserved for straight-line rent receivable balances of $49,241,000 and $34,110,000 through rental income, relating to leases for which collection of substantially all contractual lease payments was no longer deemed probable. Leases in our Triple-net and Outpatient Medical portfolios typically include some form of operating expense reimbursement by the tenant. For the six months ended June 30, 2021, we recognized $657,566,000 of rental income related to operating leases, of which $89,890,000 was for variable lease payments which primarily represents the reimbursement of operating costs such as common area maintenance expenses, utilities, insurance and real estate taxes. For the six months ended June 30, 2020, we recognized $786,265,000 of rental income related to operating leases, of which $104,605,000 was for variable lease payments.

Loans Receivable

Loans Receivable	6 Months Ended
	Jun. 30, 2021
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 $21,938,000 and $15,615,000 as of June 30, 2021 and December 31, 2020, respectively, and is included in receivables and other assets on the Consolidated Balance Sheets. The following is a summary of our loans receivable (in thousands): June 30, 2021 December 31, 2020 Mortgage loans $ 935,572 $ 299,430 Other real estate loans 179,462 152,739 Allowance for credit losses on real estate loans receivable (17,735) (8,797) Real estate loans receivable, net of credit allowance 1,097,299 443,372 Non-real estate loans 348,061 455,508 Allowance for credit losses on non-real estate loans receivable (149,697) (215,239) Non-real estate loans receivable, net of credit allowance 198,364 240,269 Total loans receivable, net of credit allowance $ 1,295,663 $ 683,641 The following is a summary of our loan activity for the periods presented (in thousands): Six Months Ended June 30, 2021 June 30, 2020 Advances on loans receivable: Investments in new loans $ 902,189 $ 2,477 Draws on existing loans 16,218 17,061 Net cash advances on loans receivable 918,407 19,538 Receipts on loans receivable: Loan payoffs 179,827 — Principal payments on loans 69,014 12,796 Net cash receipts on loans receivable 248,841 12,796 Net cash advances (receipts) on loans receivable $ 669,566 $ 6,742 During the quarter ended June 30, 2021, we provided £540 million (approximately $750,330,000 based on the Sterling/ U.S. Dollar exchange rate as of the date of funding) of senior loan financing and a £30 million delayed facility for working capital and capital expenditures to affiliates of Safanad, a global real estate and private equity firm, as part of the recapitalization of its investment in HC-One Group. The loan has a five-year term and is fully collateralized by the shares and assets of the HC-One Group, including its underlying property portfolio of owned assets across the U.K. As part of the transaction, we received equity warrants which provide us the right to participate in the capital appreciation of HC-One Group above a designated price upon liquidation. See Note 12 for additional details. The allowance for credit losses on loans receivable is maintained at a level believed adequate to absorb potential losses in our loans receivable. The determination of the credit allowance is based on a quarterly evaluation of each of these loans, including general economic conditions and estimated collectability of loan payments. We evaluate the collectability of our loans receivable based on a combination of credit quality indicators, including, but not limited to, payment status, historical loan charge-offs, financial strength of the borrower and guarantors, and nature, extent, and value of the underlying collateral. A loan is considered to have deteriorated credit quality when, based on current information and events, it is probable that we will be unable to collect all amounts due as scheduled according to the contractual terms of the loan agreement. For those loans we identified as having deteriorated credit quality we determine the amount of credit loss on an individual basis. Placement on non-accrual status may be required. Consistent with this definition, all loans on non-accrual are deemed to have deteriorated credit quality. To the extent circumstances improve and the risk of collectability is diminished, we will return these loans to income accrual status. While a loan is on non-accrual status, any cash receipts are applied against the outstanding principal balance. For the remaining loans we assess credit loss on a collective pool basis and use our historical loss experience for similar loans to determine the reserve for credit losses. The following is a summary of our loans by credit loss category (in thousands): June 30, 2021 Loan category Years of Origination Loan Carrying Value Allowance for Credit Loss Net Loan Balance No. of Loans Deteriorated loans 2007 - 2018 $ 178,253 $ (148,438) $ 29,815 3 Collective loan pool 2007-2016 198,975 (3,033) 195,942 17 Collective loan pool 2017 126,493 (1,182) 125,311 7 Collective loan pool 2018 20,652 (324) 20,328 1 Collective loan pool 2019 22,046 (347) 21,699 4 Collective loan pool 2020 49,352 (770) 48,582 8 Collective loan pool 2021 867,324 (13,338) 853,986 9 Total loans $ 1,463,095 $ (167,432) $ 1,295,663 49 In March 2020, we recognized a provision for loan losses of $6,898,000 to fully reserve for one Triple-net non-real estate loan receivable that was no longer deemed collectible. Aside from this specific reserve, the remainder of the provision for loan losses relates to the application of the historical loss experience on the collective loan pools. The following is a summary of the allowance for credit losses on loans receivable for the periods presented (in thousands): Six Months Ended June 30, 2021 June 30, 2020 Balance at beginning of period $ 224,036 $ 68,372 Adoption of ASU 2016-13 — 5,212 Provision for loan losses 7,580 8,494 Loan write-offs (1) (64,075) — Foreign currency translation (109) (93) Balance at end of period $ 167,432 $ 81,985 (1) Includes $62,753,000 related to the Genesis Healthcare lease terminations for the six months ended June 30, 2021. See Note 9 for further details. The following is a summary of our deteriorated loans (in thousands): Six Months Ended June 30, 2021 June 30, 2020 Balance of deteriorated loans at end of period (1) $ 178,253 $ 186,584 Allowance for credit losses (148,438) (76,695) Balance of deteriorated loans not reserved $ 29,815 $ 109,889 Interest recognized on deteriorated loans (2) $ 3,122 $ 7,912 (1) Current year amounts include $2,176,000 and $3,623,000 of loans on non-accrual as of June 30, 2021 and December 31, 2020, respectively. Prior year amounts include $10,716,000 and $2,534,000 as of June 30, 2020 and December 31, 2019, respectively. (2) Represents cash interest recognized in the period.

Investments in Unconsolidated E

Investments in Unconsolidated Entities	6 Months Ended
	Jun. 30, 2021
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. Our share of the results of operations for these properties has been included in our consolidated results of operations from the date of acquisition by the joint ventures and are reflected in our Consolidated Statements of Comprehensive Income as income or loss from unconsolidated entities. The following is a summary of our investments in unconsolidated entities (dollars in thousands): Percentage Ownership (1) June 30, 2021 December 31, 2020 Seniors Housing Operating 10% to 65% $ 766,273 $ 653,057 Triple-net 10% to 25% 81,100 5,629 Outpatient Medical 15% to 50% 172,739 287,548 Total $ 1,020,112 $ 946,234 (1) Includes ownership of investments classified as liabilities and excludes ownership of in substance real estate. At June 30, 2021, the aggregate unamortized basis difference of our joint venture investments of $118,278,000 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 $270,164,000 related to seven properties as of June 30, 2021 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 $20,209,000 related to these investments.

Credit Concentration

Credit Concentration	6 Months Ended
	Jun. 30, 2021
Risks and Uncertainties [Abstract]
Credit Concentration	Credit ConcentrationWe use consolidated net operating income (“NOI”) as our credit concentration metric. See Note 18 for additional information and reconciliation. The following table summarizes certain information about our credit concentration for the six months ended June 30, 2021, excluding our share of NOI in unconsolidated entities (dollars in thousands): Concentration by relationship: (1) Number of Properties Total NOI Percent of NOI (2) ProMedica 217 $ 111,157 12% Sunrise Senior Living (3) 166 109,494 12% Revera (3) 85 45,928 5% Avery Healthcare 61 41,536 5% Genesis Healthcare 15 36,677 4% Remaining portfolio 972 588,279 62% Totals 1,516 $ 933,071 100% (1) Sunrise Senior Living and Revera are in our Seniors Housing Operating segment. Genesis Healthcare and ProMedica are in our Triple-net segment. Avery Healthcare is in both the Triple-net and Seniors Housing Operating segments. (2) NOI with our top five relationships comprised 36% of total NOI for the year ended December 31, 2020. (3) Revera owns a controlling interest in Sunrise Senior Living. During the quarter ended March 31, 2021, we entered into definitive agreements to substantially exit our operating relationship with Genesis Healthcare ("Genesis"). The status of these transactions is as follows: • In April 2021, we contributed nine Triple-net properties operated by Genesis into an 80/20 joint venture with ProMedica and such properties were added to the existing master lease with ProMedica. • We have entered into definitive agreements to sell 35 Genesis properties for $496 million to a joint venture with Aurora Health Network and Peace Capital. These properties are classified as held for sale as of June 30, 2021, with dispositions expected to occur in the second half of 2021. As of June 30, 2021, we have transferred operations of 28 properties to new operators. • Additionally, we currently lease seven properties which we previously subleased to Genesis. We have entered into a forward sales agreement with Aurora Health Network that is intended to close simultaneously with the purchase option exercise in April 2023. We have transitioned the operations of these properties into a new lease agreement with a regional operator during the quarter ended June 30, 2021. • To effectuate the transition of all 51 properties, we agreed to provide Genesis a lease termination fee of $86 million upon successful transition of all properties, which will be used to immediately repay indebtedness to us. The debt reduction associated with the lease termination fee was previously reserved for as an allowance for credit losses on loans receivable. • Additionally, upon achievement of certain restructuring milestones, we will reduce Genesis' indebtedness by an additional $170 million in exchange for an equity interest in Genesis. Upon conclusion of the aforementioned loan transactions, Genesis will have $167 million of indebtedness to us, exclusive of additional paid in kind interest, which will carry a maturity date of January 1, 2024. As of June 30, 2021, our total carrying value of Genesis loans receivable, net of allowances for credit losses, w as $144,667,000.

Borrowings Under Credit Facilit

Borrowings Under Credit Facilities and Commercial Paper Program	6 Months Ended
	Jun. 30, 2021
Debt Disclosure [Abstract]
Borrowings Under Credit Facilities and Commercial Paper Program	Borrowings Under Credit Facilities and Commercial Paper Program At June 30, 2021, we had a primary unsecured credit facility with a consortium of 34 banks that includes a $4,000,000,000 unsecured revolving credit facility (none outstanding at June 30, 2021), a $500,000,000 unsecured term credit facility and a $250,000,000 Canadian-denominated unsecured term credit facility. The unsecured revolving credit facility is comprised of a $1,000,000,000 tranche that matures on June 4, 2023 and a $3,000,000,000 tranche that matures on June 4, 2025. Both tranches may be extended for two successive terms of six 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 June 30, 2021). The following information relates to aggregate borrowings under the unsecured revolving credit facility and commercial paper program for the periods presented (dollars in thousands): Three Months Ended June 30, Six Months Ended June 30, 2021 2020 2021 2020 Balance outstanding at quarter end $ — $ — $ — $ — Maximum amount outstanding at any month end $ 195,000 $ 685,000 $ 195,000 $ 2,100,000 Average amount outstanding (total of daily principal balances divided by days in period) $ 289,231 $ 405,165 $ 145,414 $ 999,490 Weighted average interest rate (actual interest expense divided by average borrowings outstanding) 0.76 % 1.57 % 0.76 % 2.08 %

Senior Unsecured Notes and Secu

Senior Unsecured Notes and Secured Debt	6 Months Ended
	Jun. 30, 2021
Debt Disclosure [Abstract]
Senior Unsecured Notes and Secured Debt	Senior Unsecured Notes and Secured Debt We may repurchase, redeem or refinance senior unsecured notes from time to time, taking advantage of favorable market conditions when available. We may purchase senior notes for cash through open market purchases, privately negotiated transactions, a tender offer or, in some cases, through the early redemption of such securities pursuant to their terms. The senior unsecured notes are redeemable at our option, at any time in whole or from time to time in part, at a redemption price equal to the sum of: (i) the principal amount of the notes (or portion of such notes) being redeemed plus accrued and unpaid interest thereon up to the redemption date and (ii) any “make-whole” amount due under the terms of the notes in connection with early redemptions. Redemptions and repurchases of debt, if any, will depend on prevailing market conditions, our liquidity requirements, contractual restrictions and other factors. At June 30, 2021, the annual principal payments due on these debt obligations were as follows (in thousands): Senior Unsecured Notes (1,2) Secured Debt (1,3) Totals 2021 $ — $ 253,459 $ 253,459 2022 10,000 486,699 496,699 2023 (4, 5) 701,525 489,409 1,190,934 2024 1,350,000 185,318 1,535,318 2025 1,250,000 181,449 1,431,449 Thereafter (6, 7, 8) 7,941,460 714,794 8,656,254 Totals $ 11,252,985 $ 2,311,128 $ 13,564,113 (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 0.79% to 6.50%. (3) Annual interest rates range from 0.03% to 7.93%. Carrying value of the properties securing the debt totaled $5,312,000,000 at June 30, 2021. (4) Includes a $250,000,000 Canadian-denominated unsecured term credit facility (approximately $201,525,000 based on the Canadian/U.S. Dollar exchange rate on June 30, 2021). The loan matures on July 19, 2023 and bears interest at the Canadian Dealer Offered Rate plus 0.90% (1.31% at June 30, 2021). (5) Includes a $500,000,000 unsecured term credit facility. The loan matures on July 19, 2023 and bears interest at LIBOR plus 0.90% (1.00% at June 30, 2021). (6) Includes a $300,000,000 Canadian-denominated 2.95% senior unsecured notes due 2027 (approximately $241,830,000 based on the Canadian/U.S. Dollar exchange rate on June 30, 2021). (7) Includes a £550,000,000 4.80% senior unsecured notes due 2028 (approximately $759,330,000 based on the Sterling/U.S. Dollar exchange rate in effect on June 30, 2021). (8) Includes a £500,000,000 4.50% senior unsecured notes due 2034 (approximately $690,300,000 based on the Sterling/U.S. Dollar exchange rate in effect on June 30, 2021). The following is a summary of our senior unsecured notes principal activity during the periods presented (dollars in thousands): Six Months Ended June 30, 2021 June 30, 2020 Weighted Avg. Weighted Avg. Amount Interest Rate Amount Interest Rate Beginning balance $ 11,509,533 3.67% $ 10,427,562 4.03% Debt issued 1,250,000 2.50% 1,600,000 1.89% Debt extinguished (1,533,752) 2.42% — —% Foreign currency 27,204 3.57% (114,851) 4.30% Ending balance $ 11,252,985 3.71% $ 11,912,711 3.65% The following is a summary of our secured debt principal activity for the periods presented (dollars in thousands): Six Months Ended June 30, 2021 June 30, 2020 Weighted Avg. Weighted Avg. Amount Interest Rate Amount Interest Rate Beginning balance $ 2,378,073 3.27% $ 2,993,342 3.63% Debt issued — —% 44,921 2.58% Debt extinguished (66,593) 6.01% (314,631) 2.94% Principal payments (31,670) 3.48% (30,709) 3.55% Foreign currency 31,318 2.89% (64,934) 3.13% Ending balance $ 2,311,128 3.10% $ 2,627,989 3.09%

