Welltower (WELL) 10-Q 5 Nov 21 2021 Q3 Quarterly report Financial data

Cover Page

Cover Page - shares	9 Months Ended
	Sep. 30, 2021	Oct. 29, 2021
Document Information [Line Items]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 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		435,274,528
Entity Central Index Key	0000766704
Amendment Flag	false
Document Fiscal Year Focus	2021
Document Fiscal Period Focus	Q3
Current Fiscal Year End Date	--12-31
Common stock, $1.00 par value per share
Document Information [Line Items]
Title of 12(b) Security	Common stock, $1.00 par value per share
Trading Symbol	WELL
Security Exchange Name	NYSE
4.800% Notes due 2028
Document Information [Line Items]
Title of 12(b) Security	4.800% Notes due 2028
Trading Symbol	WELL28
Security Exchange Name	NYSE
4.500% Notes due 2034
Document Information [Line Items]
Title of 12(b) Security	4.500% Notes due 2034
Trading Symbol	WELL34
Security Exchange Name	NYSE

CONSOLIDATED BALANCE SHEETS

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Real property owned:
Land and land improvements	$ 3,698,858	$ 3,440,650
Buildings and improvements	29,775,951	28,024,971
Acquired lease intangibles	1,653,415	1,500,030
Real property held for sale, net of accumulated depreciation	251,152	216,613
Construction in progress	562,487	487,742
Less accumulated depreciation and amortization	(6,634,061)	(6,104,297)
Net real property owned	29,307,802	27,565,709
Right of use assets, net	526,614	465,866
Real estate loans receivable, net of credit allowance	1,115,645	443,372
Net real estate investments	30,950,061	28,474,947
Other assets:
Investments in unconsolidated entities	977,955	946,234
Goodwill	68,321	68,321
Cash and cash equivalents	303,982	1,545,046
Restricted cash	58,663	475,997
Straight-line rent receivable	346,159	344,066
Receivables and other assets	774,884	629,031
Total other assets	2,529,964	4,008,695
Total Assets	33,480,025	32,483,642
Liabilities:
Unsecured credit facility and commercial paper	290,996	0
Senior unsecured notes	11,116,067	11,420,790
Secured debt	2,262,345	2,377,930
Lease liabilities	544,547	418,266
Accrued expenses and other liabilities	1,093,959	1,041,594
Total liabilities	15,307,914	15,258,580
Redeemable noncontrolling interests	389,195	343,490
Equity:
Common stock	436,640	418,691
Capital in excess of par value	22,148,859	20,823,145
Treasury stock	(108,478)	(104,490)
Cumulative net income	8,605,064	8,327,598
Cumulative dividends	(14,115,705)	(13,343,721)
Accumulated other comprehensive income (loss)	(103,177)	(148,504)
Total Welltower Inc. stockholders’ equity	16,863,203	15,972,719
Noncontrolling interests	919,713	908,853
Total equity	17,782,916	16,881,572
Total liabilities and equity	$ 33,480,025	$ 32,483,642

CONSOLIDATED STATEMENTS OF COMP

CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (UNAUDITED) - USD ($) shares in Thousands, $ in Thousands		3 Months Ended		9 Months Ended
		Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Revenues:
Rental income		$ 357,984	$ 275,046	$ 1,015,550	$ 1,061,311
Total revenues		1,239,797	1,036,874	3,432,851	3,483,951
Expenses:
Property operating expenses		729,400	634,717	1,989,383	1,977,262
Depreciation and amortization		267,754	255,532	753,065	795,704
Interest expense		122,522	124,851	368,005	393,215
General and administrative expenses		32,256	31,003	93,618	100,546
Loss (gain) on derivatives and financial instruments, net		(8,078)	1,395	(6,503)	10,480
Loss (gain) on extinguishment of debt, net		(5)	33,004	50,964	33,253
Provision for loan losses, net		(271)	2,857	7,309	11,351
Impairment of assets		1,490	23,313	48,750	126,291
Other expenses		3,575	11,544	26,256	37,247
Total expenses		1,148,643	1,118,216	3,330,847	3,485,349
Income (loss) from continuing operations before income taxes and other items		91,154	(81,342)	102,004	(1,398)
Income tax (expense) benefit		(4,940)	(2,003)	(6,662)	(9,678)
Income (loss) from unconsolidated entities		(15,832)	(5,981)	(10,759)	(8,341)
Gain (loss) on real estate dispositions, net		119,954	484,304	223,702	902,991
Income (loss) from continuing operations		190,336	394,978	308,285	883,574
Net income		190,336	394,978	308,285	883,574
Less: Net income (loss) attributable to noncontrolling interests	[1]	10,673	69,393	30,819	68,459
Net income (loss) attributable to common stockholders		$ 179,663	$ 325,585	$ 277,466	$ 815,115
Average number of common shares outstanding:
Basic (in shares)		428,031	417,027	420,955	414,822
Diluted (in shares)		429,983	418,987	422,835	416,860
Basic:
Income (loss) from continuing operations (in dollars per share)		$ 0.44	$ 0.95	$ 0.73	$ 2.13
Net income (loss) attributable to common stockholders (in dollars per share)		0.42	0.78	0.66	1.96
Diluted:
Income (loss) from continuing operations (in dollars per share)		0.44	0.94	0.73	2.12
Net income (loss) attributable to common stockholders (in dollars per share)	[2]	0.42	0.77	0.65	1.94
Dividends declared and paid per common share (in dollars per share)		$ 0.61	$ 0.61	$ 1.83	$ 2.09
Other comprehensive income (loss):
Foreign currency translation gain (loss)		$ (112,263)	$ 143,353	$ (55,059)	$ (109,209)
Derivative and financial instruments designated as hedges gain (loss)		130,711	(145,512)	100,866	86,429
Total other comprehensive income (loss)		18,448	(2,159)	45,807	(22,780)
Total comprehensive income (loss)		208,784	392,819	354,092	860,794
Less: Total comprehensive income (loss) attributable to noncontrolling interests	[3]	4,350	76,847	31,299	59,991
Total comprehensive income (loss) attributable to common stockholders		204,434	315,972	322,793	800,803
Resident fees and services
Revenues:
Revenue from contract with customer		835,617	740,956	2,299,972	2,360,488
Interest income
Revenues:
Revenue from contract with customer		39,864	16,750	97,891	48,060
Other income
Revenues:
Revenue from contract with customer		$ 6,332	$ 4,122	$ 19,438	$ 14,092
[1]	Includes amounts attributable to redeemable noncontrolling interests.
[2]	Includes adjustment to the numerator for income (loss) attributable to OP unitholders.
[3]	(1) Includes amounts attributable to redeemable noncontrolling interests.

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
Comprehensive income:
Net income (loss)	393,235									325,585							67,650
Other comprehensive income (loss)	(2,275)														(9,613)		7,338
Total comprehensive income	390,960
Net change in noncontrolling interests	(118,041)					(7,894)											(110,147)
Amounts related to stock incentive plans, net of forfeitures	6,364			18		6,569		(223)
Net proceeds from issuance of common stock	(198)					(198)
Dividends paid:
Common stock dividends	(254,510)												(254,510)
Balances at end of period at Sep. 30, 2020	16,961,102			418,361		20,835,026		(94,022)		8,163,869			(13,088,891)		(126,469)		853,228
Balances at beginning of period at Dec. 31, 2020	16,881,572			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
Comprehensive income:
Net income (loss)	190,133									179,663							10,470
Other comprehensive income (loss)	18,575														24,771		(6,196)
Total comprehensive income	208,708
Net change in noncontrolling interests	(18,957)					(4,013)											(14,944)
Amounts related to stock incentive plans, net of forfeitures	5,090			3		4,932		155
Net proceeds from issuance of common stock	998,806			12,704		986,102
Dividends paid:
Common stock dividends	(261,560)												(261,560)
Balances at end of period at Sep. 30, 2021	$ 17,782,916			$ 436,640		$ 22,148,859		$ (108,478)		$ 8,605,064			$ (14,115,705)		$ (103,177)		$ 919,713

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS (UNAUDITED) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020
Operating activities:
Net income	$ 308,285	$ 883,574
Adjustments to reconcile net income to net cash provided from (used in) operating activities:
Depreciation and amortization	753,065	795,704
Other amortization expenses	13,951	9,613
Provision for loan losses, net	7,309	11,351
Impairment of assets	48,750	126,291
Stock-based compensation expense	14,868	20,938
Loss (gain) on derivatives and financial instruments, net	(6,503)	10,480
Loss (gain) on extinguishment of debt, net	50,964	33,253
Loss (income) from unconsolidated entities	10,759	8,341
Rental income less than (in excess of) cash received	(9,607)	66,874
Amortization related to above (below) market leases, net	(2,045)	(1,373)
Loss (gain) on real estate dispositions, net	(223,702)	(902,991)
Distributions by unconsolidated entities	11,783	7,835
Increase (decrease) in accrued expenses and other liabilities	97,924	40,443
Decrease (increase) in receivables and other assets	(83,806)	(749)
Net cash provided from (used in) operating activities	991,995	1,109,584
Investing activities:
Cash disbursed for acquisitions, net of cash acquired	(2,735,206)	(393,374)
Cash disbursed for capital improvements to existing properties	(165,691)	(183,324)
Cash disbursed for construction in progress	(263,325)	(126,699)
Capitalized interest	(14,027)	(13,234)
Investment in loans receivable	(953,006)	(216,307)
Principal collected on loans receivable	250,415	14,345
Other investments, net of payments	(10,885)	(2,145)
Contributions to unconsolidated entities	(278,833)	(301,031)
Distributions by unconsolidated entities	238,066	41,884
Proceeds from (payments on) derivatives	2,312	(13,319)
Proceeds from sales of real property	941,708	3,522,949
Net cash provided from (used in) investing activities	(2,988,472)	2,329,745
Financing activities:
Net increase (decrease) under unsecured credit facility and commercial paper	290,996
Net increase (decrease) under unsecured credit facility and commercial paper		(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)	(566,248)
Net proceeds from the issuance of secured debt	2,693	44,921
Payments on secured debt	(118,854)	(538,091)
Net proceeds from the issuance of common stock	1,366,464	595,313
Repurchase of common stock	0	(7,656)
Payments for deferred financing costs and prepayment penalties	(72,251)	(35,925)
Contributions by noncontrolling interests	84,073	14,267
Distributions to noncontrolling interests	(108,912)	(298,369)
Cash distributions to stockholders	(770,457)	(864,115)
Other financing activities	(9,322)	(11,244)
Net cash provided from (used in) financing activities	338,919	(1,666,195)
Effect of foreign currency translation on cash and cash equivalents and restricted cash	(840)	(3,566)
Increase (decrease) in cash, cash equivalents and restricted cash	(1,658,398)	1,769,568
Cash, cash equivalents and restricted cash at beginning of period	2,021,043	385,765
Cash, cash equivalents and restricted cash at end of period	362,645	2,155,333
Supplemental cash flow information:
Interest paid	341,134	362,130
Income taxes paid (received), net	$ 1,288	$ (485)

Business

Business	9 Months Ended
	Sep. 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	9 Months Ended
	Sep. 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 nine months ended September 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 has steadily increased in recent months, with 96% of communities open for new admissions and nearly all communities allowing visitors, in-person tours and communal dining and activities. 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. have resulted in a significant decrease in total resident case counts since mid-January across the portfolio. As of September 30, 2021, occupancy has increased approximately 440 bps to 76.7% since the pandemic-low of 72.3% on March 12, 2021. Monthly spot occupancy rates through September 30, 2021 are as follows: December 2020 January 2021 February 2021 March 2021 April 2021 May 2021 June 2021 July 2021 August 2021 September 2021 Spot occupancy (1) 74.8 % 73.4 % 72.5 % 72.7 % 73.2 % 73.7 % 74.6 % 75.2 % 75.9 % 76.7 % Sequential occupancy change (2) (1.4) % (0.8) % 0.1 % 0.5 % 0.5 % 0.9 % 0.6 % 0.8 % 0.8 % (1) Spot occupancy represents approximate month end occupancy at our share for 591 properties in operation as of December 31, 2020, including unconsolidated properties but excluding acquisitions, executed dispositions, development conversions since this date as well as one property closed for redevelopment. (2) Sequential occupancy changes are based on actual spot occupancy and may not recalculate due to rounding. During the quarter ended September 30, 2021, the U.S. and U.K. portfolios reported spot occupancy gains of approximately 260 bps and 300 bps, respectively. Canada reported a spot occupancy gain of approximately 70 bps. 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 $2,092,000 and $24,883,000 for the three and nine months ended September 30, 2021, respectively, as compared to a net expense of $18,193,000 and $65,614,000 during the three and nine months ended September 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 nine months ended September 30, 2021, we received total Provider Relief Funds of approximately $40,975,000, 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 nine months ended September 30, 2021, we collected approximately 94% 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 collectability 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. During the nine months ended September 30, 2021, we have collected virtually all rent due from tenants in our Outpatient Medical portfolio, with uncollected amounts primarily attributable to local jurisdictions with COVID-19 related ordinances providing temporary rent relief to tenants. We evaluate leases individually and recognize rent on a cash basis if collectability of substantially all contractual rent payments is not probable. 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	9 Months Ended
	Sep. 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): Nine Months Ended September 30, 2021 September 30, 2020 Seniors Housing Operating Triple-net Outpatient Totals Seniors Housing Operating Triple-net Outpatient Totals Land and land improvements $ 264,706 $ 48,099 $ 45,350 $ 358,155 $ 15,758 $ — $ 43,252 $ 59,010 Buildings and improvements 1,655,067 436,828 227,390 2,319,285 132,481 765 171,630 304,876 Acquired lease intangibles 142,439 — 17,333 159,772 10,810 — 23,823 34,633 Right of use assets, net 77,455 — — 77,455 — — — — Total net real estate assets 2,139,667 484,927 290,073 2,914,667 159,049 765 238,705 398,519 Receivables and other assets 6,041 — 3,534 9,575 257 — 139 396 Total assets acquired (1) 2,145,708 484,927 293,607 2,924,242 159,306 765 238,844 398,915 Lease liabilities (138,126) — — (138,126) — — — — Accrued expenses and other liabilities (20,748) (8,703) (266) (29,717) (671) — (2,043) (2,714) Total liabilities acquired (158,874) (8,703) (266) (167,843) (671) — (2,043) (2,714) Noncontrolling interests (2) (2,597) (2,056) (16,540) (21,193) (2,827) — — (2,827) Cash disbursed for acquisitions 1,984,237 474,168 276,801 2,735,206 155,808 765 236,801 393,374 Construction in progress additions 190,672 60,251 29,448 280,371 75,617 33,021 33,593 142,231 Less: Capitalized interest (9,658) (2,092) (2,277) (14,027) (7,760) (2,569) (2,905) (13,234) Accruals (3) 38 — (3,057) (3,019) (1,376) — (922) (2,298) Cash disbursed for construction in progress 181,052 58,159 24,114 263,325 66,481 30,452 29,766 126,699 Capital improvements to existing properties 115,115 26,496 24,080 165,691 130,465 5,971 46,888 183,324 Total cash invested in real property, net of cash acquired $ 2,280,404 $ 558,823 $ 324,995 $ 3,164,222 $ 352,754 $ 37,188 $ 313,455 $ 703,397 (1) Excludes $301,000 and $580,000 of unrestricted and restricted cash acquired during the nine months ended September 30, 2021 and September 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 July 30, 2021, we acquired a portfolio of 85 seniors housing properties owned by Holiday Retirement for $1,576,600,000, which are included in our Seniors Housing Operating segment. Atria Senior Living assumed operations of the portfolio following its acquisition of the Holiday Retirement management company pursuant to an incentive-based management agreement. As part of this transaction, a wholly owned subsidiary assumed the leasehold interest in a 26 property portfolio and subsequently purchased eight of the leased properties from the landlord. The lease, identified as an operating lease, expires in 2035 and was recognized as a right of use asset, net of above market lease intangibles, and lease liability. No rent will be paid in excess of net cash flow related to the remaining leasehold properties. Construction Activity The following is a summary of the construction projects that were placed into service and began generating revenues during the periods presented (in thousands): Nine Months Ended September 30, 2021 September 30, 2020 Development projects: Seniors Housing Operating $ 58,844 $ 93,188 Triple-net 22,990 59,201 Outpatient Medical 116,612 43,493 Total development projects 198,446 195,882 Expansion projects — 48,600 Total construction in progress conversions $ 198,446 $ 244,482

Real Estate Intangibles

Real Estate Intangibles	9 Months Ended
	Sep. 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): September 30, 2021 December 31, 2020 Assets: In place lease intangibles $ 1,549,294 $ 1,406,705 Above market tenant leases 54,542 52,621 Lease commissions 49,579 40,704 Gross historical cost 1,653,415 1,500,030 Accumulated amortization (1,249,032) (1,177,513) Net book value $ 404,383 $ 322,517 Weighted-average amortization period in years 8.3 10.5 Liabilities: Below market tenant leases $ 75,083 $ 77,851 Accumulated amortization (43,484) (40,871) Net book value $ 31,599 $ 36,980 Weighted-average amortization period in years 8.4 8.3 The following is a summary of real estate intangible amortization income (expense) for the periods presented (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Rental income related to (above)/below market tenant leases, net $ 384 $ 327 $ 1,241 $ 1,252 Amortization related to in place lease intangibles and lease commissions (32,872) (28,948) (76,083) (98,241) The future estimated aggregate amortization of intangible assets and liabilities is as follows for the periods presented (in thousands): Assets Liabilities 2021 $ 36,111 $ 1,962 2022 112,533 7,311 2023 70,483 5,179 2024 33,451 3,053 2025 23,099 2,524 Thereafter 128,706 11,570 Total $ 404,383 $ 31,599

Dispositions, Real Property Hel

Dispositions, Real Property Held for Sale and Impairment	9 Months Ended
	Sep. 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 September 30, 2021, two Seniors Housing Operating, 20 Triple-net, and two Outpatient Medical properties with an aggregate real estate balance of $251,152,000 were classified as held for sale. In addition to the real property balances held for sale, net other assets and (liabilities) of $18,081,000 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 $293,526,000. During the nine months ended September 30, 2021, we recorded $19,567,000 of impairment charges related to four Triple-net properties and one Outpatient Medical property classified as held for sale for which the carrying value exceeded the estimated fair value less cost to sell. Additionally, during the nine months ended September 30, 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 nine months ended September 30, 2020, we recorded $79,905,000 of impairment charges related to 13 Seniors Housing Operating properties and one Triple-net property classified as held for sale for which the carrying value exceeded the estimated fair value less cost to sell. Additionally, during the nine months ended September 30, 2020, we recorded $46,386,000 of impairment charges related to four Seniors Housing Operating properties and four Triple-net properties that were held for use in which the carrying value exceeded the estimated fair value. The following is a summary of our real property disposition activity for the periods presented (in thousands): Nine Months Ended September 30, 2021 2020 Real estate dispositions: Seniors Housing Operating $ 112,837 $ 1,093,477 Triple-net 439,974 33,445 Outpatient Medical 159,000 1,394,971 Total dispositions 711,811 2,521,893 Gain (loss) on real estate dispositions, net 223,702 902,991 Net other assets/(liabilities) disposed 6,195 98,065 Proceeds from real estate dispositions $ 941,708 $ 3,522,949 Operating results attributable to properties sold or classified as held for sale which do not meet the definition of discontinued operations are not reclassified on our Consolidated Statements of Comprehensive Income. The following represents the activity related to these properties for the periods presented (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Revenues: Total revenues $ 7,103 $ 7,471 (1) $ 58,302 $ 262,951 Expenses: Interest expense 32 1,737 1,471 10,039 Property operating expenses 925 33,330 7,942 150,501 Provision for depreciation 440 18,085 8,665 72,877 Total expenses 1,397 53,152 18,078 233,417 Income (loss) from real estate dispositions, net $ 5,706 $ (45,681) $ 40,224 $ 29,534 (1) During the three months ended September 30, 2020, we reserved for straight-line rent receivable balances on properties operated by Genesis Healthcare. See also Note 9 for additional information.

Leases

Leases	9 Months Ended
	Sep. 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): Nine Months Ended Classification September 30, 2021 September 30, 2020 Operating lease cost: (1) Real estate lease expense Property operating expenses $ 16,430 $ 17,397 Non-real estate investment lease expense General and administrative expenses 3,461 3,673 Finance lease cost: Amortization of leased assets Property operating expenses 6,120 6,229 Interest on lease liabilities Interest expense 4,950 4,693 Sublease income Rental income (5,972) (3,130) Total $ 24,989 $ 28,862 (1) Includes short-term leases which are immaterial. Supplemental balance sheet information related to leases is as follows (in thousands): Classification September 30, 2021 December 31, 2020 Right of use assets: Operating leases - real estate Right of use assets, net $ 371,034 $ 310,017 Finance leases - real estate Right of use assets, net 155,580 155,849 Real estate right of use assets, net 526,614 465,866 Operating leases - non-real estate investments Receivables and other assets 6,686 9,624 Total right of use assets, net $ 533,300 $ 475,490 Lease liabilities: Operating leases $ 434,303 $ 311,164 Financing leases 110,244 107,102 Total $ 544,547 $ 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 nine months ended September 30, 2021 and 2020, we reserved for previously recognized straight-line rent receivable balances of $49,241,000 and $146,508,000 through rental income, relating to leases for which collection of substantially all contractual lease payments was no longer deemed probable. Included in the 2020 amount was $91,025,000 related to Genesis Healthcare, whom noted substantial doubt as to their ability to continue as a going concern. Leases in our Triple-net and Outpatient Medical portfolios typically include some form of operating expense reimbursement by the tenant. For the nine months ended September 30, 2021, we recognized $1,015,550,000 of rental income related to operating leases, of which $134,632,000 wa s for variable lease payments which primarily represents the reimbursement of operating costs such as common area maintenance expenses, utilities, insurance and real estate taxes. For the nine months ended September 30, 2020, we recognized $1,061,311,000 of rental income related to operating leases, of which $153,217,000 was for variable lease payments.
Leases	Leases We lease land, buildings, office space and certain equipment. Many of our leases include a renewal option to extend the term from one The components of lease expense were as follows for the period presented (in thousands): Nine Months Ended Classification September 30, 2021 September 30, 2020 Operating lease cost: (1) Real estate lease expense Property operating expenses $ 16,430 $ 17,397 Non-real estate investment lease expense General and administrative expenses 3,461 3,673 Finance lease cost: Amortization of leased assets Property operating expenses 6,120 6,229 Interest on lease liabilities Interest expense 4,950 4,693 Sublease income Rental income (5,972) (3,130) Total $ 24,989 $ 28,862 (1) Includes short-term leases which are immaterial. Supplemental balance sheet information related to leases is as follows (in thousands): Classification September 30, 2021 December 31, 2020 Right of use assets: Operating leases - real estate Right of use assets, net $ 371,034 $ 310,017 Finance leases - real estate Right of use assets, net 155,580 155,849 Real estate right of use assets, net 526,614 465,866 Operating leases - non-real estate investments Receivables and other assets 6,686 9,624 Total right of use assets, net $ 533,300 $ 475,490 Lease liabilities: Operating leases $ 434,303 $ 311,164 Financing leases 110,244 107,102 Total $ 544,547 $ 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 nine months ended September 30, 2021 and 2020, we reserved for previously recognized straight-line rent receivable balances of $49,241,000 and $146,508,000 through rental income, relating to leases for which collection of substantially all contractual lease payments was no longer deemed probable. Included in the 2020 amount was $91,025,000 related to Genesis Healthcare, whom noted substantial doubt as to their ability to continue as a going concern. Leases in our Triple-net and Outpatient Medical portfolios typically include some form of operating expense reimbursement by the tenant. For the nine months ended September 30, 2021, we recognized $1,015,550,000 of rental income related to operating leases, of which $134,632,000 wa s for variable lease payments which primarily represents the reimbursement of operating costs such as common area maintenance expenses, utilities, insurance and real estate taxes. For the nine months ended September 30, 2020, we recognized $1,061,311,000 of rental income related to operating leases, of which $153,217,000 was for variable lease payments.
Leases	Leases We lease land, buildings, office space and certain equipment. Many of our leases include a renewal option to extend the term from one The components of lease expense were as follows for the period presented (in thousands): Nine Months Ended Classification September 30, 2021 September 30, 2020 Operating lease cost: (1) Real estate lease expense Property operating expenses $ 16,430 $ 17,397 Non-real estate investment lease expense General and administrative expenses 3,461 3,673 Finance lease cost: Amortization of leased assets Property operating expenses 6,120 6,229 Interest on lease liabilities Interest expense 4,950 4,693 Sublease income Rental income (5,972) (3,130) Total $ 24,989 $ 28,862 (1) Includes short-term leases which are immaterial. Supplemental balance sheet information related to leases is as follows (in thousands): Classification September 30, 2021 December 31, 2020 Right of use assets: Operating leases - real estate Right of use assets, net $ 371,034 $ 310,017 Finance leases - real estate Right of use assets, net 155,580 155,849 Real estate right of use assets, net 526,614 465,866 Operating leases - non-real estate investments Receivables and other assets 6,686 9,624 Total right of use assets, net $ 533,300 $ 475,490 Lease liabilities: Operating leases $ 434,303 $ 311,164 Financing leases 110,244 107,102 Total $ 544,547 $ 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 nine months ended September 30, 2021 and 2020, we reserved for previously recognized straight-line rent receivable balances of $49,241,000 and $146,508,000 through rental income, relating to leases for which collection of substantially all contractual lease payments was no longer deemed probable. Included in the 2020 amount was $91,025,000 related to Genesis Healthcare, whom noted substantial doubt as to their ability to continue as a going concern. Leases in our Triple-net and Outpatient Medical portfolios typically include some form of operating expense reimbursement by the tenant. For the nine months ended September 30, 2021, we recognized $1,015,550,000 of rental income related to operating leases, of which $134,632,000 wa s for variable lease payments which primarily represents the reimbursement of operating costs such as common area maintenance expenses, utilities, insurance and real estate taxes. For the nine months ended September 30, 2020, we recognized $1,061,311,000 of rental income related to operating leases, of which $153,217,000 was for variable lease payments.

Loans Receivable

Loans Receivable	9 Months Ended
	Sep. 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 $26,361,000 and $15,615,000 as of September 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): September 30, 2021 December 31, 2020 Mortgage loans $ 957,114 $ 299,430 Other real estate loans 174,078 152,739 Allowance for credit losses on real estate loans receivable (15,547) (8,797) Real estate loans receivable, net of credit allowance 1,115,645 443,372 Non-real estate loans 362,077 455,508 Allowance for credit losses on non-real estate loans receivable (151,255) (215,239) Non-real estate loans receivable, net of credit allowance 210,822 240,269 Total loans receivable, net of credit allowance $ 1,326,467 $ 683,641 The following is a summary of our loan activity for the periods presented (in thousands): Nine Months Ended September 30, 2021 September 30, 2020 Advances on loans receivable: Investments in new loans $ 935,594 $ 194,942 Draws on existing loans 17,412 21,365 Net cash advances on loans receivable 953,006 216,307 Receipts on loans receivable: Loan payoffs 179,827 — Principal payments on loans 70,588 14,345 Net cash receipts on loans receivable 250,415 14,345 Net cash advances (receipts) on loans receivable $ 702,591 $ 201,962 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): September 30, 2021 Loan category Years of Origination Loan Carrying Value Allowance for Credit Loss Net Loan Balance No. of Loans Deteriorated loans 2007 - 2018 $ 178,301 $ (148,438) $ 29,863 3 Collective loan pool 2007-2016 201,939 (3,061) 198,878 17 Collective loan pool 2017 125,661 (1,127) 124,534 7 Collective loan pool 2018 23,263 (346) 22,917 2 Collective loan pool 2019 22,047 (334) 21,713 4 Collective loan pool 2020 46,335 (703) 45,632 6 Collective loan pool 2021 895,723 (12,793) 882,930 17 Total loans $ 1,493,269 $ (166,802) $ 1,326,467 56 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): Nine Months Ended September 30, 2021 September 30, 2020 Balance at beginning of period $ 224,036 $ 68,372 Adoption of ASU 2016-13 — 5,212 Provision for loan losses 7,309 11,351 Loan write-offs (1) (64,075) — Foreign currency translation (468) (40) Balance at end of period $ 166,802 $ 84,895 (1) Include s $64,075,000 related t o the Genesis Healthcare lease terminations for the nine months ended September 30, 2021. See Note 9 for further details. The following is a summary of our deteriorated loans (in thousands): Nine Months Ended September 30, 2021 September 30, 2020 Balance of deteriorated loans at end of period (1) $ 178,301 $ 249,314 Allowance for credit losses (148,438) (76,695) Balance of deteriorated loans not reserved $ 29,863 $ 172,619 Interest recognized on deteriorated loans (2) $ 3,171 $ 13,847 (1) Current year amounts include $2,157,000 and $3,623,000 of loans on non-accrual as of September 30, 2021 and December 31, 2020, respectively. Prior year amounts include $10,686,000 and $2,534,000 as of September 30, 2020 and December 31, 2019, respectively. (2) Represents cash interest recognized in the period.

Investments in Unconsolidated E

Investments in Unconsolidated Entities	9 Months Ended
	Sep. 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) September 30, 2021 December 31, 2020 Seniors Housing Operating 10% to 65% $ 771,337 $ 653,057 Triple-net 10% to 25% 46,466 5,629 Outpatient Medical 15% to 50% 160,152 287,548 Total $ 977,955 $ 946,234 (1) Includes ownership of investments classified as liabilities and excludes ownership of in substance real estate. At September 30, 2021, the aggregate unamortized basis difference of our joint venture investments of $118,012,000 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. As of September 30, 2021, we have made loans totaling $273,654,000 related to eight properties 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 $16,667,000 related to these investments.

Credit Concentration

Credit Concentration	9 Months Ended
	Sep. 30, 2021
Risks and Uncertainties [Abstract]
Credit Concentration	Credit Concentration We use consolidated net operating income (“NOI”) as our credit concentration metric. See Note 18 for additional information and reconciliation. The following table summarizes certain information about our credit concentration for the nine months ended September 30, 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 205 $ 168,832 12% Sunrise Senior Living (3) 155 157,256 11% Revera (3) 85 71,139 5% Avery Healthcare 61 62,325 5% Belmont Village 21 45,475 4% Remaining portfolio 1,079 938,441 63% Totals 1,606 $ 1,443,468 100% (1) ProMedica is in our Triple-net segment. Sunrise Senior Living, Revera and Belmont Village are in our Seniors Housing Operating 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. • As of September 30, 2021, operations have transitioned for 39 of the remaining properties, with three additional properties expected to transition before year end. • 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. As of September 30, 2021, we have closed on the sale of 21 of these properties for proceeds of $331 million and the remaining 14 are classified as held for sale. • 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 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 September 30, 2021, our total carrying value of Genesis loans receivable, net of allowances for credit losses, was $149,574,000 .