Derivative Instruments

Derivative Instruments	6 Months Ended
	Jun. 30, 2021
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 $2,562,000 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 six months ended June 30, 2021 and 2020, we settled certain net investment hedges necessitating cash payments of $7,196,000 and generating cash proceeds of $3,485,000, 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. Equity Warrants We received equity warrants through our lending activities further described in Note 7, which were accounted for as loan origination fees. The warrants provide us the right to participate in the capital appreciation of the underlying company above a designated price upon liquidation and contain net settlement terms qualifying as derivatives under ASC Topic 815. The warrants are classified within receivables and other assets on our Consolidated Balance Sheets. These warrants are measured at fair value with changes in fair value being recognized within gain (loss) on derivatives and financial instruments in our Consolidated Statements of Comprehensive Income. The following presents the notional amount of derivatives and other financial instruments as of the dates indicated (in thousands): June 30, 2021 December 31, 2020 Derivatives designated as net investment hedges: Denominated in Canadian Dollars $ 625,000 $ 625,000 Denominated in Pound Sterling £ 1,880,708 £ 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) $ 25,000 $ 450,000 Derivative instruments not designated: Interest rate caps denominated in U.S. Dollars $ 26,137 $ 26,137 Forward sales contracts denominated in Canadian Dollars $ 80,000 $ 80,000 (1) At June 30, 2021 the maximum maturity date was November 1, 2023. The following presents the impact of derivative instruments on the Consolidated Statements of Comprehensive Income for the periods presented (in thousands): Three Months Ended June 30, Six Months Ended June 30, Description Location 2021 2020 2021 2020 Gain (loss) on derivative instruments designated as hedges recognized in income Interest expense $ 5,544 $ 4,106 $ 11,567 $ 10,751 Gain (loss) on derivative instruments not designated as hedges recognized in income Interest expense $ (936) $ (1,953) $ (1,656) $ (2,048) Gain (loss) on derivative and financial instruments designated as hedges recognized in OCI OCI $ (9,808) $ (27,171) $ (29,845) $ 231,941

Commitments and Contingencies

Commitments and Contingencies	6 Months Ended
	Jun. 30, 2021
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and ContingenciesAt June 30, 2021, we had 12 outstanding letter of credit obligations totaling $22,404,000 and expiring between 2021 and 2024. At June 30, 2021, we had outstanding construction in progress of $458,844,000 and were committed to providing additional funds of approximately $819,168,000 to complete construction. Additionally, at June 30, 2021, we had outstanding investments classified as in substance real estate of $270,164,000 and were committed to provide additional funds of $20,209,000 (see Note 8 for additional information). Purchase obligations at June 30, 2021, include $1,576,800,000 representing a definitive agreement to acquire 86 seniors housing properties from Holiday Retirement, expected to close during the third quarter. Purchase obligations also include $58,673,000 of contingent purchase obligations to fund capital improvements. Rents due from the tenant are increased to reflect the additional investment in the property.

Stockholders' Equity

Stockholders' Equity	6 Months Ended
	Jun. 30, 2021
Equity [Abstract]
Stockholders' Equity	Stockholders’ Equity The following is a summary of our stockholders’ equity capital accounts as of the dates indicated: June 30, 2021 December 31, 2020 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 424,339,944 419,124,469 Outstanding shares 422,561,863 417,400,602 Common Stock In May 2021, we entered into an amended and restated equity distribution agreement whereby we can offer and sell up to $2,000,000,000 a ggregate amount of our common stock ("ATM Program"). The ATM Program also allows us to enter into forward sale agreement s. As of June 30, 2021, we had $1,905,854,000 of remaining capacity under the ATM Program, which excludes forward sales agreements outstanding for the sale of 13,052,375 shares with maturity dates in 2022 which we expect to physically settle for cash proceeds of $1,036,503,000 . 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. We did not repurchase any shares of our common stock during the six months ended June 30, 2021. The following is a summary of our common stock issuances during the six months ended June 30, 2021 and 2020 (dollars in thousands, except shares and average price amounts): Shares Issued Average Price Gross Proceeds Net Proceeds 2020 Dividend reinvestment plan issuances 264,153 $ 72.33 $ 19,105 $ 19,105 2020 Option exercises 251 47.81 12 12 2020 ATM Program issuances 6,799,978 86.48 588,072 576,196 2020 Stock incentive plans, net of forfeitures 183,398 — — 2020 Totals 7,247,780 $ 607,189 $ 595,313 2021 ATM Program issuances 5,015,673 74.15 371,937 366,464 2021 Stock incentive plans, net of forfeitures 145,588 — — 2021 Totals 5,161,261 $ 371,937 $ 366,464 Dividends The decrease in dividends is attributable to the declaration of a reduced cash dividend beginning with the quarter ending March 31, 2020 . The following is a summary of our dividend payments (in thousands, except per share amounts): Six Months Ended June 30, 2021 June 30, 2020 Per Share Amount Per Share Amount Common stock $ 1.22 $ 510,424 $ 1.48 $ 610,847 Accumulated Other Comprehensive Income The following is a summary of accumulated other comprehensive income (loss) for the periods presented (in thousands): June 30, 2021 December 31, 2020 Foreign currency translation $ (571,391) $ (621,792) Derivative and financial instruments designated as hedges 443,443 473,288 Total accumulated other comprehensive income (loss) $ (127,948) $ (148,504)

Stock Incentive Plans

Stock Incentive Plans	6 Months Ended
	Jun. 30, 2021
Share-based Payment Arrangement [Abstract]
Stock Incentive Plans	Stock Incentive PlansOur 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

Earnings Per Share

Earnings Per Share	6 Months Ended
	Jun. 30, 2021
Earnings Per Share [Abstract]
Earnings Per Share	Earnings Per Share The following table sets forth the computation of basic and diluted earnings per share (in thousands, except per share data): Three Months Ended June 30, Six Months Ended June 30, 2021 2020 2021 2020 Numerator for basic earnings per share - net income (loss) attributable to common stockholders $ 26,257 $ 179,246 $ 97,803 $ 489,530 Adjustment for net income (loss) attributable to OP units (873) (1,366) (2,225) (2,754) Numerator for diluted earnings per share $ 25,384 $ 177,880 $ 95,578 $ 486,776 Denominator for basic earnings per share - weighted average shares 417,452 417,084 417,360 413,696 Effect of dilutive securities: Non-vested restricted shares 438 619 430 661 Redeemable OP units 1,396 1,396 1,396 1,396 Employee stock purchase program 19 22 19 22 Dilutive potential common shares 1,853 2,037 1,845 2,079 Denominator for diluted earnings per share - adjusted weighted average shares 419,305 419,121 419,205 415,775 Basic earnings per share $ 0.06 $ 0.43 $ 0.23 $ 1.18 Diluted earnings per share $ 0.06 $ 0.42 $ 0.23 $ 1.17 As of June 30, 2021, forward sales agreements outstanding f or the sale of 13,052,375 s hares of common stock were not included in the computation of diluted earnings per share because such forward sales were anti-dilutive to the three and six month periods ended June 30, 2021.

Disclosure about Fair Value of

Disclosure about Fair Value of Financial Instruments	6 Months Ended
	Jun. 30, 2021
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, 2020 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. Equity Warrants — The fair value of equity warrants is estimated using Level 3 inputs and includes data points such as net equity of the underlying HC-One Group real estate portfolio, marketability discount for private company warrants, dividend yield, volatility and risk-free rate. 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. Redeemable OP Unitholder Interests — Our redeemable OP unitholder interests are recorded on the balance sheet at fair value using Level 2 inputs unless the fair value is below the initial amount in which case the redeemable OP unitholder interests are recorded at the initial amount adjusted for distributions to the unitholders and income or loss attributable to the unitholders. The fair value is measured using the closing price of our common stock, as units may be redeemed at the election of the holder for cash or, at our option, one share of our common stock per unit, subject to adjustment in certain circumstances. The carrying amounts and estimated fair values of our financial instruments are as follows (in thousands): June 30, 2021 December 31, 2020 Carrying Amount Fair Value Carrying Amount Fair Value Financial assets: Mortgage loans receivable $ 919,812 $ 935,528 $ 293,752 $ 297,207 Other real estate loans receivable 177,487 173,889 149,620 152,211 Equity securities 3,061 3,061 4,636 4,636 Cash and cash equivalents 513,602 513,602 1,545,046 1,545,046 Restricted cash 295,102 295,102 475,997 475,997 Non-real estate loans receivable 198,364 202,877 240,269 255,724 Foreign currency forward contracts, interest rate swaps and cross currency swaps 6,256 6,256 4,668 4,668 Equity warrants 32,419 32,419 — — Financial liabilities: Senior unsecured notes $ 11,157,732 $ 12,544,312 $ 11,420,790 $ 13,093,926 Secured debt 2,304,178 2,364,951 2,377,930 2,451,782 Foreign currency forward contracts, interest rate swaps and cross currency swaps 89,929 89,929 118,054 118,054 Redeemable OP unitholder interests $ 148,332 $ 148,332 $ 116,240 $ 115,346 Items Measured at Fair Value on a Recurring Basis The market approach is utilized to measure fair value for our financial assets and liabilities reported at fair value on a recurring basis. The market approach uses prices and other relevant information generated by market transactions involving identical or comparable assets or liabilities. The following summarizes items measured at fair value on a recurring basis (in thousands): Fair Value Measurements as of June 30, 2021 Total Level 1 Level 2 Level 3 Equity securities $ 3,061 $ 3,061 $ — $ — Equity warrants 32,419 — — 32,419 Foreign currency forward contracts, interest rate swaps and cross currency swaps, net asset (liability) (1) (83,673) — (83,673) — Totals $ (48,193) $ 3,061 $ (83,673) $ 32,419 (1) Please see Note 12 for additional information. Items Measured at Fair Value on a Nonrecurring Basis

Segment Reporting

Segment Reporting	6 Months Ended
	Jun. 30, 2021
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, 2020). 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 inter-segment transactions are eliminated. Summary information for the reportable segments (which excludes unconsolidated entities) is as follows (in thousands): Three Months Ended June 30, 2021: Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 740,891 $ — $ — $ — $ 740,891 Rental income — 204,725 149,998 — 354,723 Interest income 856 32,861 4,731 — 38,448 Other income 802 1,355 4,343 430 6,930 Total revenues 742,549 238,941 159,072 430 1,140,992 Property operating expenses 582,361 12,627 45,495 2,174 642,657 Consolidated net operating income 160,188 226,314 113,577 (1,744) 498,335 Depreciation and amortization 131,035 54,406 55,444 — 240,885 Interest expense 10,553 1,704 3,907 106,177 122,341 General and administrative expenses — — — 31,436 31,436 Loss (gain) on derivatives and financial instruments, net — (359) — — (359) Loss (gain) on extinguishment of debt, net 3,106 — — 52,506 55,612 Provision for loan losses (181) 10,019 (3,641) — 6,197 Impairment of assets 17,713 3,768 2,211 — 23,692 Other expenses 3,709 4,110 1,098 2,770 11,687 Income (loss) from continuing operations before income taxes and other items (5,747) 152,666 54,558 (194,633) 6,844 Income tax (expense) benefit — — — 2,221 2,221 Income (loss) from unconsolidated entities (12,938) 4,877 85 — (7,976) Gain (loss) on real estate dispositions, net (28) 42,709 1,987 — 44,668 Income (loss) from continuing operations (18,713) 200,252 56,630 (192,412) 45,757 Net income (loss) $ (18,713) $ 200,252 $ 56,630 $ (192,412) $ 45,757 Total assets $ 16,129,367 $ 9,490,724 $ 6,212,491 $ 343,534 $ 32,176,116 Three Months Ended June 30, 2020: Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 769,560 $ — $ — $ — $ 769,560 Rental income — 217,492 178,813 — 396,305 Interest income 88 15,520 461 — 16,069 Other income 4,002 607 1,557 375 6,541 Total revenues 773,650 233,619 180,831 375 1,188,475 Property operating expenses 595,513 13,563 51,688 — 660,764 Consolidated net operating income 178,137 220,056 129,143 375 527,711 Depreciation and amortization 139,163 58,138 68,070 — 265,371 Interest expense 14,029 2,746 4,326 105,256 126,357 General and administrative expenses — — — 34,062 34,062 Loss (gain) on derivatives and financial instruments, net — 1,434 — — 1,434 Loss (gain) on extinguishment of debt, net (492) — 741 — 249 Provision for loan losses — 1,451 (29) — 1,422 Impairment of assets 75,151 — — — 75,151 Other expenses 5,251 3,500 6,456 4,204 19,411 Income (loss) from continuing operations before income taxes and other items (54,965) 152,787 49,579 (143,147) 4,254 Income tax (expense) benefit — — — (2,233) (2,233) Income (loss) from unconsolidated entities (6,787) 6,403 1,716 — 1,332 Gain (loss) on real estate dispositions, net 14,465 2,148 139,250 — 155,863 Income (loss) from continuing operations (47,287) 161,338 190,545 (145,380) 159,216 Net income (loss) $ (47,287) $ 161,338 $ 190,545 $ (145,380) $ 159,216 Six Months Ended June 30, 2021 Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 1,464,355 $ — $ — $ — $ 1,464,355 Rental income — 357,188 300,378 — 657,566 Interest income 1,975 47,783 8,269 — 58,027 Other income 2,621 2,452 6,648 1,385 13,106 Total revenues 1,468,951 407,423 315,295 1,385 2,193,054 Property operating expenses 1,138,329 25,468 92,358 3,828 1,259,983 Consolidated net operating income 330,622 381,955 222,937 (2,443) 933,071 Depreciation and amortization 263,621 111,073 110,617 — 485,311 Interest expense 21,971 3,586 7,922 212,004 245,483 General and administrative expenses — — — 61,362 61,362 Loss (gain) on derivatives and financial instruments, net — 1,575 — — 1,575 Loss (gain) on extinguishment of debt, net (1,537) — — 52,506 50,969 Provision for loan losses 70 10,872 (3,362) — 7,580 Impairment of assets 22,317 22,732 2,211 — 47,260 Other expenses 7,168 9,093 1,810 4,610 22,681 Income (loss) from continuing operations before income taxes and other items 17,012 223,024 103,739 (332,925) 10,850 Income tax (expense) benefit — — — (1,722) (1,722) Income (loss) from unconsolidated entities (7,704) 9,784 2,993 — 5,073 Gain (loss) on real estate dispositions, net 5,167 44,751 53,830 — 103,748 Income (loss) from continuing operations 14,475 277,559 160,562 (334,647) 117,949 Net income (loss) $ 14,475 $ 277,559 $ 160,562 $ (334,647) $ 117,949 Six Months Ended June 30, 2020 Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 1,619,532 $ — $ — $ — $ 1,619,532 Rental income — 408,877 377,388 — 786,265 Interest income 192 30,191 927 — 31,310 Other income 5,054 2,280 1,845 791 9,970 Total revenues 1,624,778 441,348 380,160 791 2,447,077 Property operating expenses 1,203,384 26,865 112,296 — 1,342,545 Consolidated net operating income 421,394 414,483 267,864 791 1,104,532 Depreciation and amortization 285,937 115,832 138,403 — 540,172 Interest expense 30,463 5,598 9,134 223,169 268,364 General and administrative expenses — — — 69,543 69,543 Loss (gain) on derivatives and financial — 9,085 — — 9,085 Loss (gain) on extinguishment of debt, net (492) — 741 — 249 Provision for loan losses — 18.69 8,523 — (29) 18.69 — 8,494 Impairment of assets 78,646 24,332 — — 102,978 Other expenses 8,240 4,013 7,463 5,987 25,703 Income (loss) from continuing operations before income taxes and other items 18,600 247,100 112,152 (297,908) 79,944 Income tax (expense) benefit — — — (7,675) (7,675) Income (loss) from unconsolidated entities (17,811) 12,199 3,252 — (2,360) Gain (loss) on real estate dispositions, net 14,316 51,785 352,586 — 418,687 Income (loss) from continuing operations 15,105 311,084 467,990 (305,583) 488,596 Net income (loss) $ 15,105 $ 311,084 $ 467,990 $ (305,583) $ 488,596 Our portfolio of properties and other investments are located in the United States, the United Kingdom and Canada. Revenues and assets are attributed to the country in which the property is physically located. The following is a summary of geographic information for the periods presented (dollars in thousands): Three Months Ended Six Months Ended June 30, 2021 June 30, 2020 June 30, 2021 June 30, 2020 Revenues: Amount (1) % Amount % Amount (1) % Amount % United States $ 893,672 78.4 % $ 973,772 81.9 % $ 1,719,320 78.4 % $ 2,001,553 81.8 % United Kingdom 140,756 12.3 % 109,437 9.2 % 259,630 11.8 % 227,319 9.3 % Canada 106,564 9.3 % 105,266 8.9 % 214,104 9.8 % 218,205 8.9 % Total $ 1,140,992 100.0 % $ 1,188,475 100.0 % $ 2,193,054 100.0 % $ 2,447,077 100.0 % As of June 30, 2021 December 31, 2020 Assets: Amount % Amount % United States $ 25,673,854 79.8 % $ 26,658,659 82.1 % United Kingdom 4,075,693 12.7 % 3,352,549 10.3 % Canada 2,426,569 7.5 % 2,472,434 7.6 % Total $ 32,176,116 100.0 % $ 32,483,642 100.0 % (1) The United States, United Kingdom and Canada represent 73%, 13% and 14% of our resident fees and services revenue for the three and six month periods ended June 30, 2021, respectively.