Borrowings Under Credit Facilit

Borrowings Under Credit Facilities and Commercial Paper Program	9 Months Ended
	Sep. 30, 2021
Debt Disclosure [Abstract]
Borrowings Under Credit Facilities and Commercial Paper Program	Borrowings Under Credit Facilities and Commercial Paper Program At September 30, 2021, we had a primary unsecured credit facility with a consortium of 34 banks that included a $4,000,000,000 unsecured revolving credit facility, a $500,000,000 unsecured term credit facility and a $250,000,000 Canadian-denominated unsecured term credit facility. The unsecured revolving credit facility is comprised of a $1,000,000,000 tranche that matures on June 4, 2023 (none outstanding at September 30, 2021) and a $3,000,000,000 tranche that matures on June 4, 2025 ($51,000,000 outstanding at September 30, 2021). Both tranches may be extended for two successive terms of six months at our option. The term credit facilities mature on July 19, 2023. We have an option, through an accordion feature, to upsize the unsecured revolving credit facility and the $500,000,000 unsecured term credit facility by up to an additional $1,250,000,000, in the aggregate, and the $250,000,000 Canadian-denominated unsecured term credit facility by up to an additional $250,000,000. The primary unsecured credit facility also allows us to borrow up to $1,000,000,000 in alternate currencies (none outstanding at September 30, 2021). Borrowings under the unsecured revolving credit facility are subject to interest payable at the applicable margin over LIBOR interest rate. The applicable margin is based on our debt ratings and was 0.775% at September 30, 2021. In addition, we pay a facility fee quarterly to each bank based on the bank’s commitment amount. The facility fee depends on our debt ratings and was 0.15% at September 30, 2021. 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. As of September 30, 2021, there was a balance of $239,996,000 outstanding on the commercial paper program ($240,000,000 in principal outstanding net of an unamortized discount of $4,000), which reduces the borrowing capacity of the unsecured revolving credit facility. The notes bear interest at various floating rates with a weighted average of 0.19% as of September 30, 2021 and a weighted average maturity of four days as of September 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 September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Balance outstanding at quarter end $ 291,000 $ — $ 291,000 $ — Maximum amount outstanding at any month end $ 990,000 $ — $ 990,000 $ 2,100,000 Average amount outstanding (total of daily principal balances divided by days in period) $ 470,935 $ — $ 255,114 $ 663,895 Weighted average interest rate (actual interest expense divided by average borrowings outstanding) 0.21 % — % 0.42 % 2.09 %

Senior Unsecured Notes and Secu

Senior Unsecured Notes and Secured Debt	9 Months Ended
	Sep. 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 September 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 $ — $ 211,978 $ 211,978 2022 — 481,702 481,702 2023 (4, 5) 697,270 504,855 1,202,125 2024 1,350,000 183,192 1,533,192 2025 1,260,000 178,544 1,438,544 Thereafter (6, 7, 8) 7,901,074 709,510 8,610,584 Totals $ 11,208,344 $ 2,269,781 $ 13,478,125 (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 0.78% to 6.50%. (3) Annual interest rates range from 0.02% to 7.93%. Carrying value of the properties securing the debt totaled $5,261,000,000 at September 30, 2021. (4) Includes a $250,000,000 Canadian-denominated unsecured term credit facility (approximately $197,270,000 based on the Canadian/U.S. Dollar exchange rate on September 30, 2021). The loan matures on July 19, 2023 and bears interest at the Canadian Dealer Offered Rate plus 0.90% (1.33% at September 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% (0.98% at September 30, 2021). (6) Includes a $300,000,000 Canadian-denominated 2.95% senior unsecured notes due 2027 (approximately $236,724,000 based on the Canadian/U.S. Dollar exchange rate on September 30, 2021). (7) Includes a £550,000,000 4.80% senior unsecured notes due 2028 (approximately $740,850,000 based on the Sterling/U.S. Dollar exchange rate in effect on September 30, 2021). (8) Includes a £500,000,000 4.50% senior unsecured notes due 2034 (approximately $673,500,000 based on the Sterling/U.S. Dollar exchange rate in effect on September 30, 2021). The following is a summary of our senior unsecured notes principal activity during the periods presented (dollars in thousands): Nine Months Ended September 30, 2021 September 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% (566,248) 3.26% Foreign currency (17,437) 4.37% (48,037) 4.14% Ending balance $ 11,208,344 3.71% $ 11,413,277 3.67% The following is a summary of our secured debt principal activity for the periods presented (dollars in thousands): Nine Months Ended September 30, 2021 September 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 2,693 3.75% 44,921 2.58% Debt extinguished (70,144) 6.02% (491,506) 2.61% Principal payments (48,710) 3.39% (46,585) 3.60% Foreign currency 7,869 2.97% (30,984) 3.19% Ending balance $ 2,269,781 3.10% $ 2,469,188 3.16%

Derivative Instruments

Derivative Instruments	9 Months Ended
	Sep. 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 nine months ended September 30, 2021 and 2020, we settled certain net investment hedges generating cash proceeds of $8,879,000 and $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): September 30, 2021 December 31, 2020 Derivatives designated as net investment hedges: Denominated in Canadian Dollars $ 625,000 $ 625,000 Denominated in Pound Sterling £ 1,904,708 £ 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 Forward purchase contracts denominated in Pound Sterling £ (37,408) £ — (1) At September 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 September 30, Nine Months Ended September 30, Description Location 2021 2020 2021 2020 Gain (loss) on derivative instruments designated as hedges recognized in income Interest expense $ 5,849 $ 5,724 $ 17,416 $ 16,475 Gain (loss) on derivative instruments not designated as hedges recognized in income Interest expense $ 241 $ (1,159) $ (1,415) $ (3,207) Gain (loss) on equity warrants recognized in income Gain (loss) on derivatives and financial instruments $ 9,216 $ — $ 9,216 $ — Gain (loss) on derivative and financial instruments designated as hedges recognized in OCI OCI $ 130,711 $ (145,512) $ 100,866 $ 86,429

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
	Sep. 30, 2021
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and ContingenciesAt September 30, 2021, we had 13 outstanding letter of credit obligations totaling $28,366,000 and expiring between 2021 and 2022. At September 30, 2021, we had outstanding construction in progress of $562,487,000 and were committed to providing additional funds of approximately $1,072,343,000 to complete construction. Additionally, at September 30, 2021, we had outstanding investments classified as in substance real estate of $273,654,000 and were committed to provide additional funds of $16,667,000 (see Note 8 for additional information). Purchase obligations include $101,284,000 of contingent purchase obligations to fund capital improvements. Rents due from the tenant are increased to reflect the additional investment in the property.

Stockholders' Equity

Stockholders' Equity	9 Months Ended
	Sep. 30, 2021
Equity [Abstract]
Stockholders' Equity	Stockholders’ Equity The following is a summary of our stockholders’ equity capital accounts as of the dates indicated: September 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 437,049,822 419,124,469 Outstanding shares 435,273,885 417,400,602 Common Stock In July 2021, we entered into an amended and restated equity distribution agreement whereby we can offer and sell up to $2,500,000,000 aggregate amount of our common stock ("ATM Program"). The ATM Program also allows us to enter into forward sale agreements. As of September 30, 2021, we had $2,491,418,000 of remaining capacity under the ATM Program, which excludes forward sales agreements outstanding for the sale of 11,798,154 shares with maturity dates in 2022 which we expect to physically settle for cash proceeds of $993,881,000. 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 nine months ended September 30, 2021. The following is a summary of our common stock issuances during the nine months ended September 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 185,994 — — 2020 Totals 7,250,376 $ 607,189 $ 595,313 2021 ATM Program issuances 17,720,008 77.91 1,380,519 1,366,464 2021 Stock incentive plans, net of forfeitures 153,275 — — 2021 Totals 17,873,283 $ 1,380,519 $ 1,366,464 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): Nine Months Ended September 30, 2021 September 30, 2020 Per Share Amount Per Share Amount Common stock $ 1.83 $ 771,984 $ 2.09 $ 865,357 Accumulated Other Comprehensive Income The following is a summary of accumulated other comprehensive income (loss) for the periods presented (in thousands): September 30, 2021 December 31, 2020 Foreign currency translation $ (677,331) $ (621,792) Derivative and financial instruments designated as hedges 574,154 473,288 Total accumulated other comprehensive income (loss) $ (103,177) $ (148,504)

Stock Incentive Plans

Stock Incentive Plans	9 Months Ended
	Sep. 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	9 Months Ended
	Sep. 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 September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Numerator for basic earnings per share - net income (loss) attributable to common stockholders $ 179,663 $ 325,585 $ 277,466 $ 815,115 Adjustment for net income (loss) attributable to OP units (473) (1,716) (2,699) (4,470) Numerator for diluted earnings per share $ 179,190 $ 323,869 $ 274,767 $ 810,645 Denominator for basic earnings per share - weighted average shares 428,031 417,027 420,955 414,822 Effect of dilutive securities: Non-vested restricted shares 537 542 465 620 Redeemable OP units 1,396 1,396 1,396 1,396 Employee stock purchase program 19 22 19 22 Dilutive potential common shares 1,952 1,960 1,880 2,038 Denominator for diluted earnings per share - adjusted weighted average shares 429,983 418,987 422,835 416,860 Basic earnings per share $ 0.42 $ 0.78 $ 0.66 $ 1.96 Diluted earnings per share $ 0.42 $ 0.77 $ 0.65 $ 1.94 As of September 30, 2021, forward sales agreements outstanding f or the sale of 11,798,154 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 nine month periods ended September 30, 2021.

Disclosure about Fair Value of

Disclosure about Fair Value of Financial Instruments	9 Months Ended
	Sep. 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 enterprise value of the underlying HC-One Group real estate portfolio, marketability discount for private company warrants, dividend yield, volatility and risk-free rate. The enterprise value is driven by projected cash flows, weighted average cost of capital and a terminal capitalization 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): September 30, 2021 December 31, 2020 Carrying Amount Fair Value Carrying Amount Fair Value Financial assets: Mortgage loans receivable $ 941,357 $ 967,813 $ 293,752 $ 297,207 Other real estate loans receivable 174,288 174,088 149,620 152,211 Equity securities 1,922 1,922 4,636 4,636 Cash and cash equivalents 303,982 303,982 1,545,046 1,545,046 Restricted cash 58,663 58,663 475,997 475,997 Non-real estate loans receivable 210,822 212,054 240,269 255,724 Foreign currency forward contracts, interest rate swaps and cross currency swaps 19,637 19,637 4,668 4,668 Equity warrants 40,658 40,658 — — Financial liabilities: Borrowings under unsecured credit facility and commercial paper program $ 290,996 $ 290,996 $ — $ — Senior unsecured notes 11,116,067 12,485,436 11,420,790 13,093,926 Secured debt 2,262,345 2,325,322 2,377,930 2,451,782 Foreign currency forward contracts, interest rate swaps and cross currency swaps 27,731 27,731 118,054 118,054 Redeemable OP unitholder interests $ 147,083 $ 147,083 $ 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 September 30, 2021 Total Level 1 Level 2 Level 3 Equity securities $ 1,922 $ 1,922 $ — $ — Equity warrants 40,658 — — 40,658 Foreign currency forward contracts, interest rate swaps and cross currency swaps, net asset (liability) (1) (8,094) — (8,094) — Totals $ 34,486 $ 1,922 $ (8,094) $ 40,658 (1) Please see Note 12 for additional information. The following table summarizes the change in fair value for equity warrants using unobservable Level 3 inputs for the nine months ended September 30, 2021 (in thousands): Nine Months Ended September 30, 2021 Beginning balance $ — Warrants acquired 32,419 Mark-to-market adjustment 9,216 Foreign currency (977) Ending balance $ 40,658 The most significant assumptions utilized in the valuation of the equity warrants are the cash flows of the underlying HC-One Group enterprise, as well as the terminal capitalization rate of 11%. Items Measured at Fair Value on a Nonrecurring Basis

Segment Reporting

Segment Reporting	9 Months Ended
	Sep. 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 cash investments recorded in 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 September 30, 2021: Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 835,617 $ — $ — $ — $ 835,617 Rental income — 200,641 157,343 — 357,984 Interest income 1,135 38,257 472 — 39,864 Other income 2,767 1,087 1,688 790 6,332 Total revenues 839,519 239,985 159,503 790 1,239,797 Property operating expenses 666,610 11,664 48,072 3,054 729,400 Consolidated net operating income 172,909 228,321 111,431 (2,264) 510,397 Depreciation and amortization 157,176 54,226 56,352 — 267,754 Interest expense 9,360 1,548 4,811 106,803 122,522 General and administrative expenses — — — 32,256 32,256 Loss (gain) on derivatives and financial instruments, net — (8,078) — — (8,078) Loss (gain) on extinguishment of debt, net — — (5) — (5) Provision for loan losses, net 152 (323) (100) — (271) Impairment of assets — 1,490 — — 1,490 Other expenses 5,449 (4,248) 640 1,734 3,575 Income (loss) from continuing operations before income taxes and other items 772 183,706 49,733 (143,057) 91,154 Income tax (expense) benefit — — — (4,940) (4,940) Income (loss) from unconsolidated entities (15,810) 5,038 (5,060) — (15,832) Gain (loss) on real estate dispositions, net (615) 81,712 38,857 — 119,954 Income (loss) from continuing operations (15,653) 270,456 83,530 (147,997) 190,336 Net income (loss) $ (15,653) $ 270,456 $ 83,530 $ (147,997) $ 190,336 Total assets $ 17,741,955 $ 9,317,352 $ 6,247,215 $ 173,503 $ 33,480,025 Three Months Ended September 30, 2020: Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 740,956 $ — $ — $ — $ 740,956 Rental income — 103,938 171,108 — 275,046 Interest income 113 15,877 760 — 16,750 Other income 996 1,113 836 1,177 4,122 Total revenues 742,065 120,928 172,704 1,177 1,036,874 Property operating expenses 567,704 12,567 52,728 1,718 634,717 Consolidated net operating income 174,361 108,361 119,976 (541) 402,157 Depreciation and amortization 133,224 58,157 64,151 — 255,532 Interest expense 12,728 2,070 4,287 105,766 124,851 General and administrative expenses — — — 31,003 31,003 Loss (gain) on derivatives and financial instruments, net — 1,395 — — 1,395 Loss (gain) on extinguishment of debt, net — — — 33,004 33,004 Provision for loan losses, net 86 372 2,399 — 2,857 Impairment of assets 12,778 10,535 — — 23,313 Other expenses 6,488 2,805 781 1,470 11,544 Income (loss) from continuing operations before income taxes and other items 9,057 33,027 48,358 (171,784) (81,342) Income tax (expense) benefit — — — (2,003) (2,003) Income (loss) from unconsolidated entities (7,678) (423) 2,120 — (5,981) Gain (loss) on real estate dispositions, net 313,319 (619) 171,604 — 484,304 Income (loss) from continuing operations 314,698 31,985 222,082 (173,787) 394,978 Net income (loss) $ 314,698 $ 31,985 $ 222,082 $ (173,787) $ 394,978 Nine Months Ended September 30, 2021 Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 2,299,972 $ — $ — $ — $ 2,299,972 Rental income — 557,829 457,721 — 1,015,550 Interest income 3,110 86,040 8,741 — 97,891 Other income 5,388 3,539 8,336 2,175 19,438 Total revenues 2,308,470 647,408 474,798 2,175 3,432,851 Property operating expenses 1,804,939 37,132 140,430 6,882 1,989,383 Consolidated net operating income 503,531 610,276 334,368 (4,707) 1,443,468 Depreciation and amortization 420,797 165,299 166,969 — 753,065 Interest expense 31,331 5,134 12,733 318,807 368,005 General and administrative expenses — — — 93,618 93,618 Loss (gain) on derivatives and financial instruments, net — (6,503) — — (6,503) Loss (gain) on extinguishment of debt, net (1,537) — (5) 52,506 50,964 Provision for loan losses, net 222 10,549 (3,462) — 7,309 Impairment of assets 22,317 24,222 2,211 — 48,750 Other expenses 12,617 4,845 2,450 6,344 26,256 Income (loss) from continuing operations before income taxes and other items 17,784 406,730 153,472 (475,982) 102,004 Income tax (expense) benefit — — — (6,662) (6,662) Income (loss) from unconsolidated entities (23,514) 14,822 (2,067) — (10,759) Gain (loss) on real estate dispositions, net 4,552 126,463 92,687 — 223,702 Income (loss) from continuing operations (1,178) 548,015 244,092 (482,644) 308,285 Net income (loss) $ (1,178) $ 548,015 $ 244,092 $ (482,644) $ 308,285 Nine Months Ended September 30, 2020 Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 2,360,488 $ — $ — $ — $ 2,360,488 Rental income — 512,815 548,496 — 1,061,311 Interest income 305 46,068 1,687 — 48,060 Other income 6,050 3,393 2,681 1,968 14,092 Total revenues 2,366,843 562,276 552,864 1,968 3,483,951 Property operating expenses 1,771,088 39,432 165,024 1,718 1,977,262 Consolidated net operating income 595,755 522,844 387,840 250 1,506,689 Depreciation and amortization 419,161 173,989 202,554 — 795,704 Interest expense 43,191 7,668 13,421 328,935 393,215 General and administrative expenses — — — 100,546 100,546 Loss (gain) on derivatives and financial — 10,480 — — 10,480 Loss (gain) on extinguishment of debt, net (492) — 741 33,004 33,253 Provision for loan losses, net 86 18.69 8,895 — 2,370 18.69 — 11,351 Impairment of assets 91,424 34,867 — — 126,291 Other expenses 13,463 6,818 8,244 8,722 37,247 Income (loss) from continuing operations before income taxes and other items 28,922 280,127 160,510 (470,957) (1,398) Income tax (expense) benefit — — — (9,678) (9,678) Income (loss) from unconsolidated entities (25,489) 11,776 5,372 — (8,341) Gain (loss) on real estate dispositions, net 327,635 51,166 524,190 — 902,991 Income (loss) from continuing operations 331,068 343,069 690,072 (480,635) 883,574 Net income (loss) $ 331,068 $ 343,069 $ 690,072 $ (480,635) $ 883,574 Our portfolio of properties and other investments are located in the United States, the United Kingdom and Canada. Revenues and assets are attributed to the country in which the property is physically located. The following is a summary of geographic information for the periods presented (dollars in thousands): Three Months Ended Nine Months Ended September 30, 2021 September 30, 2020 September 30, 2021 September 30, 2020 Revenues: Amount (1) % Amount % Amount (1) % Amount % United States $ 990,034 79.9 % $ 819,057 79.0 % $ 2,709,354 78.9 % $ 2,820,609 81.0 % United Kingdom 146,308 11.8 % 110,281 10.6 % 405,938 11.8 % 337,601 9.7 % Canada 103,455 8.3 % 107,536 10.4 % 317,559 9.3 % 325,741 9.3 % Total $ 1,239,797 100.0 % $ 1,036,874 100.0 % $ 3,432,851 100.0 % $ 3,483,951 100.0 % As of September 30, 2021 December 31, 2020 Assets: Amount % Amount % United States $ 27,132,959 81.0 % $ 26,658,659 82.1 % United Kingdom 3,978,661 11.9 % 3,352,549 10.3 % Canada 2,368,405 7.1 % 2,472,434 7.6 % Total $ 33,480,025 100.0 % $ 32,483,642 100.0 % (1) The United States, United Kingdom and Canada represent 74%, 13% and 13% of our resident fees and services revenue for the three and nine month periods ended September 30, 2021, respectively.

Income Taxes and Distributions

Income Taxes and Distributions	9 Months Ended
	Sep. 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 nine months ended September 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.

Variable Interest Entities

Variable Interest Entities	9 Months Ended
	Sep. 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): September 30, 2021 December 31, 2020 Assets: Net real estate investments $ 451,723 $ 454,333 Cash and cash equivalents 15,067 15,547 Receivables and other assets 7,999 11,171 Total assets (1) $ 474,789 $ 481,051 Liabilities and equity: Secured debt $ 164,010 $ 165,671 Lease liabilities 3,648 1,325 Accrued expenses and other liabilities 12,939 14,997 Total equity 294,192 299,058 Total liabilities and equity $ 474,789 $ 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)	9 Months Ended
	Sep. 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 nine months ended September 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)	9 Months Ended
	Sep. 30, 2021
Accounting Policies [Abstract]
Schedule of Seniors Housing Operating portfolio	Monthly spot occupancy rates through September 30, 2021 are as follows: December 2020 January 2021 February 2021 March 2021 April 2021 May 2021 June 2021 July 2021 August 2021 September 2021 Spot occupancy (1) 74.8 % 73.4 % 72.5 % 72.7 % 73.2 % 73.7 % 74.6 % 75.2 % 75.9 % 76.7 % Sequential occupancy change (2) (1.4) % (0.8) % 0.1 % 0.5 % 0.5 % 0.9 % 0.6 % 0.8 % 0.8 % (1) Spot occupancy represents approximate month end occupancy at our share for 591 properties in operation as of December 31, 2020, including unconsolidated properties but excluding acquisitions, executed dispositions, development conversions since this date as well as one property closed for redevelopment. (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)	9 Months Ended
	Sep. 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): Nine Months Ended September 30, 2021 September 30, 2020 Seniors Housing Operating Triple-net Outpatient Totals Seniors Housing Operating Triple-net Outpatient Totals Land and land improvements $ 264,706 $ 48,099 $ 45,350 $ 358,155 $ 15,758 $ — $ 43,252 $ 59,010 Buildings and improvements 1,655,067 436,828 227,390 2,319,285 132,481 765 171,630 304,876 Acquired lease intangibles 142,439 — 17,333 159,772 10,810 — 23,823 34,633 Right of use assets, net 77,455 — — 77,455 — — — — Total net real estate assets 2,139,667 484,927 290,073 2,914,667 159,049 765 238,705 398,519 Receivables and other assets 6,041 — 3,534 9,575 257 — 139 396 Total assets acquired (1) 2,145,708 484,927 293,607 2,924,242 159,306 765 238,844 398,915 Lease liabilities (138,126) — — (138,126) — — — — Accrued expenses and other liabilities (20,748) (8,703) (266) (29,717) (671) — (2,043) (2,714) Total liabilities acquired (158,874) (8,703) (266) (167,843) (671) — (2,043) (2,714) Noncontrolling interests (2) (2,597) (2,056) (16,540) (21,193) (2,827) — — (2,827) Cash disbursed for acquisitions 1,984,237 474,168 276,801 2,735,206 155,808 765 236,801 393,374 Construction in progress additions 190,672 60,251 29,448 280,371 75,617 33,021 33,593 142,231 Less: Capitalized interest (9,658) (2,092) (2,277) (14,027) (7,760) (2,569) (2,905) (13,234) Accruals (3) 38 — (3,057) (3,019) (1,376) — (922) (2,298) Cash disbursed for construction in progress 181,052 58,159 24,114 263,325 66,481 30,452 29,766 126,699 Capital improvements to existing properties 115,115 26,496 24,080 165,691 130,465 5,971 46,888 183,324 Total cash invested in real property, net of cash acquired $ 2,280,404 $ 558,823 $ 324,995 $ 3,164,222 $ 352,754 $ 37,188 $ 313,455 $ 703,397 (1) Excludes $301,000 and $580,000 of unrestricted and restricted cash acquired during the nine months ended September 30, 2021 and September 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): Nine Months Ended September 30, 2021 September 30, 2020 Development projects: Seniors Housing Operating $ 58,844 $ 93,188 Triple-net 22,990 59,201 Outpatient Medical 116,612 43,493 Total development projects 198,446 195,882 Expansion projects — 48,600 Total construction in progress conversions $ 198,446 $ 244,482

Real Estate Intangibles (Tables

Real Estate Intangibles (Tables)	9 Months Ended
	Sep. 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): September 30, 2021 December 31, 2020 Assets: In place lease intangibles $ 1,549,294 $ 1,406,705 Above market tenant leases 54,542 52,621 Lease commissions 49,579 40,704 Gross historical cost 1,653,415 1,500,030 Accumulated amortization (1,249,032) (1,177,513) Net book value $ 404,383 $ 322,517 Weighted-average amortization period in years 8.3 10.5 Liabilities: Below market tenant leases $ 75,083 $ 77,851 Accumulated amortization (43,484) (40,871) Net book value $ 31,599 $ 36,980 Weighted-average amortization period in years 8.4 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 September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Rental income related to (above)/below market tenant leases, net $ 384 $ 327 $ 1,241 $ 1,252 Amortization related to in place lease intangibles and lease commissions (32,872) (28,948) (76,083) (98,241)
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 $ 36,111 $ 1,962 2022 112,533 7,311 2023 70,483 5,179 2024 33,451 3,053 2025 23,099 2,524 Thereafter 128,706 11,570 Total $ 404,383 $ 31,599

Dispositions, Real Property H_2

Dispositions, Real Property Held for Sale and Impairment (Tables)	9 Months Ended
	Sep. 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): Nine Months Ended September 30, 2021 2020 Real estate dispositions: Seniors Housing Operating $ 112,837 $ 1,093,477 Triple-net 439,974 33,445 Outpatient Medical 159,000 1,394,971 Total dispositions 711,811 2,521,893 Gain (loss) on real estate dispositions, net 223,702 902,991 Net other assets/(liabilities) disposed 6,195 98,065 Proceeds from real estate dispositions $ 941,708 $ 3,522,949
Dispositions and Assets Held for Sale	The following represents the activity related to these properties for the periods presented (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Revenues: Total revenues $ 7,103 $ 7,471 (1) $ 58,302 $ 262,951 Expenses: Interest expense 32 1,737 1,471 10,039 Property operating expenses 925 33,330 7,942 150,501 Provision for depreciation 440 18,085 8,665 72,877 Total expenses 1,397 53,152 18,078 233,417 Income (loss) from real estate dispositions, net $ 5,706 $ (45,681) $ 40,224 $ 29,534 (1) During the three months ended September 30, 2020, we reserved for straight-line rent receivable balances on properties operated by Genesis Healthcare. See also Note 9 for additional information.

Leases (Tables)

Leases (Tables)	9 Months Ended
	Sep. 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): Nine Months Ended Classification September 30, 2021 September 30, 2020 Operating lease cost: (1) Real estate lease expense Property operating expenses $ 16,430 $ 17,397 Non-real estate investment lease expense General and administrative expenses 3,461 3,673 Finance lease cost: Amortization of leased assets Property operating expenses 6,120 6,229 Interest on lease liabilities Interest expense 4,950 4,693 Sublease income Rental income (5,972) (3,130) Total $ 24,989 $ 28,862 (1) Includes short-term leases which are immaterial.
Supplemental Balance Sheet Information Related to Leases	Supplemental balance sheet information related to leases is as follows (in thousands): Classification September 30, 2021 December 31, 2020 Right of use assets: Operating leases - real estate Right of use assets, net $ 371,034 $ 310,017 Finance leases - real estate Right of use assets, net 155,580 155,849 Real estate right of use assets, net 526,614 465,866 Operating leases - non-real estate investments Receivables and other assets 6,686 9,624 Total right of use assets, net $ 533,300 $ 475,490 Lease liabilities: Operating leases $ 434,303 $ 311,164 Financing leases 110,244 107,102 Total $ 544,547 $ 418,266

Loans Receivable (Tables)

Loans Receivable (Tables)	9 Months Ended
	Sep. 30, 2021
Receivables [Abstract]
Summary of Loans Receivable	The following is a summary of our loans receivable (in thousands): September 30, 2021 December 31, 2020 Mortgage loans $ 957,114 $ 299,430 Other real estate loans 174,078 152,739 Allowance for credit losses on real estate loans receivable (15,547) (8,797) Real estate loans receivable, net of credit allowance 1,115,645 443,372 Non-real estate loans 362,077 455,508 Allowance for credit losses on non-real estate loans receivable (151,255) (215,239) Non-real estate loans receivable, net of credit allowance 210,822 240,269 Total loans receivable, net of credit allowance $ 1,326,467 $ 683,641
Summary of Loan Activity	The following is a summary of our loan activity for the periods presented (in thousands): Nine Months Ended September 30, 2021 September 30, 2020 Advances on loans receivable: Investments in new loans $ 935,594 $ 194,942 Draws on existing loans 17,412 21,365 Net cash advances on loans receivable 953,006 216,307 Receipts on loans receivable: Loan payoffs 179,827 — Principal payments on loans 70,588 14,345 Net cash receipts on loans receivable 250,415 14,345 Net cash advances (receipts) on loans receivable $ 702,591 $ 201,962
Schedule of Credit Loss	The following is a summary of our loans by credit loss category (in thousands): September 30, 2021 Loan category Years of Origination Loan Carrying Value Allowance for Credit Loss Net Loan Balance No. of Loans Deteriorated loans 2007 - 2018 $ 178,301 $ (148,438) $ 29,863 3 Collective loan pool 2007-2016 201,939 (3,061) 198,878 17 Collective loan pool 2017 125,661 (1,127) 124,534 7 Collective loan pool 2018 23,263 (346) 22,917 2 Collective loan pool 2019 22,047 (334) 21,713 4 Collective loan pool 2020 46,335 (703) 45,632 6 Collective loan pool 2021 895,723 (12,793) 882,930 17 Total loans $ 1,493,269 $ (166,802) $ 1,326,467 56 Nine Months Ended September 30, 2021 September 30, 2020 Balance at beginning of period $ 224,036 $ 68,372 Adoption of ASU 2016-13 — 5,212 Provision for loan losses 7,309 11,351 Loan write-offs (1) (64,075) — Foreign currency translation (468) (40) Balance at end of period $ 166,802 $ 84,895 (1) Include s $64,075,000 related t o the Genesis Healthcare lease terminations for the nine months ended September 30, 2021. See Note 9 for further details.
Summary of Impaired Loans	The following is a summary of our deteriorated loans (in thousands): Nine Months Ended September 30, 2021 September 30, 2020 Balance of deteriorated loans at end of period (1) $ 178,301 $ 249,314 Allowance for credit losses (148,438) (76,695) Balance of deteriorated loans not reserved $ 29,863 $ 172,619 Interest recognized on deteriorated loans (2) $ 3,171 $ 13,847 (1) Current year amounts include $2,157,000 and $3,623,000 of loans on non-accrual as of September 30, 2021 and December 31, 2020, respectively. Prior year amounts include $10,686,000 and $2,534,000 as of September 30, 2020 and December 31, 2019, respectively. (2) Represents cash interest recognized in the period.

Investments in Unconsolidated_2

Investments in Unconsolidated Entities (Tables)	9 Months Ended
	Sep. 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) September 30, 2021 December 31, 2020 Seniors Housing Operating 10% to 65% $ 771,337 $ 653,057 Triple-net 10% to 25% 46,466 5,629 Outpatient Medical 15% to 50% 160,152 287,548 Total $ 977,955 $ 946,234 (1) Includes ownership of investments classified as liabilities and excludes ownership of in substance real estate.