Income Taxes and Distributions

Income Taxes and Distributions	6 Months Ended
	Jun. 30, 2021
Income Tax Disclosure [Abstract]
Income Taxes And Distributions	Income Taxes and Distributions We elected to be taxed as a REIT commencing with our first taxable year. To qualify as a REIT for federal income tax purposes, at least 90% of taxable income (excluding 100% of net capital gains) must be distributed to stockholders. REITs that do not distribute a certain amount of taxable income in the current year are also subject to a 4% federal excise tax. The main differences between undistributed net income for federal income tax purposes and financial statement purposes are the recognition of straight-line rent for reporting purposes, basis differences in acquisitions, recording of impairments, differing useful lives and depreciation and amortization methods for real property and the provision for loan losses for reporting purposes versus bad debt expense for tax purposes. Under the provisions of the REIT Investment Diversification and Empowerment Act of 2007 (“RIDEA”), for taxable years beginning after July 30, 2008, a REIT may lease “qualified health care properties” on an arm’s-length basis to a taxable REIT subsidiary (“TRS”) if the property is operated on behalf of such TRS by a person who qualifies as an “eligible independent contractor”. Generally, the rent received from the TRS will meet the related party rent exception and will be treated as “rents from real property”. A “qualified health care property” includes real property and any personal property that is, or is necessary or incidental to the use of, a hospital, nursing facility, assisted living facility, congregate care facility, qualified continuing care facility, or other licensed facility which extends medical or nursing or ancillary services to patients. We have entered into various joint ventures that were structured under RIDEA. Resident level rents and related operating expenses for these facilities are reported in the unaudited consolidated financial statements and are subject to federal and state income taxes as the operations of such facilities are included in TRS entities. Certain net operating loss carryforwards could be utilized to offset taxable income in future years. Income taxes reflected in the financial statements primarily represents U.S. federal, state and local income taxes as well as non-U.S. income based or withholding taxes on certain investments located in jurisdictions outside the U.S. The provision for income taxes for the six months ended June 30, 2021 and 2020, 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. The CARES Act, among its economic stimulus provisions, includes a number of tax provisions relating to refundable payroll tax credits, deferment of employer side social security payments, net operating loss carrybacks, alternative minimum tax credit

Variable Interest Entities

Variable Interest Entities	6 Months Ended
	Jun. 30, 2021
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Variable Interest Entities	Variable Interest Entities We have entered into joint ventures to own certain seniors housing and outpatient medical assets which are deemed to be VIEs. We have concluded that we are the primary beneficiary of these VIEs based on a combination of operational control of the joint venture and the rights to receive residual returns or the obligation to absorb losses arising from the joint ventures. Except for capital contributions associated with the initial joint venture formations, the joint ventures have been and are expected to be funded from the ongoing operations of the underlying properties. Accordingly, such joint ventures have been consolidated, and the table below summarizes the balance sheets of consolidated VIEs in the aggregate (in thousands): June 30, 2021 December 31, 2020 Assets: Net real estate investments $ 449,437 $ 454,333 Cash and cash equivalents 12,469 15,547 Receivables and other assets 8,755 11,171 Total assets (1) $ 470,661 $ 481,051 Liabilities and equity: Secured debt $ 164,510 $ 165,671 Lease liabilities 1,324 1,325 Accrued expenses and other liabilities 11,368 14,997 Total equity 293,459 299,058 Total liabilities and equity $ 470,661 $ 481,051 (1) Note that assets of the consolidated VIEs can only be used to settle obligations relating to such VIEs. Liabilities of the consolidated VIEs represent claims against the specific assets of the VIEs.

Accounting Policies and Relat_2

Accounting Policies and Related Matters (Policies)	6 Months Ended
	Jun. 30, 2021
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation The accompanying unaudited consolidated financial statements have been prepared in accordance with U.S. generally accepted accounting principles (“U.S. GAAP”) for interim financial information and with instructions to Quarterly Report on Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all of the information and footnotes required by U.S. GAAP for complete financial statements. In the opinion of management, all adjustments (such as normal recurring accruals) considered necessary for a fair presentation have been included. Operating results for the six months ended June 30, 2021 are not necessarily an indication of the results that may be expected for the year ending December 31, 2021. 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, 2020.
New Accounting Standards	New Accounting Standards • In August 2020, the FASB issued ASU 2020-06, “Debt-Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging-Contracts in Entity’s Own Equity (Subtopic 815-40) Accounting for Convertible Instruments and Contracts in an Entity’s Own Equity”. This ASU simplifies accounting for convertible instruments and removes certain settlement conditions that are required for equity contracts to qualify for the derivative scope exception. This ASU also simplifies the diluted earnings per share calculation in certain areas and provides updated disclosure requirements. The ASU is effective for public business entities beginning after December 15, 2021 including interim periods within those fiscal years. Early adoption is permitted. We are currently evaluating the guidance and the impact it may have on our consolidated financial statements. • In March 2020, the FASB issued an amendment to the reference rate reform standard which provides the option for a limited period of time to ease the potential burden in accounting for, or recognizing the effects of, reference rate reform on contract modifications and hedge accounting. An example of such reform is the expected market transition from the London Interbank Offered Rate ("LIBOR") and other interbank offered rates to alternative reference rates. Entities that make this optional expedient election would not have to remeasure the contracts at the modification date or reassess the accounting treatment if certain criteria are met and would continue applying hedge accounting for relationships affected by reference rate reform. The new standard was effective for us upon issuance and elections can be made through December 31, 2022. We are currently evaluating our options with regards to existing contracts and hedging relationships and the impact of adopting this update on our consolidated financial statements.

Accounting Policies and Relat_3

Accounting Policies and Related Matters (Tables)	6 Months Ended
	Jun. 30, 2021
Accounting Policies [Abstract]
Schedule of Seniors Housing Operating portfolio	Monthly spot occupancy rates through June 30, 2021 are as follows: December 2020 January 2021 February 2021 March 2021 April 2021 May 2021 June 2021 Spot occupancy (1) 74.7 % 73.3 % 72.5 % 72.6 % 73.2 % 73.6 % 74.6 % Sequential occupancy change (2) (1.4) % (0.8) % 0.1 % 0.5 % 0.5 % 0.9 % (1) Spot occupancy represents approximate month end occupancy at our share for 592 properties in operation as of December 31, 2020, including unconsolidated properties but excluding acquisitions, dispositions and development conversions since this date. (2) Sequential occupancy changes are based on actual spot occupancy and may not recalculate due to rounding.

Real Property Acquisitions an_2

Real Property Acquisitions and Development (Tables)	6 Months Ended
	Jun. 30, 2021
Real Estate [Abstract]
Estimated Fair Value of Allocated Purchase Price of Asset and Liabilities	The following is a summary of our real property investment activity by segment for the periods presented (in thousands): Six Months Ended June 30, 2021 June 30, 2020 Seniors Housing Operating Triple-net Outpatient Totals Seniors Housing Operating Triple-net Outpatient Totals Land and land improvements $ 25,636 $ 30,849 $ 29,735 $ 86,220 $ 15,758 $ — $ 40,847 $ 56,605 Buildings and improvements 167,791 268,210 152,737 588,738 132,480 765 171,457 304,702 Acquired lease intangibles 10,679 — 6,274 16,953 10,810 — 23,823 34,633 Receivables and other assets 634 — 8 642 257 — 139 396 Total assets acquired (1) 204,740 299,059 188,754 692,553 159,305 765 236,266 396,336 Accrued expenses and other liabilities (2,923) (8,703) (266) (11,892) (671) — (2,036) (2,707) Total liabilities acquired (2,923) (8,703) (266) (11,892) (671) — (2,036) (2,707) Noncontrolling interests (2) (2,597) (2,056) (14,723) (19,376) (2,827) — — (2,827) Cash disbursed for acquisitions 199,220 288,300 173,765 661,285 155,807 765 234,230 390,802 Construction in progress additions 93,108 46,904 13,371 153,383 53,705 26,262 26,677 106,644 Less: Capitalized interest (6,014) (1,238) (2,106) (9,358) (5,470) (1,826) (1,991) (9,287) Accruals (3) 8 — 311 319 (1,343) — (2,983) (4,326) Cash disbursed for construction in progress 87,102 45,666 11,576 144,344 46,892 24,436 21,703 93,031 Capital improvements to existing properties 64,438 15,568 14,477 94,483 87,002 4,700 30,401 122,103 Total cash invested in real property, net of cash acquired $ 350,760 $ 349,534 $ 199,818 $ 900,112 $ 289,701 $ 29,901 $ 286,334 $ 605,936 (1) Excludes $301,000 and $580,000 of unrestricted and restricted cash acquired during the six months ended June 30, 2021 and June 30, 2020, respectively. (2) Includes amounts attributable to both redeemable noncontrolling interests and noncontrolling interests. (3) R epresents non-cash accruals for amounts to be paid in future periods for properties that converted, off-set by amounts paid in the current period. The following is a summary of the construction projects that were placed into service and began generating revenues during the periods presented (in thousands): Six Months Ended June 30, 2021 June 30, 2020 Development projects: Seniors Housing Operating $ 58,844 $ 93,188 Triple-net 22,990 33,627 Outpatient Medical 101,867 43,493 Total development projects 183,701 170,308 Expansion projects — 35,637 Total construction in progress conversions $ 183,701 $ 205,945

Real Estate Intangibles (Tables

Real Estate Intangibles (Tables)	6 Months Ended
	Jun. 30, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
Summary of Real Estate Intangibles Excluding Those Related to Ground Lease or Classified as Held For Sale	The following is a summary of our real estate intangibles, excluding those related to ground leases or classified as held for sale, as of the dates indicated (dollars in thousands): June 30, 2021 December 31, 2020 Assets: In place lease intangibles $ 1,416,212 $ 1,406,705 Above market tenant leases 53,066 52,621 Lease commissions 47,693 40,704 Gross historical cost 1,516,971 1,500,030 Accumulated amortization (1,223,550) (1,177,513) Net book value $ 293,421 $ 322,517 Weighted-average amortization period in years 10.7 10.5 Liabilities: Below market tenant leases $ 74,183 $ 77,851 Accumulated amortization (41,552) (40,871) Net book value $ 32,631 $ 36,980 Weighted-average amortization period in years 8.3 8.3
Summary of Real Estate Intangible Amortization	The following is a summary of real estate intangible amortization income (expense) for the periods presented (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2021 2020 2021 2020 Rental income related to (above)/below market tenant leases, net $ 432 $ 402 $ 857 $ 925 Amortization related to in place lease intangibles and lease commissions (20,432) (33,316) (43,211) (69,293)
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 2021 $ 40,278 $ 3,904 2022 48,245 7,234 2023 34,780 5,092 2024 27,176 2,976 2025 21,943 2,447 Thereafter 120,999 10,978 Total $ 293,421 $ 32,631

Dispositions, Real Property H_2

Dispositions, Real Property Held for Sale and Impairment (Tables)	6 Months Ended
	Jun. 30, 2021
Discontinued Operations and Disposal Groups [Abstract]
Summary of Real Property Disposition Activity	The following is a summary of our real property disposition activity for the periods presented (in thousands): Six Months Ended June 30, 2021 2020 Real estate dispositions: Seniors Housing Operating $ 112,809 $ 706,964 Triple-net 88,367 33,445 Outpatient Medical 137,890 808,992 Total dispositions 339,066 1,549,401 Gain (loss) on real estate dispositions, net 103,748 418,687 Net other assets/liabilities disposed 3,866 29,999 Proceeds from real estate dispositions $ 446,680 $ 1,998,087
Dispositions and Assets Held for Sale	The following represents the activity related to these properties for the periods presented (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2021 2020 2021 2020 Revenues: Total revenues $ 19,441 $ 107,997 $ 48,943 $ 253,500 Expenses: Interest expense 323 3,395 1,438 8,302 Property operating expenses 3,034 50,297 6,203 116,515 Provision for depreciation 1,397 28,090 7,396 54,004 Total expenses 4,754 81,782 15,037 178,821 Income (loss) from real estate dispositions, net $ 14,687 $ 26,215 $ 33,906 $ 74,679

Leases (Tables)

Leases (Tables)	6 Months Ended
	Jun. 30, 2021
Leases [Abstract]
Components of Lease Expense, Lease Terms and Discount Rate, and Supplemental Cash Flow Information	The components of lease expense were as follows for the period presented (in thousands): Six Months Ended Classification June 30, 2021 June 30, 2020 Operating lease cost: (1) Real estate lease expense Property operating expenses $ 10,538 $ 12,516 Non-real estate investment lease expense General and administrative expenses 2,354 2,549 Finance lease cost: Amortization of leased assets Property operating expenses 4,111 4,043 Interest on lease liabilities Interest expense 3,310 2,695 Sublease income Rental income (1,267) (2,087) Total $ 19,046 $ 19,716 (1) Includes short-term leases which are immaterial.
Supplemental Balance Sheet Information Related to Leases	Supplemental balance sheet information related to leases is as follows (in thousands): Classification June 30, 2021 December 31, 2020 Right of use assets: Operating leases - real estate Right of use assets, net $ 296,150 $ 310,017 Finance leases - real estate Right of use assets, net 157,471 155,849 Real estate right of use assets, net 453,621 465,866 Operating leases - non-real estate investments Receivables and other assets 7,248 9,624 Total right of use assets, net $ 460,869 $ 475,490 Lease liabilities: Operating leases $ 298,722 $ 311,164 Financing leases 110,906 107,102 Total $ 409,628 $ 418,266

Loans Receivable (Tables)

Loans Receivable (Tables)	6 Months Ended
	Jun. 30, 2021
Receivables [Abstract]
Summary of Loans Receivable	The following is a summary of our loans receivable (in thousands): June 30, 2021 December 31, 2020 Mortgage loans $ 935,572 $ 299,430 Other real estate loans 179,462 152,739 Allowance for credit losses on real estate loans receivable (17,735) (8,797) Real estate loans receivable, net of credit allowance 1,097,299 443,372 Non-real estate loans 348,061 455,508 Allowance for credit losses on non-real estate loans receivable (149,697) (215,239) Non-real estate loans receivable, net of credit allowance 198,364 240,269 Total loans receivable, net of credit allowance $ 1,295,663 $ 683,641
Summary of Loan Activity	The following is a summary of our loan activity for the periods presented (in thousands): Six Months Ended June 30, 2021 June 30, 2020 Advances on loans receivable: Investments in new loans $ 902,189 $ 2,477 Draws on existing loans 16,218 17,061 Net cash advances on loans receivable 918,407 19,538 Receipts on loans receivable: Loan payoffs 179,827 — Principal payments on loans 69,014 12,796 Net cash receipts on loans receivable 248,841 12,796 Net cash advances (receipts) on loans receivable $ 669,566 $ 6,742
Schedule of Credit Loss	The following is a summary of our loans by credit loss category (in thousands): June 30, 2021 Loan category Years of Origination Loan Carrying Value Allowance for Credit Loss Net Loan Balance No. of Loans Deteriorated loans 2007 - 2018 $ 178,253 $ (148,438) $ 29,815 3 Collective loan pool 2007-2016 198,975 (3,033) 195,942 17 Collective loan pool 2017 126,493 (1,182) 125,311 7 Collective loan pool 2018 20,652 (324) 20,328 1 Collective loan pool 2019 22,046 (347) 21,699 4 Collective loan pool 2020 49,352 (770) 48,582 8 Collective loan pool 2021 867,324 (13,338) 853,986 9 Total loans $ 1,463,095 $ (167,432) $ 1,295,663 49 Six Months Ended June 30, 2021 June 30, 2020 Balance at beginning of period $ 224,036 $ 68,372 Adoption of ASU 2016-13 — 5,212 Provision for loan losses 7,580 8,494 Loan write-offs (1) (64,075) — Foreign currency translation (109) (93) Balance at end of period $ 167,432 $ 81,985 (1) Includes $62,753,000 related to the Genesis Healthcare lease terminations for the six months ended June 30, 2021. See Note 9 for further details.
Summary of Impaired Loans	The following is a summary of our deteriorated loans (in thousands): Six Months Ended June 30, 2021 June 30, 2020 Balance of deteriorated loans at end of period (1) $ 178,253 $ 186,584 Allowance for credit losses (148,438) (76,695) Balance of deteriorated loans not reserved $ 29,815 $ 109,889 Interest recognized on deteriorated loans (2) $ 3,122 $ 7,912 (1) Current year amounts include $2,176,000 and $3,623,000 of loans on non-accrual as of June 30, 2021 and December 31, 2020, respectively. Prior year amounts include $10,716,000 and $2,534,000 as of June 30, 2020 and December 31, 2019, respectively. (2) Represents cash interest recognized in the period.

Investments in Unconsolidated_2

Investments in Unconsolidated Entities (Tables)	6 Months Ended
	Jun. 30, 2021
Equity Method Investments and Joint Ventures [Abstract]
Summary of Seniors Housing Operating portfolio	The following is a summary of our investments in unconsolidated entities (dollars in thousands): Percentage Ownership (1) June 30, 2021 December 31, 2020 Seniors Housing Operating 10% to 65% $ 766,273 $ 653,057 Triple-net 10% to 25% 81,100 5,629 Outpatient Medical 15% to 50% 172,739 287,548 Total $ 1,020,112 $ 946,234 (1) Includes ownership of investments classified as liabilities and excludes ownership of in substance real estate.

Credit Concentration (Tables)

Credit Concentration (Tables)	6 Months Ended
	Jun. 30, 2021
Risks and Uncertainties [Abstract]
Summary of Credit Concentration	The following table summarizes certain information about our credit concentration for the six months ended June 30, 2021, excluding our share of NOI in unconsolidated entities (dollars in thousands): Concentration by relationship: (1) Number of Properties Total NOI Percent of NOI (2) ProMedica 217 $ 111,157 12% Sunrise Senior Living (3) 166 109,494 12% Revera (3) 85 45,928 5% Avery Healthcare 61 41,536 5% Genesis Healthcare 15 36,677 4% Remaining portfolio 972 588,279 62% Totals 1,516 $ 933,071 100% (1) Sunrise Senior Living and Revera are in our Seniors Housing Operating segment. Genesis Healthcare and ProMedica are in our Triple-net segment. Avery Healthcare is in both the Triple-net and Seniors Housing Operating segments. (2) NOI with our top five relationships comprised 36% of total NOI for the year ended December 31, 2020. (3) Revera owns a controlling interest in Sunrise Senior Living.

Borrowings Under Credit Facil_2

Borrowings Under Credit Facilities and Commercial Paper Program (Tables)	6 Months Ended
	Jun. 30, 2021
Debt Disclosure [Abstract]
Aggregate Borrowings Under Unsecured Revolving Credit Facility and Commercial Paper	The following information relates to aggregate borrowings under the unsecured revolving credit facility and commercial paper program for the periods presented (dollars in thousands): Three Months Ended June 30, Six Months Ended June 30, 2021 2020 2021 2020 Balance outstanding at quarter end $ — $ — $ — $ — Maximum amount outstanding at any month end $ 195,000 $ 685,000 $ 195,000 $ 2,100,000 Average amount outstanding (total of daily principal balances divided by days in period) $ 289,231 $ 405,165 $ 145,414 $ 999,490 Weighted average interest rate (actual interest expense divided by average borrowings outstanding) 0.76 % 1.57 % 0.76 % 2.08 %

Senior Unsecured Notes and Se_2

Senior Unsecured Notes and Secured Debt (Tables)	6 Months Ended
	Jun. 30, 2021
Debt Disclosure [Abstract]
Annual Principal Payments Due on Debt Obligations	At June 30, 2021, the annual principal payments due on these debt obligations were as follows (in thousands): Senior Unsecured Notes (1,2) Secured Debt (1,3) Totals 2021 $ — $ 253,459 $ 253,459 2022 10,000 486,699 496,699 2023 (4, 5) 701,525 489,409 1,190,934 2024 1,350,000 185,318 1,535,318 2025 1,250,000 181,449 1,431,449 Thereafter (6, 7, 8) 7,941,460 714,794 8,656,254 Totals $ 11,252,985 $ 2,311,128 $ 13,564,113 (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 0.79% to 6.50%. (3) Annual interest rates range from 0.03% to 7.93%. Carrying value of the properties securing the debt totaled $5,312,000,000 at June 30, 2021. (4) Includes a $250,000,000 Canadian-denominated unsecured term credit facility (approximately $201,525,000 based on the Canadian/U.S. Dollar exchange rate on June 30, 2021). The loan matures on July 19, 2023 and bears interest at the Canadian Dealer Offered Rate plus 0.90% (1.31% at June 30, 2021). (5) Includes a $500,000,000 unsecured term credit facility. The loan matures on July 19, 2023 and bears interest at LIBOR plus 0.90% (1.00% at June 30, 2021). (6) Includes a $300,000,000 Canadian-denominated 2.95% senior unsecured notes due 2027 (approximately $241,830,000 based on the Canadian/U.S. Dollar exchange rate on June 30, 2021). (7) Includes a £550,000,000 4.80% senior unsecured notes due 2028 (approximately $759,330,000 based on the Sterling/U.S. Dollar exchange rate in effect on June 30, 2021). (8) Includes a £500,000,000 4.50% senior unsecured notes due 2034 (approximately $690,300,000 based on the Sterling/U.S. Dollar exchange rate in effect on June 30, 2021).
Summary of Principal Activity	The following is a summary of our senior unsecured notes principal activity during the periods presented (dollars in thousands): Six Months Ended June 30, 2021 June 30, 2020 Weighted Avg. Weighted Avg. Amount Interest Rate Amount Interest Rate Beginning balance $ 11,509,533 3.67% $ 10,427,562 4.03% Debt issued 1,250,000 2.50% 1,600,000 1.89% Debt extinguished (1,533,752) 2.42% — —% Foreign currency 27,204 3.57% (114,851) 4.30% Ending balance $ 11,252,985 3.71% $ 11,912,711 3.65% The following is a summary of our secured debt principal activity for the periods presented (dollars in thousands): Six Months Ended June 30, 2021 June 30, 2020 Weighted Avg. Weighted Avg. Amount Interest Rate Amount Interest Rate Beginning balance $ 2,378,073 3.27% $ 2,993,342 3.63% Debt issued — —% 44,921 2.58% Debt extinguished (66,593) 6.01% (314,631) 2.94% Principal payments (31,670) 3.48% (30,709) 3.55% Foreign currency 31,318 2.89% (64,934) 3.13% Ending balance $ 2,311,128 3.10% $ 2,627,989 3.09%

Derivative Instruments (Tables)

Derivative Instruments (Tables)	6 Months Ended
	Jun. 30, 2021
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Notional Amount of Derivatives and Other Financial Instruments	The following presents the notional amount of derivatives and other financial instruments as of the dates indicated (in thousands): June 30, 2021 December 31, 2020 Derivatives designated as net investment hedges: Denominated in Canadian Dollars $ 625,000 $ 625,000 Denominated in Pound Sterling £ 1,880,708 £ 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) $ 25,000 $ 450,000 Derivative instruments not designated: Interest rate caps denominated in U.S. Dollars $ 26,137 $ 26,137 Forward sales contracts denominated in Canadian Dollars $ 80,000 $ 80,000
Impact of Derivative Instruments on the Consolidated Statements of Comprehensive Income	The following presents the impact of derivative instruments on the Consolidated Statements of Comprehensive Income for the periods presented (in thousands): Three Months Ended June 30, Six Months Ended June 30, Description Location 2021 2020 2021 2020 Gain (loss) on derivative instruments designated as hedges recognized in income Interest expense $ 5,544 $ 4,106 $ 11,567 $ 10,751 Gain (loss) on derivative instruments not designated as hedges recognized in income Interest expense $ (936) $ (1,953) $ (1,656) $ (2,048) Gain (loss) on derivative and financial instruments designated as hedges recognized in OCI OCI $ (9,808) $ (27,171) $ (29,845) $ 231,941

Stockholders' Equity (Tables)

Stockholders' Equity (Tables)	6 Months Ended
	Jun. 30, 2021
Equity [Abstract]
Summary of Stockholders' Equity Capital Accounts	The following is a summary of our stockholders’ equity capital accounts as of the dates indicated: June 30, 2021 December 31, 2020 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 424,339,944 419,124,469 Outstanding shares 422,561,863 417,400,602 The following is a summary of our common stock issuances during the six months ended June 30, 2021 and 2020 (dollars in thousands, except shares and average price amounts): Shares Issued Average Price Gross Proceeds Net Proceeds 2020 Dividend reinvestment plan issuances 264,153 $ 72.33 $ 19,105 $ 19,105 2020 Option exercises 251 47.81 12 12 2020 ATM Program issuances 6,799,978 86.48 588,072 576,196 2020 Stock incentive plans, net of forfeitures 183,398 — — 2020 Totals 7,247,780 $ 607,189 $ 595,313 2021 ATM Program issuances 5,015,673 74.15 371,937 366,464 2021 Stock incentive plans, net of forfeitures 145,588 — — 2021 Totals 5,161,261 $ 371,937 $ 366,464
Summary of Dividend Payments	The following is a summary of our dividend payments (in thousands, except per share amounts): Six Months Ended June 30, 2021 June 30, 2020 Per Share Amount Per Share Amount Common stock $ 1.22 $ 510,424 $ 1.48 $ 610,847
Summary of Accumulated Other Comprehensive Income (Loss)	The following is a summary of accumulated other comprehensive income (loss) for the periods presented (in thousands): June 30, 2021 December 31, 2020 Foreign currency translation $ (571,391) $ (621,792) Derivative and financial instruments designated as hedges 443,443 473,288 Total accumulated other comprehensive income (loss) $ (127,948) $ (148,504)

Earnings Per Share (Tables)

Earnings Per Share (Tables)	6 Months Ended
	Jun. 30, 2021
Earnings Per Share [Abstract]
Computation of Basic and Diluted Earnings Per Share	The following table sets forth the computation of basic and diluted earnings per share (in thousands, except per share data): Three Months Ended June 30, Six Months Ended June 30, 2021 2020 2021 2020 Numerator for basic earnings per share - net income (loss) attributable to common stockholders $ 26,257 $ 179,246 $ 97,803 $ 489,530 Adjustment for net income (loss) attributable to OP units (873) (1,366) (2,225) (2,754) Numerator for diluted earnings per share $ 25,384 $ 177,880 $ 95,578 $ 486,776 Denominator for basic earnings per share - weighted average shares 417,452 417,084 417,360 413,696 Effect of dilutive securities: Non-vested restricted shares 438 619 430 661 Redeemable OP units 1,396 1,396 1,396 1,396 Employee stock purchase program 19 22 19 22 Dilutive potential common shares 1,853 2,037 1,845 2,079 Denominator for diluted earnings per share - adjusted weighted average shares 419,305 419,121 419,205 415,775 Basic earnings per share $ 0.06 $ 0.43 $ 0.23 $ 1.18 Diluted earnings per share $ 0.06 $ 0.42 $ 0.23 $ 1.17

Disclosure about Fair Value o_2

Disclosure about Fair Value of Financial Instruments (Tables)	6 Months Ended
	Jun. 30, 2021
Fair Value Disclosures [Abstract]
Carrying Amounts and Estimated Fair Values of Financial Instruments	The carrying amounts and estimated fair values of our financial instruments are as follows (in thousands): June 30, 2021 December 31, 2020 Carrying Amount Fair Value Carrying Amount Fair Value Financial assets: Mortgage loans receivable $ 919,812 $ 935,528 $ 293,752 $ 297,207 Other real estate loans receivable 177,487 173,889 149,620 152,211 Equity securities 3,061 3,061 4,636 4,636 Cash and cash equivalents 513,602 513,602 1,545,046 1,545,046 Restricted cash 295,102 295,102 475,997 475,997 Non-real estate loans receivable 198,364 202,877 240,269 255,724 Foreign currency forward contracts, interest rate swaps and cross currency swaps 6,256 6,256 4,668 4,668 Equity warrants 32,419 32,419 — — Financial liabilities: Senior unsecured notes $ 11,157,732 $ 12,544,312 $ 11,420,790 $ 13,093,926 Secured debt 2,304,178 2,364,951 2,377,930 2,451,782 Foreign currency forward contracts, interest rate swaps and cross currency swaps 89,929 89,929 118,054 118,054 Redeemable OP unitholder interests $ 148,332 $ 148,332 $ 116,240 $ 115,346
Summary of Items Measured at Fair Value on a Recurring Basis	The following summarizes items measured at fair value on a recurring basis (in thousands): Fair Value Measurements as of June 30, 2021 Total Level 1 Level 2 Level 3 Equity securities $ 3,061 $ 3,061 $ — $ — Equity warrants 32,419 — — 32,419 Foreign currency forward contracts, interest rate swaps and cross currency swaps, net asset (liability) (1) (83,673) — (83,673) — Totals $ (48,193) $ 3,061 $ (83,673) $ 32,419 (1) Please see Note 12 for additional information.