Credit Concentration (Tables)

Credit Concentration (Tables)	9 Months Ended
	Sep. 30, 2021
Risks and Uncertainties [Abstract]
Summary of Credit Concentration	The following table summarizes certain information about our credit concentration for the nine months ended September 30, 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 205 $ 168,832 12% Sunrise Senior Living (3) 155 157,256 11% Revera (3) 85 71,139 5% Avery Healthcare 61 62,325 5% Belmont Village 21 45,475 4% Remaining portfolio 1,079 938,441 63% Totals 1,606 $ 1,443,468 100% (1) ProMedica is in our Triple-net segment. Sunrise Senior Living, Revera and Belmont Village are in our Seniors Housing Operating 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)	9 Months Ended
	Sep. 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 September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Balance outstanding at quarter end $ 291,000 $ — $ 291,000 $ — Maximum amount outstanding at any month end $ 990,000 $ — $ 990,000 $ 2,100,000 Average amount outstanding (total of daily principal balances divided by days in period) $ 470,935 $ — $ 255,114 $ 663,895 Weighted average interest rate (actual interest expense divided by average borrowings outstanding) 0.21 % — % 0.42 % 2.09 %

Senior Unsecured Notes and Se_2

Senior Unsecured Notes and Secured Debt (Tables)	9 Months Ended
	Sep. 30, 2021
Debt Disclosure [Abstract]
Annual Principal Payments Due on Debt Obligations	At September 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 $ — $ 211,978 $ 211,978 2022 — 481,702 481,702 2023 (4, 5) 697,270 504,855 1,202,125 2024 1,350,000 183,192 1,533,192 2025 1,260,000 178,544 1,438,544 Thereafter (6, 7, 8) 7,901,074 709,510 8,610,584 Totals $ 11,208,344 $ 2,269,781 $ 13,478,125 (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 0.78% to 6.50%. (3) Annual interest rates range from 0.02% to 7.93%. Carrying value of the properties securing the debt totaled $5,261,000,000 at September 30, 2021. (4) Includes a $250,000,000 Canadian-denominated unsecured term credit facility (approximately $197,270,000 based on the Canadian/U.S. Dollar exchange rate on September 30, 2021). The loan matures on July 19, 2023 and bears interest at the Canadian Dealer Offered Rate plus 0.90% (1.33% at September 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% (0.98% at September 30, 2021). (6) Includes a $300,000,000 Canadian-denominated 2.95% senior unsecured notes due 2027 (approximately $236,724,000 based on the Canadian/U.S. Dollar exchange rate on September 30, 2021). (7) Includes a £550,000,000 4.80% senior unsecured notes due 2028 (approximately $740,850,000 based on the Sterling/U.S. Dollar exchange rate in effect on September 30, 2021). (8) Includes a £500,000,000 4.50% senior unsecured notes due 2034 (approximately $673,500,000 based on the Sterling/U.S. Dollar exchange rate in effect on September 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): Nine Months Ended September 30, 2021 September 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% (566,248) 3.26% Foreign currency (17,437) 4.37% (48,037) 4.14% Ending balance $ 11,208,344 3.71% $ 11,413,277 3.67% The following is a summary of our secured debt principal activity for the periods presented (dollars in thousands): Nine Months Ended September 30, 2021 September 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 2,693 3.75% 44,921 2.58% Debt extinguished (70,144) 6.02% (491,506) 2.61% Principal payments (48,710) 3.39% (46,585) 3.60% Foreign currency 7,869 2.97% (30,984) 3.19% Ending balance $ 2,269,781 3.10% $ 2,469,188 3.16%

Derivative Instruments (Tables)

Derivative Instruments (Tables)	9 Months Ended
	Sep. 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): September 30, 2021 December 31, 2020 Derivatives designated as net investment hedges: Denominated in Canadian Dollars $ 625,000 $ 625,000 Denominated in Pound Sterling £ 1,904,708 £ 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 Forward purchase contracts denominated in Pound Sterling £ (37,408) £ —
Impact of Derivative Instruments on the Consolidated Statements of Comprehensive Income	The following presents the impact of derivative instruments on the Consolidated Statements of Comprehensive Income for the periods presented (in thousands): Three Months Ended September 30, Nine Months Ended September 30, Description Location 2021 2020 2021 2020 Gain (loss) on derivative instruments designated as hedges recognized in income Interest expense $ 5,849 $ 5,724 $ 17,416 $ 16,475 Gain (loss) on derivative instruments not designated as hedges recognized in income Interest expense $ 241 $ (1,159) $ (1,415) $ (3,207) Gain (loss) on equity warrants recognized in income Gain (loss) on derivatives and financial instruments $ 9,216 $ — $ 9,216 $ — Gain (loss) on derivative and financial instruments designated as hedges recognized in OCI OCI $ 130,711 $ (145,512) $ 100,866 $ 86,429

Stockholders' Equity (Tables)

Stockholders' Equity (Tables)	9 Months Ended
	Sep. 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: September 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 437,049,822 419,124,469 Outstanding shares 435,273,885 417,400,602 The following is a summary of our common stock issuances during the nine months ended September 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 185,994 — — 2020 Totals 7,250,376 $ 607,189 $ 595,313 2021 ATM Program issuances 17,720,008 77.91 1,380,519 1,366,464 2021 Stock incentive plans, net of forfeitures 153,275 — — 2021 Totals 17,873,283 $ 1,380,519 $ 1,366,464
Summary of Dividend Payments	The following is a summary of our dividend payments (in thousands, except per share amounts): Nine Months Ended September 30, 2021 September 30, 2020 Per Share Amount Per Share Amount Common stock $ 1.83 $ 771,984 $ 2.09 $ 865,357
Summary of Accumulated Other Comprehensive Income (Loss)	The following is a summary of accumulated other comprehensive income (loss) for the periods presented (in thousands): September 30, 2021 December 31, 2020 Foreign currency translation $ (677,331) $ (621,792) Derivative and financial instruments designated as hedges 574,154 473,288 Total accumulated other comprehensive income (loss) $ (103,177) $ (148,504)

Earnings Per Share (Tables)

Earnings Per Share (Tables)	9 Months Ended
	Sep. 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 September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Numerator for basic earnings per share - net income (loss) attributable to common stockholders $ 179,663 $ 325,585 $ 277,466 $ 815,115 Adjustment for net income (loss) attributable to OP units (473) (1,716) (2,699) (4,470) Numerator for diluted earnings per share $ 179,190 $ 323,869 $ 274,767 $ 810,645 Denominator for basic earnings per share - weighted average shares 428,031 417,027 420,955 414,822 Effect of dilutive securities: Non-vested restricted shares 537 542 465 620 Redeemable OP units 1,396 1,396 1,396 1,396 Employee stock purchase program 19 22 19 22 Dilutive potential common shares 1,952 1,960 1,880 2,038 Denominator for diluted earnings per share - adjusted weighted average shares 429,983 418,987 422,835 416,860 Basic earnings per share $ 0.42 $ 0.78 $ 0.66 $ 1.96 Diluted earnings per share $ 0.42 $ 0.77 $ 0.65 $ 1.94

Disclosure about Fair Value o_2

Disclosure about Fair Value of Financial Instruments (Tables)	9 Months Ended
	Sep. 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): September 30, 2021 December 31, 2020 Carrying Amount Fair Value Carrying Amount Fair Value Financial assets: Mortgage loans receivable $ 941,357 $ 967,813 $ 293,752 $ 297,207 Other real estate loans receivable 174,288 174,088 149,620 152,211 Equity securities 1,922 1,922 4,636 4,636 Cash and cash equivalents 303,982 303,982 1,545,046 1,545,046 Restricted cash 58,663 58,663 475,997 475,997 Non-real estate loans receivable 210,822 212,054 240,269 255,724 Foreign currency forward contracts, interest rate swaps and cross currency swaps 19,637 19,637 4,668 4,668 Equity warrants 40,658 40,658 — — Financial liabilities: Borrowings under unsecured credit facility and commercial paper program $ 290,996 $ 290,996 $ — $ — Senior unsecured notes 11,116,067 12,485,436 11,420,790 13,093,926 Secured debt 2,262,345 2,325,322 2,377,930 2,451,782 Foreign currency forward contracts, interest rate swaps and cross currency swaps 27,731 27,731 118,054 118,054 Redeemable OP unitholder interests $ 147,083 $ 147,083 $ 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 September 30, 2021 Total Level 1 Level 2 Level 3 Equity securities $ 1,922 $ 1,922 $ — $ — Equity warrants 40,658 — — 40,658 Foreign currency forward contracts, interest rate swaps and cross currency swaps, net asset (liability) (1) (8,094) — (8,094) — Totals $ 34,486 $ 1,922 $ (8,094) $ 40,658 (1) Please see Note 12 for additional information.
Schedule of Level 3 Reconciliation	The following table summarizes the change in fair value for equity warrants using unobservable Level 3 inputs for the nine months ended September 30, 2021 (in thousands): Nine Months Ended September 30, 2021 Beginning balance $ — Warrants acquired 32,419 Mark-to-market adjustment 9,216 Foreign currency (977) Ending balance $ 40,658

Segment Reporting (Tables)

Segment Reporting (Tables)	9 Months Ended
	Sep. 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 September 30, 2021: Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 835,617 $ — $ — $ — $ 835,617 Rental income — 200,641 157,343 — 357,984 Interest income 1,135 38,257 472 — 39,864 Other income 2,767 1,087 1,688 790 6,332 Total revenues 839,519 239,985 159,503 790 1,239,797 Property operating expenses 666,610 11,664 48,072 3,054 729,400 Consolidated net operating income 172,909 228,321 111,431 (2,264) 510,397 Depreciation and amortization 157,176 54,226 56,352 — 267,754 Interest expense 9,360 1,548 4,811 106,803 122,522 General and administrative expenses — — — 32,256 32,256 Loss (gain) on derivatives and financial instruments, net — (8,078) — — (8,078) Loss (gain) on extinguishment of debt, net — — (5) — (5) Provision for loan losses, net 152 (323) (100) — (271) Impairment of assets — 1,490 — — 1,490 Other expenses 5,449 (4,248) 640 1,734 3,575 Income (loss) from continuing operations before income taxes and other items 772 183,706 49,733 (143,057) 91,154 Income tax (expense) benefit — — — (4,940) (4,940) Income (loss) from unconsolidated entities (15,810) 5,038 (5,060) — (15,832) Gain (loss) on real estate dispositions, net (615) 81,712 38,857 — 119,954 Income (loss) from continuing operations (15,653) 270,456 83,530 (147,997) 190,336 Net income (loss) $ (15,653) $ 270,456 $ 83,530 $ (147,997) $ 190,336 Total assets $ 17,741,955 $ 9,317,352 $ 6,247,215 $ 173,503 $ 33,480,025 Three Months Ended September 30, 2020: Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 740,956 $ — $ — $ — $ 740,956 Rental income — 103,938 171,108 — 275,046 Interest income 113 15,877 760 — 16,750 Other income 996 1,113 836 1,177 4,122 Total revenues 742,065 120,928 172,704 1,177 1,036,874 Property operating expenses 567,704 12,567 52,728 1,718 634,717 Consolidated net operating income 174,361 108,361 119,976 (541) 402,157 Depreciation and amortization 133,224 58,157 64,151 — 255,532 Interest expense 12,728 2,070 4,287 105,766 124,851 General and administrative expenses — — — 31,003 31,003 Loss (gain) on derivatives and financial instruments, net — 1,395 — — 1,395 Loss (gain) on extinguishment of debt, net — — — 33,004 33,004 Provision for loan losses, net 86 372 2,399 — 2,857 Impairment of assets 12,778 10,535 — — 23,313 Other expenses 6,488 2,805 781 1,470 11,544 Income (loss) from continuing operations before income taxes and other items 9,057 33,027 48,358 (171,784) (81,342) Income tax (expense) benefit — — — (2,003) (2,003) Income (loss) from unconsolidated entities (7,678) (423) 2,120 — (5,981) Gain (loss) on real estate dispositions, net 313,319 (619) 171,604 — 484,304 Income (loss) from continuing operations 314,698 31,985 222,082 (173,787) 394,978 Net income (loss) $ 314,698 $ 31,985 $ 222,082 $ (173,787) $ 394,978 Nine Months Ended September 30, 2021 Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 2,299,972 $ — $ — $ — $ 2,299,972 Rental income — 557,829 457,721 — 1,015,550 Interest income 3,110 86,040 8,741 — 97,891 Other income 5,388 3,539 8,336 2,175 19,438 Total revenues 2,308,470 647,408 474,798 2,175 3,432,851 Property operating expenses 1,804,939 37,132 140,430 6,882 1,989,383 Consolidated net operating income 503,531 610,276 334,368 (4,707) 1,443,468 Depreciation and amortization 420,797 165,299 166,969 — 753,065 Interest expense 31,331 5,134 12,733 318,807 368,005 General and administrative expenses — — — 93,618 93,618 Loss (gain) on derivatives and financial instruments, net — (6,503) — — (6,503) Loss (gain) on extinguishment of debt, net (1,537) — (5) 52,506 50,964 Provision for loan losses, net 222 10,549 (3,462) — 7,309 Impairment of assets 22,317 24,222 2,211 — 48,750 Other expenses 12,617 4,845 2,450 6,344 26,256 Income (loss) from continuing operations before income taxes and other items 17,784 406,730 153,472 (475,982) 102,004 Income tax (expense) benefit — — — (6,662) (6,662) Income (loss) from unconsolidated entities (23,514) 14,822 (2,067) — (10,759) Gain (loss) on real estate dispositions, net 4,552 126,463 92,687 — 223,702 Income (loss) from continuing operations (1,178) 548,015 244,092 (482,644) 308,285 Net income (loss) $ (1,178) $ 548,015 $ 244,092 $ (482,644) $ 308,285 Nine Months Ended September 30, 2020 Seniors Housing Operating Triple-net Outpatient Medical Non-segment / Corporate Total Resident fees and services $ 2,360,488 $ — $ — $ — $ 2,360,488 Rental income — 512,815 548,496 — 1,061,311 Interest income 305 46,068 1,687 — 48,060 Other income 6,050 3,393 2,681 1,968 14,092 Total revenues 2,366,843 562,276 552,864 1,968 3,483,951 Property operating expenses 1,771,088 39,432 165,024 1,718 1,977,262 Consolidated net operating income 595,755 522,844 387,840 250 1,506,689 Depreciation and amortization 419,161 173,989 202,554 — 795,704 Interest expense 43,191 7,668 13,421 328,935 393,215 General and administrative expenses — — — 100,546 100,546 Loss (gain) on derivatives and financial — 10,480 — — 10,480 Loss (gain) on extinguishment of debt, net (492) — 741 33,004 33,253 Provision for loan losses, net 86 18.69 8,895 — 2,370 18.69 — 11,351 Impairment of assets 91,424 34,867 — — 126,291 Other expenses 13,463 6,818 8,244 8,722 37,247 Income (loss) from continuing operations before income taxes and other items 28,922 280,127 160,510 (470,957) (1,398) Income tax (expense) benefit — — — (9,678) (9,678) Income (loss) from unconsolidated entities (25,489) 11,776 5,372 — (8,341) Gain (loss) on real estate dispositions, net 327,635 51,166 524,190 — 902,991 Income (loss) from continuing operations 331,068 343,069 690,072 (480,635) 883,574 Net income (loss) $ 331,068 $ 343,069 $ 690,072 $ (480,635) $ 883,574
Summary of Geographic Information	The following is a summary of geographic information for the periods presented (dollars in thousands): Three Months Ended Nine Months Ended September 30, 2021 September 30, 2020 September 30, 2021 September 30, 2020 Revenues: Amount (1) % Amount % Amount (1) % Amount % United States $ 990,034 79.9 % $ 819,057 79.0 % $ 2,709,354 78.9 % $ 2,820,609 81.0 % United Kingdom 146,308 11.8 % 110,281 10.6 % 405,938 11.8 % 337,601 9.7 % Canada 103,455 8.3 % 107,536 10.4 % 317,559 9.3 % 325,741 9.3 % Total $ 1,239,797 100.0 % $ 1,036,874 100.0 % $ 3,432,851 100.0 % $ 3,483,951 100.0 % As of September 30, 2021 December 31, 2020 Assets: Amount % Amount % United States $ 27,132,959 81.0 % $ 26,658,659 82.1 % United Kingdom 3,978,661 11.9 % 3,352,549 10.3 % Canada 2,368,405 7.1 % 2,472,434 7.6 % Total $ 33,480,025 100.0 % $ 32,483,642 100.0 % (1) The United States, United Kingdom and Canada represent 74%, 13% and 13% of our resident fees and services revenue for the three and nine month periods ended September 30, 2021, respectively.