Segment Reporting (Tables)

Segment Reporting (Tables)	6 Months Ended
	Jun. 30, 2021
Segment Reporting [Abstract]
Summary Information for Reportable Segments	Summary information for the reportable segments (which excludes unconsolidated entities) is as follows (in thousands): Three Months Ended June 30, 2021: Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 740,891 $ — $ — $ — $ 740,891 Rental income — 204,725 149,998 — 354,723 Interest income 856 32,861 4,731 — 38,448 Other income 802 1,355 4,343 430 6,930 Total revenues 742,549 238,941 159,072 430 1,140,992 Property operating expenses 582,361 12,627 45,495 2,174 642,657 Consolidated net operating income 160,188 226,314 113,577 (1,744) 498,335 Depreciation and amortization 131,035 54,406 55,444 — 240,885 Interest expense 10,553 1,704 3,907 106,177 122,341 General and administrative expenses — — — 31,436 31,436 Loss (gain) on derivatives and financial instruments, net — (359) — — (359) Loss (gain) on extinguishment of debt, net 3,106 — — 52,506 55,612 Provision for loan losses (181) 10,019 (3,641) — 6,197 Impairment of assets 17,713 3,768 2,211 — 23,692 Other expenses 3,709 4,110 1,098 2,770 11,687 Income (loss) from continuing operations before income taxes and other items (5,747) 152,666 54,558 (194,633) 6,844 Income tax (expense) benefit — — — 2,221 2,221 Income (loss) from unconsolidated entities (12,938) 4,877 85 — (7,976) Gain (loss) on real estate dispositions, net (28) 42,709 1,987 — 44,668 Income (loss) from continuing operations (18,713) 200,252 56,630 (192,412) 45,757 Net income (loss) $ (18,713) $ 200,252 $ 56,630 $ (192,412) $ 45,757 Total assets $ 16,129,367 $ 9,490,724 $ 6,212,491 $ 343,534 $ 32,176,116 Three Months Ended June 30, 2020: Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 769,560 $ — $ — $ — $ 769,560 Rental income — 217,492 178,813 — 396,305 Interest income 88 15,520 461 — 16,069 Other income 4,002 607 1,557 375 6,541 Total revenues 773,650 233,619 180,831 375 1,188,475 Property operating expenses 595,513 13,563 51,688 — 660,764 Consolidated net operating income 178,137 220,056 129,143 375 527,711 Depreciation and amortization 139,163 58,138 68,070 — 265,371 Interest expense 14,029 2,746 4,326 105,256 126,357 General and administrative expenses — — — 34,062 34,062 Loss (gain) on derivatives and financial instruments, net — 1,434 — — 1,434 Loss (gain) on extinguishment of debt, net (492) — 741 — 249 Provision for loan losses — 1,451 (29) — 1,422 Impairment of assets 75,151 — — — 75,151 Other expenses 5,251 3,500 6,456 4,204 19,411 Income (loss) from continuing operations before income taxes and other items (54,965) 152,787 49,579 (143,147) 4,254 Income tax (expense) benefit — — — (2,233) (2,233) Income (loss) from unconsolidated entities (6,787) 6,403 1,716 — 1,332 Gain (loss) on real estate dispositions, net 14,465 2,148 139,250 — 155,863 Income (loss) from continuing operations (47,287) 161,338 190,545 (145,380) 159,216 Net income (loss) $ (47,287) $ 161,338 $ 190,545 $ (145,380) $ 159,216 Six Months Ended June 30, 2021 Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 1,464,355 $ — $ — $ — $ 1,464,355 Rental income — 357,188 300,378 — 657,566 Interest income 1,975 47,783 8,269 — 58,027 Other income 2,621 2,452 6,648 1,385 13,106 Total revenues 1,468,951 407,423 315,295 1,385 2,193,054 Property operating expenses 1,138,329 25,468 92,358 3,828 1,259,983 Consolidated net operating income 330,622 381,955 222,937 (2,443) 933,071 Depreciation and amortization 263,621 111,073 110,617 — 485,311 Interest expense 21,971 3,586 7,922 212,004 245,483 General and administrative expenses — — — 61,362 61,362 Loss (gain) on derivatives and financial instruments, net — 1,575 — — 1,575 Loss (gain) on extinguishment of debt, net (1,537) — — 52,506 50,969 Provision for loan losses 70 10,872 (3,362) — 7,580 Impairment of assets 22,317 22,732 2,211 — 47,260 Other expenses 7,168 9,093 1,810 4,610 22,681 Income (loss) from continuing operations before income taxes and other items 17,012 223,024 103,739 (332,925) 10,850 Income tax (expense) benefit — — — (1,722) (1,722) Income (loss) from unconsolidated entities (7,704) 9,784 2,993 — 5,073 Gain (loss) on real estate dispositions, net 5,167 44,751 53,830 — 103,748 Income (loss) from continuing operations 14,475 277,559 160,562 (334,647) 117,949 Net income (loss) $ 14,475 $ 277,559 $ 160,562 $ (334,647) $ 117,949 Six Months Ended June 30, 2020 Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 1,619,532 $ — $ — $ — $ 1,619,532 Rental income — 408,877 377,388 — 786,265 Interest income 192 30,191 927 — 31,310 Other income 5,054 2,280 1,845 791 9,970 Total revenues 1,624,778 441,348 380,160 791 2,447,077 Property operating expenses 1,203,384 26,865 112,296 — 1,342,545 Consolidated net operating income 421,394 414,483 267,864 791 1,104,532 Depreciation and amortization 285,937 115,832 138,403 — 540,172 Interest expense 30,463 5,598 9,134 223,169 268,364 General and administrative expenses — — — 69,543 69,543 Loss (gain) on derivatives and financial — 9,085 — — 9,085 Loss (gain) on extinguishment of debt, net (492) — 741 — 249 Provision for loan losses — 18.69 8,523 — (29) 18.69 — 8,494 Impairment of assets 78,646 24,332 — — 102,978 Other expenses 8,240 4,013 7,463 5,987 25,703 Income (loss) from continuing operations before income taxes and other items 18,600 247,100 112,152 (297,908) 79,944 Income tax (expense) benefit — — — (7,675) (7,675) Income (loss) from unconsolidated entities (17,811) 12,199 3,252 — (2,360) Gain (loss) on real estate dispositions, net 14,316 51,785 352,586 — 418,687 Income (loss) from continuing operations 15,105 311,084 467,990 (305,583) 488,596 Net income (loss) $ 15,105 $ 311,084 $ 467,990 $ (305,583) $ 488,596
Summary of Geographic Information	The following is a summary of geographic information for the periods presented (dollars in thousands): Three Months Ended Six Months Ended June 30, 2021 June 30, 2020 June 30, 2021 June 30, 2020 Revenues: Amount (1) % Amount % Amount (1) % Amount % United States $ 893,672 78.4 % $ 973,772 81.9 % $ 1,719,320 78.4 % $ 2,001,553 81.8 % United Kingdom 140,756 12.3 % 109,437 9.2 % 259,630 11.8 % 227,319 9.3 % Canada 106,564 9.3 % 105,266 8.9 % 214,104 9.8 % 218,205 8.9 % Total $ 1,140,992 100.0 % $ 1,188,475 100.0 % $ 2,193,054 100.0 % $ 2,447,077 100.0 % As of June 30, 2021 December 31, 2020 Assets: Amount % Amount % United States $ 25,673,854 79.8 % $ 26,658,659 82.1 % United Kingdom 4,075,693 12.7 % 3,352,549 10.3 % Canada 2,426,569 7.5 % 2,472,434 7.6 % Total $ 32,176,116 100.0 % $ 32,483,642 100.0 % (1) The United States, United Kingdom and Canada represent 73%, 13% and 14% of our resident fees and services revenue for the three and six month periods ended June 30, 2021, respectively.

Variable Interest Entities (Tab

Variable Interest Entities (Tables)	6 Months Ended
	Jun. 30, 2021
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Schedule of Variable Interest Entities	Accordingly, such joint ventures have been consolidated, and the table below summarizes the balance sheets of consolidated VIEs in the aggregate (in thousands): June 30, 2021 December 31, 2020 Assets: Net real estate investments $ 449,437 $ 454,333 Cash and cash equivalents 12,469 15,547 Receivables and other assets 8,755 11,171 Total assets (1) $ 470,661 $ 481,051 Liabilities and equity: Secured debt $ 164,510 $ 165,671 Lease liabilities 1,324 1,325 Accrued expenses and other liabilities 11,368 14,997 Total equity 293,459 299,058 Total liabilities and equity $ 470,661 $ 481,051 (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) - property	Jul. 23, 2021	Jun. 30, 2021	May 31, 2021	Apr. 30, 2021	Mar. 31, 2021	Mar. 12, 2021	Feb. 28, 2021	Jan. 30, 2021	Dec. 31, 2020
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Spot occupancy properties									592
COVID-19
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Increase in occupancy basis		2.30%
COVID-19 | United States | Subsequent event
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Increase in occupancy basis	0.60%
COVID-19 | United Kingdom | Subsequent event
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Increase in occupancy basis	0.30%
Seniors Housing Operating | COVID-19
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Spot occupancy		74.60%	73.60%	73.20%	72.60%	72.30%	72.50%	73.30%	74.70%
Sequential occupancy change		0.90%	0.50%	0.50%	0.10%		(0.80%)	(1.40%)
Seniors Housing Operating | COVID-19 | Subsequent event
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Increase in occupancy basis	0.40%

Accounting Policies and Relat_5

Accounting Policies and Related Matters - Additional Information (Details) - COVID-19 - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Rent collected percentage			95.00%
Seniors Housing Operating
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Increase in operational cost	$ 1,535	$ 40,127	$ 22,792	$ 47,421
Cost of property operating expense			$ 40,976

Real Property Acquisitions an_3

Real Property Acquisitions and Development - Estimated Fair Value of Allocated Purchase Price of Asset and Liabilities (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020
Business Acquisition [Line Items]
Land and land improvements	$ 86,220	$ 56,605
Buildings and improvements	588,738	304,702
Acquired lease intangibles	16,953	34,633
Receivables and other assets	642	396
Total assets acquired	692,553	396,336
Accrued expenses and other liabilities	(11,892)	(2,707)
Total liabilities acquired	(11,892)	(2,707)
Noncontrolling interests	(19,376)	(2,827)
Cash disbursed for acquisitions	661,285	390,802
Construction in progress additions	153,383	106,644
Less: Capitalized interest	(9,358)	(9,287)
Accruals	319	(4,326)
Cash disbursed for construction in progress	144,344	93,031
Capital improvements to existing properties	94,483	122,103
Total cash invested in real property, net of cash acquired	900,112	605,936
Cash acquired from acquisition	301	580
Seniors Housing Operating
Business Acquisition [Line Items]
Land and land improvements	25,636	15,758
Buildings and improvements	167,791	132,480
Acquired lease intangibles	10,679	10,810
Receivables and other assets	634	257
Total assets acquired	204,740	159,305
Accrued expenses and other liabilities	(2,923)	(671)
Total liabilities acquired	(2,923)	(671)
Noncontrolling interests	(2,597)	(2,827)
Cash disbursed for acquisitions	199,220	155,807
Construction in progress additions	93,108	53,705
Less: Capitalized interest	(6,014)	(5,470)
Accruals	8	(1,343)
Cash disbursed for construction in progress	87,102	46,892
Capital improvements to existing properties	64,438	87,002
Total cash invested in real property, net of cash acquired	350,760	289,701
Triple-net
Business Acquisition [Line Items]
Land and land improvements	30,849	0
Buildings and improvements	268,210	765
Acquired lease intangibles	0	0
Receivables and other assets	0	0
Total assets acquired	299,059	765
Accrued expenses and other liabilities	(8,703)	0
Total liabilities acquired	(8,703)	0
Noncontrolling interests	(2,056)	0
Cash disbursed for acquisitions	288,300	765
Construction in progress additions	46,904	26,262
Less: Capitalized interest	(1,238)	(1,826)
Accruals	0	0
Cash disbursed for construction in progress	45,666	24,436
Capital improvements to existing properties	15,568	4,700
Total cash invested in real property, net of cash acquired	349,534	29,901
Outpatient Medical
Business Acquisition [Line Items]
Land and land improvements	29,735	40,847
Buildings and improvements	152,737	171,457
Acquired lease intangibles	6,274	23,823
Receivables and other assets	8	139
Total assets acquired	188,754	236,266
Accrued expenses and other liabilities	(266)	(2,036)
Total liabilities acquired	(266)	(2,036)
Noncontrolling interests	(14,723)	0
Cash disbursed for acquisitions	173,765	234,230
Construction in progress additions	13,371	26,677
Less: Capitalized interest	(2,106)	(1,991)
Accruals	311	(2,983)
Cash disbursed for construction in progress	11,576	21,703
Capital improvements to existing properties	14,477	30,401
Total cash invested in real property, net of cash acquired	$ 199,818	$ 286,334

Real Property Acquisitions an_4

Real Property Acquisitions and Development - Narrative (Details) - Definitive Agreement To Acquire Property $ in Thousands	Jun. 30, 2021USD ($)property	Jun. 21, 2021USD ($)property
Business Acquisition [Line Items]
Number of properties | property	86
Total contingent purchase obligations | $	$ 1,576,800
Holiday Retirement
Business Acquisition [Line Items]
Number of properties | property		86
Total contingent purchase obligations | $		$ 1,576,800

Real Property Acquisitions an_5

Real Property Acquisitions and Development - Construction Activity (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020
Segment Reporting Information [Line Items]
Total development projects	$ 183,701	$ 170,308
Expansion projects	0	35,637
Total construction in progress conversions	183,701	205,945
Seniors Housing Operating
Segment Reporting Information [Line Items]
Total development projects	58,844	93,188
Triple-net
Segment Reporting Information [Line Items]
Total development projects	22,990	33,627
Outpatient Medical
Segment Reporting Information [Line Items]
Total development projects	$ 101,867	$ 43,493

Real Estate Intangibles - Summa

Real Estate Intangibles - Summary of Real Estate Intangibles Excluding Those Classified as Held For Sale (Details) - USD ($) $ in Thousands	6 Months Ended	12 Months Ended
	Jun. 30, 2021	Dec. 31, 2020
Assets:
Gross historical cost	$ 1,516,971	$ 1,500,030
Accumulated amortization	(1,223,550)	(1,177,513)
Net book value	$ 293,421	$ 322,517
Weighted-average amortization period in years	10 years 8 months 12 days	10 years 6 months
Liabilities:
Below market tenant leases	$ 74,183	$ 77,851
Accumulated amortization	(41,552)	(40,871)
Net book value	$ 32,631	$ 36,980
Weighted-average amortization period in years	8 years 3 months 18 days	8 years 3 months 18 days
In place lease intangibles
Assets:
Gross historical cost	$ 1,416,212	$ 1,406,705
Above market tenant leases
Assets:
Gross historical cost	53,066	52,621
Lease commissions
Assets:
Gross historical cost	$ 47,693	$ 40,704