Variable Interest Entities (Tab

Variable Interest Entities (Tables)	9 Months Ended
	Sep. 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): September 30, 2021 December 31, 2020 Assets: Net real estate investments $ 451,723 $ 454,333 Cash and cash equivalents 15,067 15,547 Receivables and other assets 7,999 11,171 Total assets (1) $ 474,789 $ 481,051 Liabilities and equity: Secured debt $ 164,010 $ 165,671 Lease liabilities 3,648 1,325 Accrued expenses and other liabilities 12,939 14,997 Total equity 294,192 299,058 Total liabilities and equity $ 474,789 $ 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	Sep. 30, 2021	Aug. 31, 2021	Jul. 31, 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]
Increase in occupancy basis	4.40%
Spot occupancy properties											591
United States
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Increase in occupancy basis	2.60%
United Kingdom
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Increase in occupancy basis	3.00%
Canada
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Increase in occupancy basis	0.70%
Seniors Housing Operating
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Spot occupancy	96.00%
Seniors Housing Operating | COVID-19
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Spot occupancy	76.70%	75.90%	75.20%	74.60%	73.70%	73.20%	72.70%	72.30%	72.50%	73.40%	74.80%
Sequential occupancy change	0.80%	0.80%	0.60%	0.90%	0.50%	0.50%	0.10%		(0.80%)	(1.40%)

Accounting Policies and Relat_5

Accounting Policies and Related Matters - Additional Information (Details) - COVID-19 - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Rent collected percentage			94.00%
Seniors Housing Operating
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Increase in operational cost	$ 2,092	$ 18,193	$ 24,883	$ 65,614
Cost of property operating expense			$ 40,975

Real Property Acquisitions an_3

Real Property Acquisitions and Development - Estimated Fair Value of Allocated Purchase Price of Asset and Liabilities (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020
Business Acquisition [Line Items]
Land and land improvements	$ 358,155	$ 59,010
Buildings and improvements	2,319,285	304,876
Acquired lease intangibles	159,772	34,633
Right of use assets, net	77,455	0
Total net real estate assets	2,914,667	398,519
Receivables and other assets	9,575	396
Total assets acquired	2,924,242	398,915
Lease liabilities	(138,126)	0
Accrued expenses and other liabilities	(29,717)	(2,714)
Total liabilities acquired	(167,843)	(2,714)
Noncontrolling interests	(21,193)	(2,827)
Cash disbursed for acquisitions	2,735,206	393,374
Construction in progress additions	280,371	142,231
Less: Capitalized interest	(14,027)	(13,234)
Accruals	(3,019)	(2,298)
Cash disbursed for construction in progress	263,325	126,699
Capital improvements to existing properties	165,691	183,324
Total cash invested in real property, net of cash acquired	3,164,222	703,397
Cash acquired from acquisition	301	580
Seniors Housing Operating
Business Acquisition [Line Items]
Land and land improvements	264,706	15,758
Buildings and improvements	1,655,067	132,481
Acquired lease intangibles	142,439	10,810
Right of use assets, net	77,455	0
Total net real estate assets	2,139,667	159,049
Receivables and other assets	6,041	257
Total assets acquired	2,145,708	159,306
Lease liabilities	(138,126)	0
Accrued expenses and other liabilities	(20,748)	(671)
Total liabilities acquired	(158,874)	(671)
Noncontrolling interests	(2,597)	(2,827)
Cash disbursed for acquisitions	1,984,237	155,808
Construction in progress additions	190,672	75,617
Less: Capitalized interest	(9,658)	(7,760)
Accruals	38	(1,376)
Cash disbursed for construction in progress	181,052	66,481
Capital improvements to existing properties	115,115	130,465
Total cash invested in real property, net of cash acquired	2,280,404	352,754
Triple-net
Business Acquisition [Line Items]
Land and land improvements	48,099	0
Buildings and improvements	436,828	765
Acquired lease intangibles	0	0
Right of use assets, net	0	0
Total net real estate assets	484,927	765
Receivables and other assets	0	0
Total assets acquired	484,927	765
Lease liabilities	0	0
Accrued expenses and other liabilities	(8,703)	0
Total liabilities acquired	(8,703)	0
Noncontrolling interests	(2,056)	0
Cash disbursed for acquisitions	474,168	765
Construction in progress additions	60,251	33,021
Less: Capitalized interest	(2,092)	(2,569)
Accruals	0	0
Cash disbursed for construction in progress	58,159	30,452
Capital improvements to existing properties	26,496	5,971
Total cash invested in real property, net of cash acquired	558,823	37,188
Outpatient Medical
Business Acquisition [Line Items]
Land and land improvements	45,350	43,252
Buildings and improvements	227,390	171,630
Acquired lease intangibles	17,333	23,823
Right of use assets, net	0	0
Total net real estate assets	290,073	238,705
Receivables and other assets	3,534	139
Total assets acquired	293,607	238,844
Lease liabilities	0	0
Accrued expenses and other liabilities	(266)	(2,043)
Total liabilities acquired	(266)	(2,043)
Noncontrolling interests	(16,540)	0
Cash disbursed for acquisitions	276,801	236,801
Construction in progress additions	29,448	33,593
Less: Capitalized interest	(2,277)	(2,905)
Accruals	(3,057)	(922)
Cash disbursed for construction in progress	24,114	29,766
Capital improvements to existing properties	24,080	46,888
Total cash invested in real property, net of cash acquired	$ 324,995	$ 313,455

Real Property Acquisitions an_4

Real Property Acquisitions and Development - Narrative (Details) - Holiday Retirement $ in Thousands	Jul. 30, 2021USD ($)property	Sep. 30, 2021property
Business Acquisition [Line Items]
Number of properties	85	8
Total contingent purchase obligations | $	$ 1,576,600
Number of leasehold property	26

Real Property Acquisitions an_5

Real Property Acquisitions and Development - Construction Activity (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020
Segment Reporting Information [Line Items]
Total development projects	$ 198,446	$ 195,882
Expansion projects	0	48,600
Total construction in progress conversions	198,446	244,482
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	59,201
Outpatient Medical
Segment Reporting Information [Line Items]
Total development projects	$ 116,612	$ 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	9 Months Ended	12 Months Ended
	Sep. 30, 2021	Dec. 31, 2020
Assets:
Gross historical cost	$ 1,653,415	$ 1,500,030
Accumulated amortization	(1,249,032)	(1,177,513)
Net book value	$ 404,383	$ 322,517
Weighted-average amortization period in years	8 years 3 months 18 days	10 years 6 months
Liabilities:
Below market tenant leases	$ 75,083	$ 77,851
Accumulated amortization	(43,484)	(40,871)
Net book value	$ 31,599	$ 36,980
Weighted-average amortization period in years	8 years 4 months 24 days	8 years 3 months 18 days
In place lease intangibles
Assets:
Gross historical cost	$ 1,549,294	$ 1,406,705
Above market tenant leases
Assets:
Gross historical cost	54,542	52,621
Lease commissions
Assets:
Gross historical cost	$ 49,579	$ 40,704

Real Estate Intangibles - Sum_2

Real Estate Intangibles - Summary of Real Estate Intangible Amortization (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
Rental income related to (above)/below market tenant leases, net	$ 384	$ 327	$ 1,241	$ 1,252
Amortization related to in place lease intangibles and lease commissions	$ (32,872)	$ (28,948)	$ (76,083)	$ (98,241)

Real Estate Intangibles - Sched

Real Estate Intangibles - Schedule of Future Estimated Aggregate Amortization of Intangible Assets and Liabilities (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Assets
2021	$ 36,111
2022	112,533
2024	70,483
2024	33,451
2025	23,099
Thereafter	128,706
Net book value	404,383	$ 322,517
Liabilities
2021	1,962
2022	7,311
2023	5,179
2024	3,053
2025	2,524
Thereafter	11,570
Net book value	$ 31,599	$ 36,980

Dispositions, Real Property H_3

Dispositions, Real Property Held for Sale and Impairment - Narrative (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2021USD ($)property	Sep. 30, 2020USD ($)property	Dec. 31, 2020USD ($)
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Real property held for sale | $	$ 251,152		$ 216,613
Expected proceeds from properties held for sale | $	293,526
Impairment of assets held for use | $	19,567
Held for sale
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Real property held for sale | $	$ 18,081
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	13
Impairment of assets held for use | $	$ 29,183
Impairment of assets held for sale | $		$ 79,905
Number of properties held for use | property	2	4
Triple-net
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of properties classified as held for sale | property	20	1
Impairment of assets held for use | $		$ 46,386
Number of properties subject to asset impairment | property	4
Number of properties held for use | property	2	4
Outpatient Medical
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of properties classified as held for sale | property	2
Number of properties subject to asset impairment | property	1

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		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Real estate dispositions:
Total dispositions			$ 711,811	$ 2,521,893
Gain (loss) on real estate dispositions, net	$ 119,954	$ 484,304	223,702	902,991
Net other assets/(liabilities) disposed			6,195	98,065
Proceeds from real estate dispositions			941,708	3,522,949
Seniors Housing Operating
Real estate dispositions:
Total dispositions			112,837	1,093,477
Triple-net
Real estate dispositions:
Total dispositions			439,974	33,445
Outpatient Medical
Real estate dispositions:
Total dispositions			$ 159,000	$ 1,394,971

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		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Revenues:
Total revenues	$ 7,103	$ 7,471	$ 58,302	$ 262,951
Expenses:
Interest expense	32	1,737	1,471	10,039
Property operating expenses	925	33,330	7,942	150,501
Provision for depreciation	440	18,085	8,665	72,877
Total expenses	1,397	53,152	18,078	233,417
Income (loss) from real estate dispositions, net	$ 5,706	$ (45,681)	$ 40,224	$ 29,534

Leases - Narrative (Details)

Leases - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020	Dec. 31, 2020
Lessee, Lease, Description [Line Items]
Straight line rent adjustment			$ 49,241	$ 146,508
Rental and other revenues related to operating lease payments	$ 357,984	$ 275,046	1,015,550	1,061,311
Rental and other revenues related to operating lease payments, variable leases			$ 134,632	$ 153,217
Belmont Village
Lessee, Lease, Description [Line Items]
Straight line rent adjustment					$ 91,025
Minimum
Lessee, Lease, Description [Line Items]
Lease term extension period			1 year
Maximum
Lessee, Lease, Description [Line Items]
Lease term extension period			25 years

Leases - Components of Lease Ex

Leases - Components of Lease Expense (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020
Finance lease cost:
Amortization of leased assets	$ 6,120	$ 6,229
Interest on lease liabilities	4,950	4,693
Sublease income	(5,972)	(3,130)
Total	24,989	28,862
Property operating expenses
Operating lease cost:
Lease expense	16,430	17,397
General and administrative expenses
Operating lease cost:
Lease expense	$ 3,461	$ 3,673

Leases - Supplemental Balance S

Leases - Supplemental Balance Sheet Information Related to Leases (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Right of use assets:
Total right of use assets, net	$ 526,614	$ 465,866
Lease liabilities:
Operating leases	434,303	311,164
Financing leases	110,244	107,102
Total	$ 544,547	$ 418,266
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	$ 371,034	$ 310,017
Finance leases	155,580	155,849
Corporate
Right of use assets:
Operating leases	$ 6,686	$ 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	$ 533,300	$ 475,490

Loans Receivable - Narrative (D

Loans Receivable - Narrative (Details) $ in Thousands, £ in Millions	3 Months Ended
	Jun. 30, 2021USD ($)	Sep. 30, 2021USD ($)	Jun. 30, 2021GBP (£)	Dec. 31, 2020USD ($)
Financing Receivable, Troubled Debt Restructuring [Line Items]
Interest receivable		$ 26,361		$ 15,615
Financing receivable		$ 1,326,467
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	Sep. 30, 2021	Dec. 31, 2020	Sep. 30, 2020	Dec. 31, 2019
Accounts, Notes, Loans and Financing Receivable [Line Items]
Loan Carrying Value	$ 1,493,269
Allowance for credit losses on real estate loans receivable	(166,802)	$ (224,036)	$ (84,895)	$ (68,372)
Real estate loans receivable, net of credit allowance	1,115,645	443,372
Non-real estate loans	362,077	455,508
Allowance for credit losses on non-real estate loans receivable	(151,255)	(215,239)
Non-real estate loans receivable, net of credit allowance	210,822	240,269
Total loans receivable, net of credit allowance	1,326,467	683,641
Mortgage loans
Accounts, Notes, Loans and Financing Receivable [Line Items]
Loan Carrying Value	957,114	299,430
Other real estate loans
Accounts, Notes, Loans and Financing Receivable [Line Items]
Loan Carrying Value	174,078	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	$ (15,547)	$ (8,797)

Loans Receivable - Summary of_2

Loans Receivable - Summary of Real Estate Loan Activity (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020
Advances on loans receivable:
Net cash advances on loans receivable	$ 953,006	$ 216,307
Receipts on loans receivable:
Net cash receipts on loans receivable	250,415	14,345
Seniors Housing Operating
Advances on loans receivable:
Investments in new loans	935,594	194,942
Draws on existing loans	17,412	21,365
Net cash advances on loans receivable	953,006	216,307
Receipts on loans receivable:
Loan payoffs	179,827	0
Principal payments on loans	70,588	14,345
Net cash receipts on loans receivable	250,415	14,345
Net cash advances (receipts) on loans receivable	$ 702,591	$ 201,962

Loans Receivable - Collective P

Loans Receivable - Collective Pool Basis (Details) $ in Thousands	1 Months Ended	3 Months Ended		9 Months Ended
	Mar. 31, 2020USD ($)loan	Sep. 30, 2021USD ($)loan	Sep. 30, 2020USD ($)	Sep. 30, 2021USD ($)loan	Sep. 30, 2020USD ($)	Dec. 31, 2020USD ($)	Dec. 31, 2019USD ($)
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan Carrying Value		$ 1,493,269		$ 1,493,269
Allowance for Credit Loss		(166,802)	$ (84,895)	(166,802)	$ (84,895)	$ (224,036)	$ (68,372)
Real estate loans receivable, net of credit allowance		$ 1,326,467		$ 1,326,467
No. of Loans | loan		56		56
Provision for loan losses, net	$ 6,898	$ (271)	$ 2,857	$ 7,309	$ 11,351
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		178,301		178,301
Allowance for Credit Loss		(148,438)		(148,438)
Real estate loans receivable, net of credit allowance		$ 29,863		$ 29,863
No. of Loans | loan		3		3
Collective loan pool
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan Carrying Value		$ 201,939		$ 201,939
Allowance for Credit Loss		(3,061)		(3,061)
Real estate loans receivable, net of credit allowance		$ 198,878		$ 198,878
No. of Loans | loan		17		17
Collective loan pool
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan Carrying Value		$ 125,661		$ 125,661
Allowance for Credit Loss		(1,127)		(1,127)
Real estate loans receivable, net of credit allowance		$ 124,534		$ 124,534
No. of Loans | loan		7		7
Collective loan pool
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan Carrying Value		$ 23,263		$ 23,263
Allowance for Credit Loss		(346)		(346)
Real estate loans receivable, net of credit allowance		$ 22,917		$ 22,917
No. of Loans | loan		2		2
Collective loan pool
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan Carrying Value		$ 22,047		$ 22,047
Allowance for Credit Loss		(334)		(334)
Real estate loans receivable, net of credit allowance		$ 21,713		$ 21,713
No. of Loans | loan		4		4
Collective loan pool
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan Carrying Value		$ 46,335		$ 46,335
Allowance for Credit Loss		(703)		(703)
Real estate loans receivable, net of credit allowance		$ 45,632		$ 45,632
No. of Loans | loan		6		6
Collective loan pool
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan Carrying Value		$ 895,723		$ 895,723
Allowance for Credit Loss		(12,793)		(12,793)
Real estate loans receivable, net of credit allowance		$ 882,930		$ 882,930
No. of Loans | loan		17		17