Real Estate Intangibles - Sum_2

Real Estate Intangibles - Summary of Real Estate Intangible Amortization (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
Rental income related to (above)/below market tenant leases, net	$ 432	$ 402	$ 857	$ 925
Amortization related to in place lease intangibles and lease commissions	$ (20,432)	$ (33,316)	$ (43,211)	$ (69,293)

Real Estate Intangibles - Sched

Real Estate Intangibles - Schedule of Future Estimated Aggregate Amortization of Intangible Assets and Liabilities (Details) - USD ($) $ in Thousands	Jun. 30, 2021	Dec. 31, 2020
Assets
2021	$ 40,278
2022	48,245
2024	34,780
2024	27,176
2025	21,943
Thereafter	120,999
Net book value	293,421	$ 322,517
Liabilities
2021	3,904
2022	7,234
2023	5,092
2024	2,976
2025	2,447
Thereafter	10,978
Net book value	$ 32,631	$ 36,980

Dispositions, Real Property H_3

Dispositions, Real Property Held for Sale and Impairment - Narrative (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2021USD ($)property	Jun. 30, 2020USD ($)property	Dec. 31, 2020USD ($)	[1]
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Real property held for sale | $	$ 592,699		$ 216,613
Expected proceeds from properties held for sale | $	747,153
Impairment of assets held for use | $	18,077
Held for sale
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Real property held for sale | $	$ 20,382
Seniors Housing Operating
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of properties classified as held for sale | property	2
Impairment of assets held for use | $	$ 29,183
Impairment of assets held for sale | $		$ 75,151
Number of properties held for use | property	2	12
Triple-net
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of properties classified as held for sale | property	54
Impairment of assets held for use | $		$ 27,827
Number of properties subject to asset impairment | property	3
Number of properties held for use | property	2	1
Outpatient Medical
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of properties classified as held for sale | property	2
Number of properties subject to asset impairment | property	1
[1]	Note: The consolidated balance sheet at December 31, 2020 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by U.S. generally accepted accounting principles for complete financial statements.

Dispositions, Real Property H_4

Dispositions, Real Property Held for Sale and Impairment - Summary of Real Property Disposition Activity (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Real estate dispositions:
Total dispositions			$ 339,066	$ 1,549,401
Gain (loss) on real estate dispositions, net	$ 44,668	$ 155,863	103,748	418,687
Net other assets/liabilities disposed			3,866	29,999
Proceeds from real estate dispositions			446,680	1,998,087
Seniors Housing Operating
Real estate dispositions:
Total dispositions			112,809	706,964
Triple-net
Real estate dispositions:
Total dispositions			88,367	33,445
Outpatient Medical
Real estate dispositions:
Total dispositions			$ 137,890	$ 808,992

Dispositions, Real Property H_5

Dispositions, Real Property Held for Sale and Impairment - Dispositions and Assets Held for Sale (Details) - Disposal group, disposed of by sale, not discontinued operations - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Revenues:
Total revenues	$ 19,441	$ 107,997	$ 48,943	$ 253,500
Expenses:
Interest expense	323	3,395	1,438	8,302
Property operating expenses	3,034	50,297	6,203	116,515
Provision for depreciation	1,397	28,090	7,396	54,004
Total expenses	4,754	81,782	15,037	178,821
Income (loss) from real estate dispositions, net	$ 14,687	$ 26,215	$ 33,906	$ 74,679

Leases - Narrative (Details)

Leases - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Lessee, Lease, Description [Line Items]
Straight line rent adjustment			$ 49,241	$ 34,110
Rental and other revenues related to operating lease payments	$ 354,723	$ 396,305	657,566	786,265
Rental and other revenues related to operating lease payments, variable leases			$ 89,890	$ 104,605
Minimum
Lessee, Lease, Description [Line Items]
Lease term extension period			1 year
Maximum
Lessee, Lease, Description [Line Items]
Lease term extension period			25 years

Leases - Components of Lease Ex

Leases - Components of Lease Expense (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020
Finance lease cost:
Amortization of leased assets	$ 4,111	$ 4,043
Interest on lease liabilities	3,310	2,695
Sublease income	(1,267)	(2,087)
Total	19,046	19,716
Property operating expenses
Operating lease cost:
Lease expense	10,538	12,516
General and administrative expenses
Operating lease cost:
Lease expense	$ 2,354	$ 2,549

Leases - Supplemental Balance S

Leases - Supplemental Balance Sheet Information Related to Leases (Details) - USD ($) $ in Thousands	Jun. 30, 2021	Dec. 31, 2020
Right of use assets:
Total right of use assets, net	$ 453,621	$ 465,866	[1]
Lease liabilities:
Operating leases	298,722	311,164
Financing leases	110,906	107,102
Total	$ 409,628	$ 418,266	[1]
Operating lease, right-of-use asset, statement of financial position
Finance lease, right-of-use asset, statement of financial position
Operating lease, liability, statement of financial position
Finance lease, liability, statement of financial position
Real estate
Right of use assets:
Operating leases	$ 296,150	$ 310,017
Finance leases	157,471	155,849
Corporate
Right of use assets:
Operating leases	$ 7,248	$ 9,624
Lease liabilities:
Operating lease, right-of-use asset, statement of financial position
Real estate and Corporate
Right of use assets:
Total right of use assets, net	$ 460,869	$ 475,490
[1]	Note: The consolidated balance sheet at December 31, 2020 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by U.S. generally accepted accounting principles for complete financial statements.

Loans Receivable - Narrative (D

Loans Receivable - Narrative (Details) $ in Thousands, £ in Millions	3 Months Ended
	Jun. 30, 2021USD ($)	Jun. 30, 2021GBP (£)	Dec. 31, 2020USD ($)
Financing Receivable, Troubled Debt Restructuring [Line Items]
Interest receivable	$ 21,938		$ 15,615
Financing receivable	1,295,663
Safanad
Financing Receivable, Troubled Debt Restructuring [Line Items]
Financing receivable	$ 750,330	£ 540
Working capital facility | £		£ 30
Term of receivable	5 years

Loans Receivable - Summary of R

Loans Receivable - Summary of Real Estate Loans Receivable (Details) - USD ($) $ in Thousands	Jun. 30, 2021	Dec. 31, 2020		Jun. 30, 2020	Dec. 31, 2019
Accounts, Notes, Loans and Financing Receivable [Line Items]
Loan Carrying Value	$ 1,463,095
Allowance for credit losses on real estate loans receivable	(167,432)	$ (224,036)		$ (81,985)	$ (68,372)
Real estate loans receivable, net of credit allowance	1,097,299	443,372	[1]
Non-real estate loans	348,061	455,508
Allowance for credit losses on non-real estate loans receivable	(149,697)	(215,239)
Non-real estate loans receivable, net of credit allowance	198,364	240,269
Total loans receivable, net of credit allowance	1,295,663	683,641
Mortgage loans
Accounts, Notes, Loans and Financing Receivable [Line Items]
Loan Carrying Value	935,572	299,430
Other real estate loans
Accounts, Notes, Loans and Financing Receivable [Line Items]
Loan Carrying Value	179,462	152,739
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	$ (17,735)	$ (8,797)
[1]	Note: The consolidated balance sheet at December 31, 2020 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by U.S. generally accepted accounting principles for complete financial statements.

Loans Receivable - Summary of_2

Loans Receivable - Summary of Real Estate Loan Activity (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020
Advances on loans receivable:
Net cash advances on loans receivable	$ 918,407	$ 19,538
Receipts on loans receivable:
Net cash receipts on loans receivable	248,841	12,796
Seniors Housing Operating
Advances on loans receivable:
Investments in new loans	902,189	2,477
Draws on existing loans	16,218	17,061
Net cash advances on loans receivable	918,407	19,538
Receipts on loans receivable:
Loan payoffs	179,827	0
Principal payments on loans	69,014	12,796
Net cash receipts on loans receivable	248,841	12,796
Net cash advances (receipts) on loans receivable	$ 669,566	$ 6,742

Loans Receivable - Collective P

Loans Receivable - Collective Pool Basis (Details) $ in Thousands	1 Months Ended	3 Months Ended		6 Months Ended
	Mar. 31, 2020USD ($)loan	Jun. 30, 2021USD ($)loan	Jun. 30, 2020USD ($)	Jun. 30, 2021USD ($)loan	Jun. 30, 2020USD ($)	Dec. 31, 2020USD ($)	Dec. 31, 2019USD ($)
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan Carrying Value		$ 1,463,095		$ 1,463,095
Allowance for Credit Loss		(167,432)	$ (81,985)	(167,432)	$ (81,985)	$ (224,036)	$ (68,372)
Real estate loans receivable, net of credit allowance		$ 1,295,663		$ 1,295,663
No. of Loans | loan		49		49
Provision for loan losses	$ 6,898	$ 6,197	$ 1,422	$ 7,580	$ 8,494
Triple-net
Financing Receivable, Allowance for Credit Loss [Line Items]
No. of Loans | loan	1
Deteriorated loans
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan Carrying Value		178,253		178,253
Allowance for Credit Loss		(148,438)		(148,438)
Real estate loans receivable, net of credit allowance		$ 29,815		$ 29,815
No. of Loans | loan		3		3
Collective loan pool
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan Carrying Value		$ 198,975		$ 198,975
Allowance for Credit Loss		(3,033)		(3,033)
Real estate loans receivable, net of credit allowance		$ 195,942		$ 195,942
No. of Loans | loan		17		17
Collective loan pool
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan Carrying Value		$ 126,493		$ 126,493
Allowance for Credit Loss		(1,182)		(1,182)
Real estate loans receivable, net of credit allowance		$ 125,311		$ 125,311
No. of Loans | loan		7		7
Collective loan pool
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan Carrying Value		$ 20,652		$ 20,652
Allowance for Credit Loss		(324)		(324)
Real estate loans receivable, net of credit allowance		$ 20,328		$ 20,328
No. of Loans | loan		1		1
Collective loan pool
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan Carrying Value		$ 22,046		$ 22,046
Allowance for Credit Loss		(347)		(347)
Real estate loans receivable, net of credit allowance		$ 21,699		$ 21,699
No. of Loans | loan		4		4
Collective loan pool
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan Carrying Value		$ 49,352		$ 49,352
Allowance for Credit Loss		(770)		(770)
Real estate loans receivable, net of credit allowance		$ 48,582		$ 48,582
No. of Loans | loan		8		8
Collective loan pool
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan Carrying Value		$ 867,324		$ 867,324
Allowance for Credit Loss		(13,338)		(13,338)
Real estate loans receivable, net of credit allowance		$ 853,986		$ 853,986
No. of Loans | loan		9		9

Loans Receivable - Credit Loss

Loans Receivable - Credit Loss Roll Forward (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020
Financing Receivable, Allowance for Credit Loss [Roll Forward]
Balance at beginning of period	$ 224,036	$ 68,372
Provision for loan losses	7,580	8,494
Loan write-offs (1)	(64,075)	0
Foreign currency translation	(109)	(93)
Balance at end of period	167,432	$ 81,985
Accounting Standards Update [Extensible List]		Accounting Standards Update 2016-13
Genesis Healthcare
Financing Receivable, Allowance for Credit Loss [Roll Forward]
Loan write-offs (1)	$ (62,753)
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

Loans Receivable - Summary of I

Loans Receivable - Summary of Impaired Loans (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Dec. 31, 2020	Dec. 31, 2019
Receivables [Abstract]
Balance of impaired loans at end of period	$ 178,253	$ 186,584
Allowance for credit losses	(148,438)	(76,695)
Balance of deteriorated loans not reserved	29,815	109,889
Interest recognized on impaired loans	3,122	7,912
Carrying value of nonaccrual status	$ 2,176	$ 10,716	$ 3,623	$ 2,534

Investments in Unconsolidated_3

Investments in Unconsolidated Entities - Summary of Investments in Unconsolidated Entities (Details) - USD ($) $ in Thousands	Jun. 30, 2021	Dec. 31, 2020
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated entities	$ 1,020,112	$ 946,234
Seniors Housing Operating
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated entities	$ 766,273	653,057
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	$ 81,100	5,629
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	$ 172,739	$ 287,548
Outpatient Medical | Minimum
Schedule of Equity Method Investments [Line Items]
Percentage ownership	15.00%
Outpatient Medical | Maximum
Schedule of Equity Method Investments [Line Items]
Percentage ownership	50.00%

Investments in Unconsolidated_4

Investments in Unconsolidated Entities - Narrative (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2021USD ($)property
Schedule of Equity Method Investments [Line Items]
Aggregate unamortized basis difference of joint venture investments	$ 118,278
Total loans made	270,164
Expected additional funding for investments	$ 20,209
Not Primary Beneficiary
Schedule of Equity Method Investments [Line Items]
Number of properties | property	7

Credit Concentration - Summary

Credit Concentration - Summary of Credit Concentration (Details) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2021USD ($)property	Jun. 30, 2020USD ($)	Jun. 30, 2021USD ($)property	Jun. 30, 2020USD ($)	Dec. 31, 2020
Concentration Risk [Line Items]
Total NOI	$ 498,335	$ 527,711	$ 933,071	$ 1,104,532
Percentage total investments with top five customers					36.00%
Net operating income | Credit Concentration Risk
Concentration Risk [Line Items]
Number of Properties | property	1,516		1,516
Total NOI			$ 933,071
Percent of NOI			100.00%
Net operating income | Credit Concentration Risk | ProMedica
Concentration Risk [Line Items]
Number of Properties | property	217		217
Total NOI			$ 111,157
Percent of NOI			12.00%
Net operating income | Credit Concentration Risk | Sunrise Senior Living
Concentration Risk [Line Items]
Number of Properties | property	166		166
Total NOI			$ 109,494
Percent of NOI			12.00%
Net operating income | Credit Concentration Risk | Revera
Concentration Risk [Line Items]
Number of Properties | property	85		85
Total NOI			$ 45,928
Percent of NOI			5.00%
Net operating income | Credit Concentration Risk | Avery Healthcare
Concentration Risk [Line Items]
Number of Properties | property	61		61
Total NOI			$ 41,536
Percent of NOI			5.00%
Net operating income | Credit Concentration Risk | Genesis Healthcare
Concentration Risk [Line Items]
Number of Properties | property	15		15
Total NOI			$ 36,677
Percent of NOI			4.00%
Net operating income | Credit Concentration Risk | Remaining portfolio
Concentration Risk [Line Items]
Number of Properties | property	972		972
Total NOI			$ 588,279
Percent of NOI			62.00%