Loans Receivable - Credit Loss

Loans Receivable - Credit Loss Roll Forward (Details) - USD ($) $ in Thousands	9 Months Ended		12 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Dec. 31, 2019
Financing Receivable, Allowance for Credit Loss [Roll Forward]
Balance at beginning of period	$ 224,036	$ 68,372
Provision for loan losses	7,309	11,351
Loan write-offs	(64,075)	0
Foreign currency translation	(468)	(40)
Balance at end of period	166,802	84,895	$ 68,372
Accounting Standards Update [Extensible List]			Accounting Standards Update 2016-13
Belmont Village
Financing Receivable, Allowance for Credit Loss [Roll Forward]
Loan write-offs	(64,075)
Accounting Standards Update 2016-13 | Cumulative effect, period of adoption, adjustment
Financing Receivable, Allowance for Credit Loss [Roll Forward]
Balance at beginning of period	$ 0	$ 5,212
Balance at end of period			$ 5,212

Loans Receivable - Summary of I

Loans Receivable - Summary of Impaired Loans (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Dec. 31, 2020	Dec. 31, 2019
Receivables [Abstract]
Balance of impaired loans at end of period	$ 178,301	$ 249,314
Allowance for credit losses	(148,438)	(76,695)
Balance of deteriorated loans not reserved	29,863	172,619
Interest recognized on impaired loans	3,171	13,847
Carrying value of nonaccrual status	$ 2,157	$ 10,686	$ 3,623	$ 2,534

Investments in Unconsolidated_3

Investments in Unconsolidated Entities - Summary of Investments in Unconsolidated Entities (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated entities	$ 977,955	$ 946,234
Seniors Housing Operating
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated entities	$ 771,337	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	$ 46,466	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	$ 160,152	$ 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	9 Months Ended
	Sep. 30, 2021USD ($)property
Schedule of Equity Method Investments [Line Items]
Aggregate unamortized basis difference of joint venture investments	$ 118,012
Not Primary Beneficiary
Schedule of Equity Method Investments [Line Items]
Total loans made	$ 273,654
Number of properties | property	8
Expected additional funding for investments	$ 16,667

Credit Concentration - Summary

Credit Concentration - Summary of Credit Concentration (Details) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021USD ($)property	Sep. 30, 2020USD ($)	Sep. 30, 2021USD ($)property	Sep. 30, 2020USD ($)	Dec. 31, 2020
Concentration Risk [Line Items]
Total NOI	$ 510,397	$ 402,157	$ 1,443,468	$ 1,506,689
Percentage total investments with top five customers					36.00%
Net operating income | Credit Concentration Risk
Concentration Risk [Line Items]
Number of Properties | property	1,606		1,606
Total NOI			$ 1,443,468
Percent of NOI			100.00%
Net operating income | Credit Concentration Risk | ProMedica
Concentration Risk [Line Items]
Number of Properties | property	205		205
Total NOI			$ 168,832
Percent of NOI			12.00%
Net operating income | Credit Concentration Risk | Sunrise Senior Living
Concentration Risk [Line Items]
Number of Properties | property	155		155
Total NOI			$ 157,256
Percent of NOI			11.00%
Net operating income | Credit Concentration Risk | Revera
Concentration Risk [Line Items]
Number of Properties | property	85		85
Total NOI			$ 71,139
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			$ 62,325
Percent of NOI			5.00%
Net operating income | Credit Concentration Risk | Belmont Village
Concentration Risk [Line Items]
Number of Properties | property	21		21
Total NOI			$ 45,475
Percent of NOI			4.00%
Net operating income | Credit Concentration Risk | Remaining portfolio
Concentration Risk [Line Items]
Number of Properties | property	1,079		1,079
Total NOI			$ 938,441
Percent of NOI			63.00%

Credit Concentration - Narrativ

Credit Concentration - Narrative (Details) $ in Thousands	1 Months Ended	9 Months Ended
	Apr. 30, 2021USD ($)property	Sep. 30, 2021USD ($)propertyterm	Sep. 30, 2020USD ($)property	Apr. 29, 2021USD ($)properties
Concentration Risk [Line Items]
Proceeds from real estate dispositions		$ 941,708	$ 3,522,949
Financing receivable		$ 1,326,467
Belmont Village
Concentration Risk [Line Items]
Percentage ownership				20.00%
Belmont Village | ProMedica
Concentration Risk [Line Items]
Percentage ownership				80.00%
Triple-net
Concentration Risk [Line Items]
Number of properties classified as held for sale | property		20	1
Number of properties | properties				51
Belmont Village
Concentration Risk [Line Items]
Number of lease properties | property	7
Number of lease properties transition | term		39
Number of lease properties expected to be transition | term		3
Decrease in indebtedness	$ 170,000
Termination fee	$ 86,000
Financing receivable		$ 149,574		$ 167,000
Belmont Village | Triple-net
Concentration Risk [Line Items]
Number of lease properties | property	9
Genesis Properties
Concentration Risk [Line Items]
Number of properties sold | property	35
Disposal consideration	$ 496,000
Sales of number of properties | term		21
Proceeds from real estate dispositions		$ 331,000
Number of properties classified as held for sale | term		14

Borrowings Under Credit Facil_3

Borrowings Under Credit Facilities and Commercial Paper Program - Narrative (Details)	1 Months Ended	9 Months Ended
	Jan. 31, 2019USD ($)	Sep. 30, 2021USD ($)bankterm	Dec. 31, 2020USD ($)
Line of Credit Facility [Line Items]
Number of banks in consortium | bank		34
Borrowings outstanding		$ 290,996,000	$ 0
Outstanding balance		13,478,125,000
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
Borrowings outstanding		0
Unsecured revolving credit facility | Credit Facility, Tranche Due 2025
Line of Credit Facility [Line Items]
Unsecured line of credit arrangement		3,000,000,000
Borrowings outstanding		$ 51,000,000
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
Commercial paper note program | Maximum
Line of Credit Facility [Line Items]
Debt instrument, term	397 days
Commercial paper note program | Line of Credit
Line of Credit Facility [Line Items]
Unamortized discount		4,000
Outstanding balance		239,996,000
Principal outstanding		$ 240,000,000
Weighted average interest rate		0.19%
Commercial paper note program | Line of Credit | Weighted Average
Line of Credit Facility [Line Items]
Debt instrument, term		4 days

Borrowings Under Credit Facil_4

Borrowings Under Credit Facilities and Commercial Paper Program - Aggregate Borrowings Under Unsecured Revolving Credit Facility and Commercial Paper (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Debt Disclosure [Abstract]
Balance outstanding at quarter end	$ 291,000	$ 0	$ 291,000	$ 0
Maximum amount outstanding at any month end	990,000	0	990,000	2,100,000
Average amount outstanding (total of daily principal balances divided by days in period)	$ 470,935	$ 0	$ 255,114	$ 663,895
Weighted average interest rate (actual interest expense divided by average borrowings outstanding)	0.21%	0.00%	0.42%	2.09%

Senior Unsecured Notes and Se_3

Senior Unsecured Notes and Secured Debt - Annual Principal Payments Due on Debt Obligations (Details)	9 Months Ended
	Sep. 30, 2021USD ($)	Sep. 30, 2021CAD ($)	Sep. 30, 2021GBP (£)	Dec. 31, 2020USD ($)	Sep. 30, 2020USD ($)	Dec. 31, 2019USD ($)
Annual principal payments due
2021	$ 211,978,000
2022	481,702,000
2023	1,202,125,000
2024	1,533,192,000
2025	1,438,544,000
Thereafter	8,610,584,000
Totals	13,478,125,000
Senior unsecured notes
Annual principal payments due
2021	0
2022	0
2023	697,270,000
2024	1,350,000,000
2025	1,260,000,000
Thereafter	7,901,074,000
Totals	$ 11,208,344,000			$ 11,509,533,000	$ 11,413,277,000	$ 10,427,562,000
Senior unsecured notes | Minimum
Annual principal payments due
Interest rate	0.78%	0.78%	0.78%
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	$ 197,270,000	$ 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	1.33%	1.33%	1.33%
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	0.98%	0.98%	0.98%
Senior unsecured notes | 2.95% Senior unsecured notes due 2023
Annual principal payments due
Interest rate	2.95%	2.95%	2.95%
Face amount	$ 236,724,000	$ 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	$ 740,850,000		£ 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	$ 673,500,000		£ 500,000,000
Secured debt
Annual principal payments due
2021	211,978,000
2022	481,702,000
2023	504,855,000
2024	183,192,000
2025	178,544,000
Thereafter	709,510,000
Totals	2,269,781,000			$ 2,378,073,000	$ 2,469,188,000	$ 2,993,342,000
Carrying values of properties securing the debt	$ 5,261,000,000
Secured debt | Minimum
Annual principal payments due
Interest rate	0.02%	0.02%	0.02%
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	9 Months Ended
	Sep. 30, 2021USD ($)	Sep. 30, 2020USD ($)
Amount
Debt issued	$ 1,208,241	$ 1,588,549
Debt issued	2,693	44,921
Ending balance	13,478,125
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)	(566,248)
Foreign currency	(17,437)	(48,037)
Ending balance	$ 11,208,344	$ 11,413,277
Weighted Avg. Interest Rate
Beginning balance	3.67%	4.03%
Debt issued	0.0250	0.0189
Debt extinguished	0.0242	0.0326
Foreign currency	0.0437	0.0414
Ending balance	3.71%	3.67%
Secured debt
Amount
Beginning balance	$ 2,378,073	$ 2,993,342
Debt issued	2,693	44,921
Debt extinguished	(70,144)	(491,506)
Principal payments	(48,710)	(46,585)
Foreign currency	7,869	(30,984)
Ending balance	$ 2,269,781	$ 2,469,188
Weighted Avg. Interest Rate
Beginning balance	3.27%	3.63%
Debt issued	0.0375	0.0258
Debt extinguished	0.0602	0.0261
Principal payments	0.0339	0.0360
Foreign currency	0.0297	0.0319
Ending balance	3.10%	3.16%

Derivative Instruments - Narrat

Derivative Instruments - Narrative (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Cash flow hedges to be reclassified within the next twelve months	$ 2,562
Proceeds from hedge	$ 8,879	$ 3,485

Derivative Instruments - Notion

Derivative Instruments - Notional Amount of Derivatives and Other Financial Instruments (Details) £ in Thousands, $ in Thousands, $ in Thousands	9 Months Ended		12 Months Ended
	Sep. 30, 2021CAD ($)	Sep. 30, 2021GBP (£)	Dec. 31, 2020CAD ($)	Dec. 31, 2020GBP (£)	Sep. 30, 2021GBP (£)	Sep. 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 | £					£ 1,904,708		£ 1,340,708
Net investment hedges | £		£ 1,050,000		£ 1,050,000
Denominated in Pound Sterling | Derivative Instruments Not Designated | Sales Contracts
Derivatives, Fair Value [Line Items]
Derivative liability | £					£ (37,408)		£ 0
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		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Derivative [Line Items]
Gain (loss) on derivative instruments hedges recognized in income	$ 8,078	$ (1,395)	$ 6,503	$ (10,480)
Gain (loss) on derivative and financial instruments designated as hedges recognized in OCI	130,711	(145,512)	100,866	86,429
Gain (loss) on derivatives and financial instruments
Derivative [Line Items]
Gain (loss) on derivative instruments hedges recognized in income	9,216	0	9,216	0
Designated as Hedging Instrument | OCI
Derivative [Line Items]
Gain (loss) on derivative and financial instruments designated as hedges recognized in OCI	130,711	(145,512)	100,866	86,429
Designated as Hedging Instrument | Interest expense
Derivative [Line Items]
Gain (loss) on derivative instruments hedges recognized in income	5,849	5,724	17,416	16,475
Derivative Instruments Not Designated | Interest expense
Derivative [Line Items]
Gain (loss) on derivative instruments hedges recognized in income	$ 241	$ (1,159)	$ (1,415)	$ (3,207)

Commitments and Contingencies (

Commitments and Contingencies (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2021USD ($)obligationproperty	Apr. 29, 2021properties	Dec. 31, 2020USD ($)
Other Commitments [Line Items]
Number of outstanding credit obligations | obligation	13
Letter of credit obligation	$ 28,366
Outstanding construction financings for leased properties	562,487		$ 487,742
Additional financing to complete construction	1,072,343
Not Primary Beneficiary
Other Commitments [Line Items]
Total loans made	273,654
Expected additional funding for investments	$ 16,667
Number of properties | property	8
Capital Improvements
Other Commitments [Line Items]
Total contingent purchase obligations	$ 101,284
Triple-net
Other Commitments [Line Items]
Number of properties | properties		51

Stockholders' Equity - Summary

Stockholders' Equity - Summary of Stockholders' Equity Capital Accounts (Details) - shares	Sep. 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	437,049,822	419,124,469
Outstanding shares	435,273,885	417,400,602

Stockholders' Equity - Addition

Stockholders' Equity - Additional Information (Details) - USD ($)	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Jul. 31, 2021	May 01, 2020
Class of Stock [Line Items]
Proceeds from sale of stock	$ 1,366,464,000	$ 595,313,000
At The Market Program
Class of Stock [Line Items]
Authorized amount to sell			$ 2,500,000,000
Remaining amount authorized to sell	$ 2,491,418,000
Forward sales agreement
Class of Stock [Line Items]
Anti-dilutive securities (in shares)	11,798,154
Forward sales agreement | At The Market Program
Class of Stock [Line Items]
Proceeds from sale of stock	$ 993,881,000
Repurchase program
Class of Stock [Line Items]
Authorized amount				$ 1,000,000,000

Stockholders' Equity - Common S

Stockholders' Equity - Common Stock (Details) - USD ($) $ / shares in Units, $ in Thousands	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020
Shares Issued
Dividend reinvestment plan issuances (in shares)		264,153
Option exercises (in shares)		251
ATM Program issuances (in shares)	17,720,008	6,799,978
Stock incentive plans, net of forfeitures (in shares)	153,275	185,994
Totals (in shares)	17,873,283	7,250,376
Average Price
Dividend reinvestment plan issuances (in dollars per share)		$ 72.33
Option exercises (in dollars per share)		47.81
ATM Program issuances (in dollars per share)	$ 77.91	$ 86.48
Gross Proceeds
Dividend reinvestment plan issuances		$ 19,105
Option exercises		12
ATM Program issuances	$ 1,380,519	588,072
Totals	1,380,519	607,189
Net Proceeds
Dividend reinvestment plan issuances		19,105
Option exercises		12
ATM Program issuances	1,366,464	576,196
Total	$ 1,366,464	$ 595,313

Stockholders' Equity - Dividend

Stockholders' Equity - Dividends (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Per Share
Common Stock (in dollars per share)	$ 0.61	$ 0.61	$ 1.83	$ 2.09
Amount
Common stock			$ 771,984	$ 865,357

Stockholders' Equity - Accumula

Stockholders' Equity - Accumulated Other Comprehensive Income (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Jun. 30, 2021	Mar. 31, 2021	Dec. 31, 2020	Sep. 30, 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)	$ 17,782,916	$ 16,850,829	$ 16,691,017	$ 16,881,572	$ 16,961,102	$ 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)	(677,331)			(621,792)
Derivative and financial instruments designated as hedges
Summary of accumulated other comprehensive income/(loss) [Line Items]
Total accumulated other comprehensive income (loss)	574,154			473,288
Total accumulated other comprehensive income (loss)
Summary of accumulated other comprehensive income/(loss) [Line Items]
Total accumulated other comprehensive income (loss)	$ (103,177)	$ (127,948)	$ (128,136)	$ (148,504)	$ (126,469)	$ (116,856)	$ (96,213)	$ (112,157)

Stock Incentive Plans (Details)

Stock Incentive Plans (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 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	$ 4,535	$ 6,565	$ 14,868	$ 20,938
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		9 Months Ended
		Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Earnings Per Share [Abstract]
Numerator for basic and diluted earnings per share - net income (loss) attributable to common stockholders		$ 179,663	$ 325,585	$ 277,466	$ 815,115
Adjustment for net income (loss) attributable to OP units		(473)	(1,716)	(2,699)	(4,470)
Numerator for diluted earnings per share		$ 179,190	$ 323,869	$ 274,767	$ 810,645
Denominator for basic earnings per share - weighted average shares (in shares)		428,031,000	417,027,000	420,955,000	414,822,000
Effect of dilutive securities:
Non-vested restricted shares (in shares)		537,000	542,000	465,000	620,000
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)		1,952,000	1,960,000	1,880,000	2,038,000
Denominator for diluted earnings per share - adjusted weighted average shares (in shares)		429,983,000	418,987,000	422,835,000	416,860,000
Basic earnings per share (in dollars per share)		$ 0.42	$ 0.78	$ 0.66	$ 1.96
Diluted earnings per share (in dollars per share)	[1]	$ 0.42	$ 0.77	$ 0.65	$ 1.94
Forward sales agreement
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Anti-dilutive securities (in shares)				11,798,154
[1]	Includes adjustment to the numerator for income (loss) attributable to OP unitholders.