Credit Concentration - Narrativ

Credit Concentration - Narrative (Details) $ in Thousands	1 Months Ended	6 Months Ended
	Apr. 29, 2021USD ($)propertyterm	Jun. 30, 2021USD ($)property	Jun. 30, 2020USD ($)
Concentration Risk [Line Items]
Proceeds from real estate dispositions		$ 446,680	$ 1,998,087
Financing receivable		1,295,663
Genesis Healthcare
Concentration Risk [Line Items]
Percentage ownership	20.00%
Genesis Healthcare | ProMedica
Concentration Risk [Line Items]
Percentage ownership	80.00%
Triple-net
Concentration Risk [Line Items]
Number of properties | term	51
Genesis Healthcare
Concentration Risk [Line Items]
Number of lease properties | property	7
Decrease in indebtedness	$ 170,000
Termination fee	86,000
Financing receivable	$ 167,000	$ 144,667
Genesis Healthcare | Triple-net
Concentration Risk [Line Items]
Number of lease properties | property	9
Genesis Properties
Concentration Risk [Line Items]
Number of properties sold | property	35
Proceeds from real estate dispositions	$ 496,000
Number of operational properties | property		28

Borrowings Under Credit Facil_3

Borrowings Under Credit Facilities and Commercial Paper Program - Narrative (Details)	1 Months Ended	6 Months Ended
	Jan. 31, 2019USD ($)	Jun. 30, 2021USD ($)bankterm	Dec. 31, 2020USD ($)	[1]
Line of Credit Facility [Line Items]
Number of banks in consortium | bank		34
Borrowings outstanding		$ 0	$ 0
Unsecured revolving credit facility
Line of Credit Facility [Line Items]
Unsecured line of credit arrangement		4,000,000,000
Borrowings outstanding		$ 0
Number of successive terms | term		2
Successive term		6 months
Available to borrow in alternate currencies		$ 1,000,000,000
Facility fee		0.15%
Unsecured revolving credit facility | Credit Facility, Tranche Due 2023
Line of Credit Facility [Line Items]
Unsecured line of credit arrangement		$ 1,000,000,000
Unsecured revolving credit facility | Credit Facility, Tranche Due 2025
Line of Credit Facility [Line Items]
Unsecured line of credit arrangement		$ 3,000,000,000
Unsecured revolving credit facility | LIBOR
Line of Credit Facility [Line Items]
Interest rate margin		0.775%
Unsecured revolving credit facility | Accordion feature
Line of Credit Facility [Line Items]
Unsecured line of credit arrangement		$ 1,250,000,000
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
[1]	Note: The consolidated balance sheet at December 31, 2020 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by U.S. generally accepted accounting principles for complete financial statements.

Borrowings Under Credit Facil_4

Borrowings Under Credit Facilities and Commercial Paper Program - Aggregate Borrowings Under Unsecured Revolving Credit Facility and Commercial Paper (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Debt Disclosure [Abstract]
Balance outstanding at quarter end	$ 0	$ 0	$ 0	$ 0
Maximum amount outstanding at any month end	195,000	685,000	195,000	2,100,000
Average amount outstanding (total of daily principal balances divided by days in period)	$ 289,231	$ 405,165	$ 145,414	$ 999,490
Weighted average interest rate (actual interest expense divided by average borrowings outstanding)	0.76%	1.57%	0.76%	2.08%

Senior Unsecured Notes and Se_3

Senior Unsecured Notes and Secured Debt - Annual Principal Payments Due on Debt Obligations (Details)	6 Months Ended
	Jun. 30, 2021USD ($)	Jun. 30, 2021CAD ($)	Jun. 30, 2021GBP (£)	Dec. 31, 2020USD ($)	Jun. 30, 2020USD ($)	Dec. 31, 2019USD ($)
Annual principal payments due
2021	$ 253,459,000
2022	496,699,000
2023	1,190,934,000
2024	1,535,318,000
2025	1,431,449,000
Thereafter	8,656,254,000
Totals	13,564,113,000
Senior unsecured notes
Annual principal payments due
2021	0
2022	10,000,000
2023	701,525,000
2024	1,350,000,000
2025	1,250,000,000
Thereafter	7,941,460,000
Totals	$ 11,252,985,000			$ 11,509,533,000	$ 11,912,711,000	$ 10,427,562,000
Senior unsecured notes | Minimum
Annual principal payments due
Interest rate	0.79%	0.79%	0.79%
Senior unsecured notes | Maximum
Annual principal payments due
Interest rate	6.50%	6.50%	6.50%
Senior unsecured notes | Canadian-denominated unsecured term credit facility
Annual principal payments due
Face amount	$ 201,525,000	$ 250,000,000
Senior unsecured notes | Canadian-denominated unsecured term credit facility | Canadian dealer offered rate
Annual principal payments due
Interest rate margin	0.90%
Effective rate	1.31%	1.31%	1.31%
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
Interest rate margin	0.90%
Effective rate	1.00%	1.00%	1.00%
Senior unsecured notes | 2.95% Senior unsecured notes due 2023
Annual principal payments due
Interest rate	2.95%	2.95%	2.95%
Face amount	$ 241,830,000	$ 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	$ 759,330,000		£ 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	$ 690,300,000		£ 500,000,000
Secured debt
Annual principal payments due
2021	253,459,000
2022	486,699,000
2023	489,409,000
2024	185,318,000
2025	181,449,000
Thereafter	714,794,000
Totals	2,311,128,000			$ 2,378,073,000	$ 2,627,989,000	$ 2,993,342,000
Carrying values of properties securing the debt	$ 5,312,000,000
Secured debt | Minimum
Annual principal payments due
Interest rate	0.03%	0.03%	0.03%
Secured debt | Maximum
Annual principal payments due
Interest rate	7.93%	7.93%	7.93%

Senior Unsecured Notes and Se_4

Senior Unsecured Notes and Secured Debt - Summary of Principal Activity (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2021USD ($)	Jun. 30, 2020USD ($)
Amount
Debt issued	$ 1,208,241	$ 1,588,549
Debt issued	0	44,921
Ending balance	13,564,113
Senior unsecured notes
Amount
Beginning balance	11,509,533	10,427,562
Debt issued	1,250,000	1,600,000
Debt extinguished	(1,533,752)	0
Foreign currency	27,204	(114,851)
Ending balance	$ 11,252,985	$ 11,912,711
Weighted Avg. Interest Rate
Beginning balance	3.67%	4.03%
Debt issued	0.0250	0.0189
Debt extinguished	0.0242	0
Foreign currency	0.0357	0.0430
Ending balance	3.71%	3.65%
Secured debt
Amount
Beginning balance	$ 2,378,073	$ 2,993,342
Debt issued	0	44,921
Debt extinguished	(66,593)	(314,631)
Principal payments	(31,670)	(30,709)
Foreign currency	31,318	(64,934)
Ending balance	$ 2,311,128	$ 2,627,989
Weighted Avg. Interest Rate
Beginning balance	3.27%	3.63%
Debt issued	0	0.0258
Debt extinguished	0.0601	0.0294
Principal payments	0.0348	0.0355
Foreign currency	0.0289	0.0313
Ending balance	3.10%	3.09%

Derivative Instruments - Narrat

Derivative Instruments - Narrative (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Cash flow hedges to be reclassified within the next twelve months	$ 2,562
Payments for hedge	$ 7,196
Proceeds from hedge		$ 3,485

Derivative Instruments - Notion

Derivative Instruments - Notional Amount of Derivatives and Other Financial Instruments (Details) £ in Thousands, $ in Thousands, $ in Thousands	6 Months Ended		12 Months Ended
	Jun. 30, 2021CAD ($)	Jun. 30, 2021GBP (£)	Dec. 31, 2020CAD ($)	Dec. 31, 2020GBP (£)	Jun. 30, 2021GBP (£)	Jun. 30, 2021USD ($)	Dec. 31, 2020GBP (£)	Dec. 31, 2020USD ($)
Denominated in Canadian Dollars | Designated as Hedging Instrument | Net Investment Hedging
Derivatives, Fair Value [Line Items]
Derivative asset	$ 625,000		$ 625,000
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		$ 80,000
Denominated in Pound Sterling | Designated as Hedging Instrument | Net Investment Hedging
Derivatives, Fair Value [Line Items]
Derivative asset | £					£ 1,880,708		£ 1,340,708
Net investment hedges | £		£ 1,050,000		£ 1,050,000
Denominated in U.S Dollars | Designated as Hedging Instrument | Cash Flow Hedging
Derivatives, Fair Value [Line Items]
Derivative asset						$ 25,000		$ 450,000
Denominated in U.S Dollars | Derivative Instruments Not Designated
Derivatives, Fair Value [Line Items]
Derivative asset						$ 26,137		$ 26,137

Derivative Instruments - Impact

Derivative Instruments - Impact of Derivative Instruments on the Consolidated Statements of Comprehensive Income (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Derivative [Line Items]
Gain (loss) on derivative instruments designated as hedges recognized in income	$ 359	$ (1,434)	$ (1,575)	$ (9,085)
Gain (loss) on derivative and financial instruments designated as hedges recognized in OCI	(9,808)	(27,171)	(29,845)	231,941
Designated as Hedging Instrument
Derivative [Line Items]
Gain (loss) on derivative instruments designated as hedges recognized in income	5,544	4,106	11,567	10,751
Derivative Instruments Not Designated
Derivative [Line Items]
Gain (loss) on derivative instruments designated as hedges recognized in income	$ (936)	$ (1,953)	$ (1,656)	$ (2,048)

Commitments and Contingencies (

Commitments and Contingencies (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2021USD ($)obligationproperty	Apr. 29, 2021term	Dec. 31, 2020USD ($)	[1]
Other Commitments [Line Items]
Number of outstanding credit obligations | obligation	12
Letter of credit obligation	$ 22,404
Outstanding construction financings for leased properties	458,844		$ 487,742
Additional financing to complete construction	819,168
Total loans made	270,164
Expected additional funding for investments	20,209
Capital Improvements
Other Commitments [Line Items]
Total contingent purchase obligations	58,673
Definitive Agreement To Acquire Property
Other Commitments [Line Items]
Total contingent purchase obligations	$ 1,576,800
Number of properties | property	86
Triple-net
Other Commitments [Line Items]
Number of properties | term		51
[1]	Note: The consolidated balance sheet at December 31, 2020 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by U.S. generally accepted accounting principles for complete financial statements.

Stockholders' Equity - Summary

Stockholders' Equity - Summary of Stockholders' Equity Capital Accounts (Details) - shares	Jun. 30, 2021	Dec. 31, 2020
Preferred Stock:
Authorized shares	50,000,000	50,000,000
Issued shares	0	0
Outstanding shares	0	0
Common Stock, $1.00 par value:
Authorized shares	700,000,000	700,000,000
Issued shares	424,339,944	419,124,469
Outstanding shares	422,561,863	417,400,602

Stockholders' Equity - Addition

Stockholders' Equity - Additional Information (Details) - USD ($)	6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	May 31, 2021	May 01, 2020
Class of Stock [Line Items]
Proceeds from sale of stock	$ 366,464,000	$ 595,313,000
At The Market Program
Class of Stock [Line Items]
Authorized amount to sell			$ 2,000,000,000
Remaining amount authorized to sell	$ 1,905,854,000
Forward sales agreement
Class of Stock [Line Items]
Anti-dilutive securities (in shares)	13,052,375
Forward sales agreement | At The Market Program
Class of Stock [Line Items]
Proceeds from sale of stock	$ 1,036,503,000
Repurchase program
Class of Stock [Line Items]
Authorized amount				$ 1,000,000,000

Stockholders' Equity - Common S

Stockholders' Equity - Common Stock (Details) $ / shares in Units, $ in Thousands	6 Months Ended
	Jun. 30, 2021USD ($)$ / sharesshares	Jun. 30, 2020USD ($)$ / sharesshares
Shares Issued
Dividend reinvestment plan issuances (in shares) | shares		264,153
Option exercises (in shares) | shares		251
ATM Program issuances (in shares) | shares	5,015,673	6,799,978
Stock incentive plans, net of forfeitures (in shares) | shares	145,588	183,398
Totals (in shares) | shares	5,161,261	7,247,780
Average Price
Dividend reinvestment plan issuances (in dollars per share) | $ / shares		$ 72.33
Option exercises (in dollars per share)		47.81
ATM Program issuances (in dollars per share) | $ / shares	$ 74.15	$ 86.48
Gross Proceeds
Dividend reinvestment plan issuances		$ 19,105
Option exercises		12
ATM Program issuances	$ 371,937	588,072
Totals	371,937	607,189
Net Proceeds
Dividend reinvestment plan issuances		19,105
Option exercises		12
ATM Program issuances	366,464	576,196
Total	$ 366,464	$ 595,313

Stockholders' Equity - Dividend

Stockholders' Equity - Dividends (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Per Share
Common Stock (in dollars per share)	$ 0.61	$ 0.61	$ 1.22	$ 1.48
Amount
Common stock			$ 510,424	$ 610,847

Stockholders' Equity - Accumula

Stockholders' Equity - Accumulated Other Comprehensive Income (Details) - USD ($) $ in Thousands	Jun. 30, 2021	Mar. 31, 2021	Dec. 31, 2020		Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2019
Summary of accumulated other comprehensive income/(loss) [Line Items]
Total accumulated other comprehensive income (loss)	$ 16,850,829	$ 16,691,017	$ 16,881,572	[1]	$ 16,936,527	$ 17,066,337	$ 16,506,627
Foreign currency translation
Summary of accumulated other comprehensive income/(loss) [Line Items]
Total accumulated other comprehensive income (loss)	(571,391)		(621,792)
Derivative and financial instruments designated as hedges
Summary of accumulated other comprehensive income/(loss) [Line Items]
Total accumulated other comprehensive income (loss)	443,443		473,288
Total accumulated other comprehensive income (loss)
Summary of accumulated other comprehensive income/(loss) [Line Items]
Total accumulated other comprehensive income (loss)	$ (127,948)	$ (128,136)	$ (148,504)		$ (116,856)	$ (96,213)	$ (112,157)
[1]	Note: The consolidated balance sheet at December 31, 2020 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by U.S. generally accepted accounting principles for complete financial statements.

Stock Incentive Plans (Details)

Stock Incentive Plans (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
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	$ 4,757	$ 7,290	$ 10,333	$ 14,373
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			4 years

Earnings Per Share (Details)

Earnings Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands		3 Months Ended		6 Months Ended
		Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Earnings Per Share [Abstract]
Numerator for basic and diluted earnings per share - net income (loss) attributable to common stockholders		$ 26,257	$ 179,246	$ 97,803	$ 489,530
Adjustment for net income (loss) attributable to OP units		(873)	(1,366)	(2,225)	(2,754)
Numerator for diluted earnings per share		$ 25,384	$ 177,880	$ 95,578	$ 486,776
Denominator for basic earnings per share - weighted average shares (in shares)		417,452,000	417,084,000	417,360,000	413,696,000
Effect of dilutive securities:
Non-vested restricted shares (in shares)		438,000	619,000	430,000	661,000
Redeemable op units (in shares)		1,396,000	1,396,000	1,396,000	1,396,000
Employee stock purchase program (in shares)		19,000	22,000	19,000	22,000
Dilutive potential common shares (in shares)		1,853,000	2,037,000	1,845,000	2,079,000
Denominator for diluted earnings per share - adjusted weighted average shares (in shares)		419,305,000	419,121,000	419,205,000	415,775,000
Basic earnings per share (in dollars per share)		$ 0.06	$ 0.43	$ 0.23	$ 1.18
Diluted earnings per share (in dollars per share)	[1]	$ 0.06	$ 0.42	$ 0.23	$ 1.17
Forward sales agreement
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Anti-dilutive securities (in shares)				13,052,375
[1]	Includes adjustment to the numerator for income (loss) attributable to OP unitholders.

Disclosure about Fair Value o_3

Disclosure about Fair Value of Financial Instruments - Carrying Amounts and Estimated Fair Values of Financial Instruments (Details) - USD ($) $ in Thousands	Jun. 30, 2021	Dec. 31, 2020
Financial assets:
Equity securities	$ 3,061
Restricted cash	295,102	$ 475,997	[1]
Equity warrants	32,419
Carrying Amount
Financial assets:
Equity securities		4,636
Cash and cash equivalents	513,602	1,545,046
Restricted cash	295,102	475,997
Foreign currency forward contracts, interest rate swaps and cross currency swaps	6,256	4,668
Equity warrants		0
Financial liabilities:
Senior unsecured notes	11,157,732	11,420,790
Secured debt	2,304,178	2,377,930
Foreign currency forward contracts, interest rate swaps and cross currency swaps	89,929	118,054
Redeemable OP unitholder interests	148,332	116,240
Carrying Amount | Mortgage loans receivable
Financial assets:
Loans receivable	919,812	293,752
Carrying Amount | Other real estate loans receivable
Financial assets:
Loans receivable	177,487	149,620
Carrying Amount | Non-real estate loans receivable
Financial assets:
Loans receivable	198,364	240,269
Fair Value
Financial assets:
Equity securities	3,061	4,636
Cash and cash equivalents	513,602	1,545,046
Restricted cash	295,102	475,997
Foreign currency forward contracts, interest rate swaps and cross currency swaps	6,256	4,668
Equity warrants	32,419	0
Financial liabilities:
Senior unsecured notes	12,544,312	13,093,926
Secured debt	2,364,951	2,451,782
Foreign currency forward contracts, interest rate swaps and cross currency swaps	89,929	118,054
Redeemable OP unitholder interests	148,332	115,346
Fair Value | Mortgage loans receivable
Financial assets:
Loans receivable	935,528	297,207
Fair Value | Other real estate loans receivable
Financial assets:
Loans receivable	173,889	152,211
Fair Value | Non-real estate loans receivable
Financial assets:
Loans receivable	$ 202,877	$ 255,724
[1]	Note: The consolidated balance sheet at December 31, 2020 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by U.S. generally accepted accounting principles for complete financial statements.

Disclosure about Fair Value o_4

Disclosure about Fair Value of Financial Instruments - Summary of Items Measured at Fair Value on a Recurring Basis (Details) $ in Thousands	Jun. 30, 2021USD ($)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Equity securities	$ 3,061
Equity warrants	32,419
Foreign currency forward contracts, interest rate swaps and cross currency swaps, net asset (liability)	(83,673)
Totals	(48,193)
Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Equity securities	3,061
Equity warrants	0
Foreign currency forward contracts, interest rate swaps and cross currency swaps, net asset (liability)	0
Totals	3,061
Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Equity securities	0
Equity warrants	0
Foreign currency forward contracts, interest rate swaps and cross currency swaps, net asset (liability)	(83,673)
Totals	(83,673)
Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Equity securities	0
Equity warrants	32,419
Foreign currency forward contracts, interest rate swaps and cross currency swaps, net asset (liability)	0
Totals	$ 32,419

Segment Reporting - Summary Inf

Segment Reporting - Summary Information for Reportable Segments (Details) $ in Thousands	1 Months Ended	3 Months Ended		6 Months Ended
	Mar. 31, 2020USD ($)	Jun. 30, 2021USD ($)	Jun. 30, 2020USD ($)	Jun. 30, 2021USD ($)segment	Jun. 30, 2020USD ($)	Dec. 31, 2020USD ($)	[1]
Segment Reporting [Abstract]
Number of operating segments | segment				3
Segment Reporting Information [Line Items]
Rental income		$ 354,723	$ 396,305	$ 657,566	$ 786,265
Total revenues		1,140,992	1,188,475	2,193,054	2,447,077
Property operating expenses		642,657	660,764	1,259,983	1,342,545
Consolidated net operating income		498,335	527,711	933,071	1,104,532
Depreciation and amortization		240,885	265,371	485,311	540,172
Interest expense		122,341	126,357	245,483	268,364
General and administrative expenses		31,436	34,062	61,362	69,543
Loss (gain) on derivatives and financial instruments, net		(359)	1,434	1,575	9,085
Provision for loan losses	$ 6,898	6,197	1,422	7,580	8,494
Impairment of assets		23,692	75,151	47,260	102,978
Other expenses		11,687	19,411	22,681	25,703
Income (loss) from continuing operations before income taxes and other items		6,844	4,254	10,850	79,944
Income tax (expense) benefit		2,221	(2,233)	(1,722)	(7,675)
Income (loss) from unconsolidated entities		(7,976)	1,332	5,073	(2,360)
Gain (loss) on real estate dispositions, net		44,668	155,863	103,748	418,687
Income (loss) from continuing operations		45,757	159,216	117,949	488,596
Net income (loss)		45,757	159,216	117,949	488,596
Total assets		32,176,116		32,176,116		$ 32,483,642
Loss (gain) on extinguishment of debt, net		55,612	249	50,969	249
Straight Line Rent				(9,688)	25,959
Resident fees and services
Segment Reporting Information [Line Items]
Revenue from contract with customer		740,891	769,560	1,464,355	1,619,532
Interest income
Segment Reporting Information [Line Items]
Revenue from contract with customer		38,448	16,069	58,027	31,310
Other income
Segment Reporting Information [Line Items]
Revenue from contract with customer		6,930	6,541	13,106	9,970
Operating Segments | Seniors Housing Operating
Segment Reporting Information [Line Items]
Rental income		0	0	0	0
Total revenues		742,549	773,650	1,468,951	1,624,778
Property operating expenses		582,361	595,513	1,138,329	1,203,384
Consolidated net operating income		160,188	178,137	330,622	421,394
Depreciation and amortization		131,035	139,163	263,621	285,937
Interest expense		10,553	14,029	21,971	30,463
General and administrative expenses		0	0	0	0
Loss (gain) on derivatives and financial instruments, net		0	0	0	0
Provision for loan losses		(181)	0	70	0
Impairment of assets		17,713	75,151	22,317	78,646
Other expenses		3,709	5,251	7,168	8,240
Income (loss) from continuing operations before income taxes and other items		(5,747)	(54,965)	17,012	18,600
Income tax (expense) benefit		0	0	0	0
Income (loss) from unconsolidated entities		(12,938)	(6,787)	(7,704)	(17,811)
Gain (loss) on real estate dispositions, net		(28)	14,465	5,167	14,316
Income (loss) from continuing operations		(18,713)	(47,287)	14,475	15,105
Net income (loss)		(18,713)	(47,287)	14,475	15,105
Total assets		16,129,367		16,129,367
Loss (gain) on extinguishment of debt, net		3,106	(492)	(1,537)	(492)
Operating Segments | Seniors Housing Operating | Resident fees and services
Segment Reporting Information [Line Items]
Revenue from contract with customer		740,891	769,560	1,464,355	1,619,532
Operating Segments | Seniors Housing Operating | Interest income
Segment Reporting Information [Line Items]
Revenue from contract with customer		856	88	1,975	192
Operating Segments | Seniors Housing Operating | Other income
Segment Reporting Information [Line Items]
Revenue from contract with customer		802	4,002	2,621	5,054
Operating Segments | Triple-net
Segment Reporting Information [Line Items]
Rental income		204,725	217,492	357,188	408,877
Total revenues		238,941	233,619	407,423	441,348
Property operating expenses		12,627	13,563	25,468	26,865
Consolidated net operating income		226,314	220,056	381,955	414,483
Depreciation and amortization		54,406	58,138	111,073	115,832
Interest expense		1,704	2,746	3,586	5,598
General and administrative expenses		0	0	0	0
Loss (gain) on derivatives and financial instruments, net		(359)	1,434	1,575	9,085
Provision for loan losses		10,019	1,451	10,872	8,523
Impairment of assets		3,768	0	22,732	24,332
Other expenses		4,110	3,500	9,093	4,013
Income (loss) from continuing operations before income taxes and other items		152,666	152,787	223,024	247,100
Income tax (expense) benefit		0	0	0	0
Income (loss) from unconsolidated entities		4,877	6,403	9,784	12,199
Gain (loss) on real estate dispositions, net		42,709	2,148	44,751	51,785
Income (loss) from continuing operations		200,252	161,338	277,559	311,084
Net income (loss)		200,252	161,338	277,559	311,084
Total assets		9,490,724		9,490,724
Loss (gain) on extinguishment of debt, net		0	0	0	0
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		32,861	15,520	47,783	30,191
Operating Segments | Triple-net | Other income
Segment Reporting Information [Line Items]
Revenue from contract with customer		1,355	607	2,452	2,280
Operating Segments | Outpatient Medical
Segment Reporting Information [Line Items]
Rental income		149,998	178,813	300,378	377,388
Total revenues		159,072	180,831	315,295	380,160
Property operating expenses		45,495	51,688	92,358	112,296
Consolidated net operating income		113,577	129,143	222,937	267,864
Depreciation and amortization		55,444	68,070	110,617	138,403
Interest expense		3,907	4,326	7,922	9,134
General and administrative expenses		0	0	0	0
Loss (gain) on derivatives and financial instruments, net		0	0	0	0
Provision for loan losses		(3,641)	(29)	(3,362)	(29)
Impairment of assets		2,211	0	2,211	0
Other expenses		1,098	6,456	1,810	7,463
Income (loss) from continuing operations before income taxes and other items		54,558	49,579	103,739	112,152
Income tax (expense) benefit		0	0	0	0
Income (loss) from unconsolidated entities		85	1,716	2,993	3,252
Gain (loss) on real estate dispositions, net		1,987	139,250	53,830	352,586
Income (loss) from continuing operations		56,630	190,545	160,562	467,990
Net income (loss)		56,630	190,545	160,562	467,990
Total assets		6,212,491		6,212,491
Loss (gain) on extinguishment of debt, net		0	741	0	741
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		4,731	461	8,269	927
Operating Segments | Outpatient Medical | Other income
Segment Reporting Information [Line Items]
Revenue from contract with customer		4,343	1,557	6,648	1,845
Non-segment / Corporate
Segment Reporting Information [Line Items]
Rental income		0	0	0	0
Total revenues		430	375	1,385	791
Property operating expenses		2,174	0	3,828	0
Consolidated net operating income		(1,744)	375	(2,443)	791
Depreciation and amortization		0	0	0	0
Interest expense		106,177	105,256	212,004	223,169
General and administrative expenses		31,436	34,062	61,362	69,543
Loss (gain) on derivatives and financial instruments, net		0	0	0	0
Provision for loan losses		0	0	0	0
Impairment of assets		0	0	0	0
Other expenses		2,770	4,204	4,610	5,987
Income (loss) from continuing operations before income taxes and other items		(194,633)	(143,147)	(332,925)	(297,908)
Income tax (expense) benefit		2,221	(2,233)	(1,722)	(7,675)
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		(192,412)	(145,380)	(334,647)	(305,583)
Net income (loss)		(192,412)	(145,380)	(334,647)	(305,583)
Total assets		343,534		343,534
Loss (gain) on extinguishment of debt, net		52,506	0	52,506	0
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		$ 430	$ 375	$ 1,385	$ 791
[1]	Note: The consolidated balance sheet at December 31, 2020 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by U.S. generally accepted accounting principles for complete financial statements.

Segment Reporting - Summary of

Segment Reporting - Summary of Geographic Information (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended		12 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020	Dec. 31, 2020
Revenues from External Customers and Long-Lived Assets [Line Items]
Total revenues	$ 1,140,992	$ 1,188,475	$ 2,193,054	$ 2,447,077
Total assets	32,176,116		32,176,116		$ 32,483,642	[1]
United States
Revenues from External Customers and Long-Lived Assets [Line Items]
Total revenues	893,672	973,772	1,719,320	2,001,553
Total assets	25,673,854		25,673,854		26,658,659
United Kingdom
Revenues from External Customers and Long-Lived Assets [Line Items]
Total revenues	140,756	109,437	259,630	227,319
Total assets	4,075,693		4,075,693		3,352,549
Canada
Revenues from External Customers and Long-Lived Assets [Line Items]
Total revenues	106,564	$ 105,266	214,104	$ 218,205
Total assets	$ 2,426,569		$ 2,426,569		$ 2,472,434
Revenue | Geographic Concentration Risk
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage	100.00%	100.00%	100.00%	100.00%
Revenue | United States | Geographic Concentration Risk
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage	78.40%	81.90%	78.40%	81.80%
Revenue | United Kingdom | Geographic Concentration Risk
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage	12.30%	9.20%	11.80%	9.30%
Revenue | Canada | Geographic Concentration Risk
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage	9.30%	8.90%	9.80%	8.90%
Assets | Geographic Concentration Risk
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage			100.00%		100.00%
Assets | United States | Geographic Concentration Risk
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage			79.80%		82.10%
Assets | United Kingdom | Geographic Concentration Risk
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage			12.70%		10.30%
Assets | Canada | Geographic Concentration Risk
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage			7.50%		7.60%
Resident fees and services | Revenue | United States | Geographic Concentration Risk
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage	73.00%		73.00%
Resident fees and services | Revenue | United Kingdom | Geographic Concentration Risk
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage	13.00%		13.00%
Resident fees and services | Revenue | Canada | Geographic Concentration Risk
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage	14.00%		14.00%
[1]	Note: The consolidated balance sheet at December 31, 2020 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by U.S. generally accepted accounting principles for complete financial statements.

Variable Interest Entities (Det

Variable Interest Entities (Details) - USD ($) $ in Thousands	Jun. 30, 2021	Mar. 31, 2021	Dec. 31, 2020		Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2019
Assets:
Net real estate investments	$ 29,276,536		$ 28,474,947	[1]
Cash and cash equivalents	513,602		1,545,046	[1]
Receivables and other assets	671,062		629,031	[1]
Total Assets	32,176,116		32,483,642	[1]
Liabilities and equity:
Secured debt	2,304,178		2,377,930	[1]
Lease liabilities	409,628		418,266	[1]
Total equity	16,850,829	$ 16,691,017	16,881,572	[1]	$ 16,936,527	$ 17,066,337	$ 16,506,627
Total liabilities and equity	32,176,116		32,483,642	[1]
VIE, Primary Beneficiary
Assets:
Net real estate investments	449,437		454,333
Cash and cash equivalents	12,469		15,547
Receivables and other assets	8,755		11,171
Total Assets	470,661		481,051
Liabilities and equity:
Secured debt	164,510		165,671
Lease liabilities	1,324		1,325
Accrued expenses and other liabilities	11,368		14,997
Total equity	293,459		299,058
Total liabilities and equity	$ 470,661		$ 481,051
[1]	Note: The consolidated balance sheet at December 31, 2020 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by U.S. generally accepted accounting principles for complete financial statements.