Disclosure about Fair Value o_3

Disclosure about Fair Value of Financial Instruments - Carrying Amounts and Estimated Fair Values of Financial Instruments (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Financial assets:
Equity securities	$ 1,922
Restricted cash	58,663	$ 475,997
Equity warrants	40,658
Carrying Amount
Financial assets:
Equity securities		4,636
Cash and cash equivalents	303,982	1,545,046
Restricted cash	58,663	475,997
Foreign currency forward contracts, interest rate swaps and cross currency swaps	19,637	4,668
Equity warrants		0
Financial liabilities:
Unsecured credit facility and commercial paper	290,996	0
Senior unsecured notes	11,116,067	11,420,790
Secured debt	2,262,345	2,377,930
Foreign currency forward contracts, interest rate swaps and cross currency swaps	27,731	118,054
Redeemable OP unitholder interests	147,083	116,240
Carrying Amount | Mortgage loans receivable
Financial assets:
Loans receivable	941,357	293,752
Carrying Amount | Other real estate loans receivable
Financial assets:
Loans receivable	174,288	149,620
Carrying Amount | Non-real estate loans receivable
Financial assets:
Loans receivable	210,822	240,269
Fair Value
Financial assets:
Equity securities	1,922	4,636
Cash and cash equivalents	303,982	1,545,046
Restricted cash	58,663	475,997
Foreign currency forward contracts, interest rate swaps and cross currency swaps	19,637	4,668
Equity warrants	40,658	0
Financial liabilities:
Unsecured credit facility and commercial paper	290,996	0
Senior unsecured notes	12,485,436	13,093,926
Secured debt	2,325,322	2,451,782
Foreign currency forward contracts, interest rate swaps and cross currency swaps	27,731	118,054
Redeemable OP unitholder interests	147,083	115,346
Fair Value | Mortgage loans receivable
Financial assets:
Loans receivable	967,813	297,207
Fair Value | Other real estate loans receivable
Financial assets:
Loans receivable	174,088	152,211
Fair Value | Non-real estate loans receivable
Financial assets:
Loans receivable	$ 212,054	$ 255,724

Disclosure about Fair Value o_4

Disclosure about Fair Value of Financial Instruments - Summary of Items Measured at Fair Value on a Recurring Basis (Details) $ in Thousands	Sep. 30, 2021USD ($)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Equity securities	$ 1,922
Equity warrants	40,658
Foreign currency forward contracts, interest rate swaps and cross currency swaps, net asset (liability)	(8,094)
Totals	34,486
Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Equity securities	1,922
Equity warrants	0
Foreign currency forward contracts, interest rate swaps and cross currency swaps, net asset (liability)	0
Totals	1,922
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)	(8,094)
Totals	(8,094)
Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Equity securities	0
Equity warrants	40,658
Foreign currency forward contracts, interest rate swaps and cross currency swaps, net asset (liability)	0
Totals	$ 40,658

Disclosure about Fair Value o_5

Disclosure about Fair Value of Financial Instruments - Schedule of Change in Fair Value for Equity Warrants (Details) - Warrant $ in Thousands	9 Months Ended
	Sep. 30, 2021USD ($)
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance	$ 0
Warrants acquired	32,419
Mark-to-market adjustment	9,216
Foreign currency	(977)
Ending balance	$ 40,658
Terminal Capitalization Rate
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Measurement input	0.11

Segment Reporting - Summary Inf

Segment Reporting - Summary Information for Reportable Segments (Details) $ in Thousands	1 Months Ended	3 Months Ended		9 Months Ended
	Mar. 31, 2020USD ($)	Sep. 30, 2021USD ($)	Sep. 30, 2020USD ($)	Sep. 30, 2021USD ($)segment	Sep. 30, 2020USD ($)	Dec. 31, 2020USD ($)
Segment Reporting [Abstract]
Number of operating segments | segment				3
Segment Reporting Information [Line Items]
Rental income		$ 357,984	$ 275,046	$ 1,015,550	$ 1,061,311
Total revenues		1,239,797	1,036,874	3,432,851	3,483,951
Property operating expenses		729,400	634,717	1,989,383	1,977,262
Consolidated net operating income		510,397	402,157	1,443,468	1,506,689
Depreciation and amortization		267,754	255,532	753,065	795,704
Interest expense		122,522	124,851	368,005	393,215
General and administrative expenses		32,256	31,003	93,618	100,546
Loss (gain) on derivatives and financial instruments, net		(8,078)	1,395	(6,503)	10,480
Provision for loan losses, net	$ 6,898	(271)	2,857	7,309	11,351
Impairment of assets		1,490	23,313	48,750	126,291
Other expenses		3,575	11,544	26,256	37,247
Income (loss) from continuing operations before income taxes and other items		91,154	(81,342)	102,004	(1,398)
Income tax (expense) benefit		(4,940)	(2,003)	(6,662)	(9,678)
Income (loss) from unconsolidated entities		(15,832)	(5,981)	(10,759)	(8,341)
Gain (loss) on real estate dispositions, net		119,954	484,304	223,702	902,991
Income (loss) from continuing operations		190,336	394,978	308,285	883,574
Net income (loss)		190,336	394,978	308,285	883,574
Total assets		33,480,025		33,480,025		$ 32,483,642
Loss (gain) on extinguishment of debt, net		(5)	33,004	50,964	33,253
Straight Line Rent				9,607	(66,874)
Resident fees and services
Segment Reporting Information [Line Items]
Revenue from contract with customer		835,617	740,956	2,299,972	2,360,488
Interest income
Segment Reporting Information [Line Items]
Revenue from contract with customer		39,864	16,750	97,891	48,060
Other income
Segment Reporting Information [Line Items]
Revenue from contract with customer		6,332	4,122	19,438	14,092
Operating Segments | Seniors Housing Operating
Segment Reporting Information [Line Items]
Rental income		0	0	0	0
Total revenues		839,519	742,065	2,308,470	2,366,843
Property operating expenses		666,610	567,704	1,804,939	1,771,088
Consolidated net operating income		172,909	174,361	503,531	595,755
Depreciation and amortization		157,176	133,224	420,797	419,161
Interest expense		9,360	12,728	31,331	43,191
General and administrative expenses		0	0	0	0
Loss (gain) on derivatives and financial instruments, net		0	0	0	0
Provision for loan losses, net		152	86	222	86
Impairment of assets		0	12,778	22,317	91,424
Other expenses		5,449	6,488	12,617	13,463
Income (loss) from continuing operations before income taxes and other items		772	9,057	17,784	28,922
Income tax (expense) benefit		0	0	0	0
Income (loss) from unconsolidated entities		(15,810)	(7,678)	(23,514)	(25,489)
Gain (loss) on real estate dispositions, net		(615)	313,319	4,552	327,635
Income (loss) from continuing operations		(15,653)	314,698	(1,178)	331,068
Net income (loss)		(15,653)	314,698	(1,178)	331,068
Total assets		17,741,955		17,741,955
Loss (gain) on extinguishment of debt, net		0	0	(1,537)	(492)
Operating Segments | Seniors Housing Operating | Resident fees and services
Segment Reporting Information [Line Items]
Revenue from contract with customer		835,617	740,956	2,299,972	2,360,488
Operating Segments | Seniors Housing Operating | Interest income
Segment Reporting Information [Line Items]
Revenue from contract with customer		1,135	113	3,110	305
Operating Segments | Seniors Housing Operating | Other income
Segment Reporting Information [Line Items]
Revenue from contract with customer		2,767	996	5,388	6,050
Operating Segments | Triple-net
Segment Reporting Information [Line Items]
Rental income		200,641	103,938	557,829	512,815
Total revenues		239,985	120,928	647,408	562,276
Property operating expenses		11,664	12,567	37,132	39,432
Consolidated net operating income		228,321	108,361	610,276	522,844
Depreciation and amortization		54,226	58,157	165,299	173,989
Interest expense		1,548	2,070	5,134	7,668
General and administrative expenses		0	0	0	0
Loss (gain) on derivatives and financial instruments, net		(8,078)	1,395	(6,503)	10,480
Provision for loan losses, net		(323)	372	10,549	8,895
Impairment of assets		1,490	10,535	24,222	34,867
Other expenses		(4,248)	2,805	4,845	6,818
Income (loss) from continuing operations before income taxes and other items		183,706	33,027	406,730	280,127
Income tax (expense) benefit		0	0	0	0
Income (loss) from unconsolidated entities		5,038	(423)	14,822	11,776
Gain (loss) on real estate dispositions, net		81,712	(619)	126,463	51,166
Income (loss) from continuing operations		270,456	31,985	548,015	343,069
Net income (loss)		270,456	31,985	548,015	343,069
Total assets		9,317,352		9,317,352
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		38,257	15,877	86,040	46,068
Operating Segments | Triple-net | Other income
Segment Reporting Information [Line Items]
Revenue from contract with customer		1,087	1,113	3,539	3,393
Operating Segments | Outpatient Medical
Segment Reporting Information [Line Items]
Rental income		157,343	171,108	457,721	548,496
Total revenues		159,503	172,704	474,798	552,864
Property operating expenses		48,072	52,728	140,430	165,024
Consolidated net operating income		111,431	119,976	334,368	387,840
Depreciation and amortization		56,352	64,151	166,969	202,554
Interest expense		4,811	4,287	12,733	13,421
General and administrative expenses		0	0	0	0
Loss (gain) on derivatives and financial instruments, net		0	0	0	0
Provision for loan losses, net		(100)	2,399	(3,462)	2,370
Impairment of assets		0	0	2,211	0
Other expenses		640	781	2,450	8,244
Income (loss) from continuing operations before income taxes and other items		49,733	48,358	153,472	160,510
Income tax (expense) benefit		0	0	0	0
Income (loss) from unconsolidated entities		(5,060)	2,120	(2,067)	5,372
Gain (loss) on real estate dispositions, net		38,857	171,604	92,687	524,190
Income (loss) from continuing operations		83,530	222,082	244,092	690,072
Net income (loss)		83,530	222,082	244,092	690,072
Total assets		6,247,215		6,247,215
Loss (gain) on extinguishment of debt, net		(5)	0	(5)	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		472	760	8,741	1,687
Operating Segments | Outpatient Medical | Other income
Segment Reporting Information [Line Items]
Revenue from contract with customer		1,688	836	8,336	2,681
Non-segment / Corporate
Segment Reporting Information [Line Items]
Rental income		0	0	0	0
Total revenues		790	1,177	2,175	1,968
Property operating expenses		3,054	1,718	6,882	1,718
Consolidated net operating income		(2,264)	(541)	(4,707)	250
Depreciation and amortization		0	0	0	0
Interest expense		106,803	105,766	318,807	328,935
General and administrative expenses		32,256	31,003	93,618	100,546
Loss (gain) on derivatives and financial instruments, net		0	0	0	0
Provision for loan losses, net		0	0	0	0
Impairment of assets		0	0	0	0
Other expenses		1,734	1,470	6,344	8,722
Income (loss) from continuing operations before income taxes and other items		(143,057)	(171,784)	(475,982)	(470,957)
Income tax (expense) benefit		(4,940)	(2,003)	(6,662)	(9,678)
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		(147,997)	(173,787)	(482,644)	(480,635)
Net income (loss)		(147,997)	(173,787)	(482,644)	(480,635)
Total assets		173,503		173,503
Loss (gain) on extinguishment of debt, net		0	33,004	52,506	33,004
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		$ 790	$ 1,177	$ 2,175	$ 1,968

Segment Reporting - Summary of

Segment Reporting - Summary of Geographic Information (Details) - USD ($) $ in Thousands	3 Months Ended			9 Months Ended
	Sep. 30, 2021	Mar. 31, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020	Dec. 31, 2020
Revenues from External Customers and Long-Lived Assets [Line Items]
Total revenues	$ 1,239,797		$ 1,036,874	$ 3,432,851	$ 3,483,951
Total assets	33,480,025			33,480,025		$ 32,483,642
United States
Revenues from External Customers and Long-Lived Assets [Line Items]
Total revenues	990,034		819,057	2,709,354	2,820,609
Total assets	27,132,959			27,132,959		26,658,659
United Kingdom
Revenues from External Customers and Long-Lived Assets [Line Items]
Total revenues	146,308		110,281	405,938	337,601
Total assets	3,978,661			3,978,661		3,352,549
Canada
Revenues from External Customers and Long-Lived Assets [Line Items]
Total revenues	103,455		$ 107,536	317,559	$ 325,741
Total assets	$ 2,368,405			$ 2,368,405		$ 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	79.90%		79.00%	78.90%	81.00%
Revenue | United Kingdom | Geographic Concentration Risk
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage	11.80%		10.60%	11.80%	9.70%
Revenue | Canada | Geographic Concentration Risk
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage	8.30%		10.40%	9.30%	9.30%
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		82.10%		81.00%
Assets | United Kingdom | Geographic Concentration Risk
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage		10.30%		11.90%
Assets | Canada | Geographic Concentration Risk
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage		7.60%		7.10%
Resident fees and services | Revenue | United States | Geographic Concentration Risk
Revenues from External Customers and Long-Lived Assets [Line Items]
Percentage	74.00%			74.00%
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	13.00%			13.00%

Variable Interest Entities (Det

Variable Interest Entities (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Jun. 30, 2021	Mar. 31, 2021	Dec. 31, 2020	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2019
Assets:
Net real estate investments	$ 30,950,061			$ 28,474,947
Cash and cash equivalents	303,982			1,545,046
Receivables and other assets	774,884			629,031
Total Assets	33,480,025			32,483,642
Liabilities and equity:
Secured debt	2,262,345			2,377,930
Lease liabilities	544,547			418,266
Total equity	17,782,916	$ 16,850,829	$ 16,691,017	16,881,572	$ 16,961,102	$ 16,936,527	$ 17,066,337	$ 16,506,627
Total liabilities and equity	33,480,025			32,483,642
VIE, Primary Beneficiary
Assets:
Net real estate investments	451,723			454,333
Cash and cash equivalents	15,067			15,547
Receivables and other assets	7,999			11,171
Total Assets	474,789			481,051
Liabilities and equity:
Secured debt	164,010			165,671
Lease liabilities	3,648			1,325
Accrued expenses and other liabilities	12,939			14,997
Total equity	294,192			299,058
Total liabilities and equity	$ 474,789			$ 481,051