National Health Investors (NHI) 10-Q 7 Nov 23 2023 Q3 Quarterly report Financial data

Cover

Cover - shares	9 Months Ended
	Sep. 30, 2023	Nov. 01, 2023
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2023
Document Transition Report	false
Entity File Number	001-10822
Entity Registrant Name	National Health Investors Inc
Entity Incorporation, State or Country Code	MD
Entity Tax Identification Number	62-1470956
Entity Address, Address Line One	222 Robert Rose Drive
Entity Address, City or Town	Murfreesboro
Entity Address, State or Province	TN
Entity Address, Postal Zip Code	37129
City Area Code	(615)
Local Phone Number	890-9100
Title of 12(b) Security	Common Stock, $0.01 par value
Trading Symbol	NHI
Security Exchange Name	NYSE
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		43,409,841
Amendment Flag	false
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	Q3
Entity Central Index Key	0000877860
Current Fiscal Year End Date	--12-31

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Assets:
Land	$ 180,749	$ 177,527
Buildings and improvements	2,588,823	2,549,019
Construction in progress	7,019	3,352
Real estate properties, gross	2,776,591	2,729,898
Less accumulated depreciation	(656,155)	(611,688)
Real estate properties, net	2,120,436	2,118,210
Mortgage and other notes receivable, net of reserve of $15,808 and $15,338, respectively	242,960	233,141
Cash and cash equivalents	16,579	19,291
Straight-line rent receivable	83,549	76,895
Assets held for sale, net	10,875	43,302
Other assets, net	24,691	16,585
Total Assets	2,499,090	2,507,424
Liabilities and Stockholders’ Equity:
Debt	1,144,438	1,147,511
Accounts payable and accrued expenses	29,326	25,905
Dividends payable	39,069	39,050
Deferred income	5,432	5,052
Total Liabilities	1,218,265	1,217,518
Commitments and contingencies
Redeemable noncontrolling interest	9,922	9,825
National Health Investors, Inc. Stockholders’ Equity:
43,409,841 and 43,388,742 shares issued and outstanding, respectively	434	434
Capital in excess of par value	1,602,892	1,599,427
Retained earnings	2,434,799	2,331,190
Cumulative dividends	(2,778,014)	(2,660,826)
Total National Health Investors, Inc. Stockholders’ Equity	1,260,111	1,270,225
Noncontrolling interests	10,792	9,856
Total Equity	1,270,903	1,280,081
Total Liabilities and Equity	$ 2,499,090	$ 2,507,424

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Credit loss	$ 15,808	$ 15,338
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, shares authorized (in shares)	100,000,000	100,000,000
Common stock, shares issued (in shares)	43,409,841	43,388,742
Common stock, shares outstanding (in shares)	43,409,841	43,388,742

Condensed Consolidated Statemen

Condensed Consolidated Statements Of Income - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Revenues:
Rental income	$ 62,255	$ 59,394	$ 188,505	$ 163,935
Resident fees and services	12,367	12,013	35,860	24,005
Interest income and other	5,484	4,891	16,005	19,584
Total revenues	80,106	76,298	240,370	207,524
Expenses:
Depreciation	17,515	17,533	52,862	53,577
Interest	15,086	11,412	43,308	32,472
Senior housing operating expenses	10,045	9,239	29,525	18,352
Legal	67	88	364	2,254
Franchise, excise and other taxes	2	225	443	694
General and administrative	4,430	4,744	14,390	17,893
Taxes and insurance on leased properties	2,908	2,358	8,738	7,553
Loan and realty losses	1,959	11,329	1,727	39,951
Total operating expenses	52,012	56,928	151,357	172,746
Gains on sales of real estate, net	737	14,840	13,500	28,342
Gain (loss) on operations transfer, net	0	19	20	(710)
Gain on note receivable payoff	0	0	0	1,113
Loss on early retirement of debt	0	0	(73)	(151)
Gains from equity method investment	0	0	0	569
Other non-operating income	202	0	202	0
Net income	29,033	34,229	102,662	63,941
Add: net loss attributable to noncontrolling interests	313	239	946	599
Net income attributable to stockholders	29,346	34,468	103,608	64,540
Less: net income attributable to unvested restricted stock awards	(19)	0	(38)	0
Net income attributable to common stockholders - basic	$ 29,327	$ 34,468	$ 103,570	$ 64,540
Weighted average common shares outstanding:
Basic (in shares)	43,388,841	44,339,975	43,388,779	45,236,696
Diluted (in shares)	43,388,841	44,402,582	43,389,675	45,261,123
Basic:
Net income attributable to common stockholders - basic (in US dollars per share)	$ 0.68	$ 0.78	$ 2.39	$ 1.43
Diluted:
Net income attributable to common stockholders - diluted (in US dollars per share)	$ 0.68	$ 0.78	$ 2.39	$ 1.43

Condensed Consolidated Statem_2

Condensed Consolidated Statements Of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Cash flows from operating activities:
Net income	$ 102,662	$ 63,941
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation	52,862	53,577
Amortization of debt issuance costs, debt discounts and prepaids	3,392	3,216
Amortization of commitment fees and note receivable discounts	(323)	(802)
Amortization of lease incentives	1,798	7,477
Straight-line rent adjustments	(6,011)	11,360
Non-cash rental income	(2,500)	0
Non-cash interest income on mortgage and other notes receivable	(1,302)	(3,256)
Non-cash lease deposit liability recognized as rental income	0	(8,838)
Gains on sales of real estate, net	(13,500)	(28,342)
Gain on note receivable payoff	0	(1,113)
Gains from equity method investment	0	(569)
Loss on operations transfer, net	0	710
Loss on early retirement of debt	73	151
Loan and realty losses	1,727	39,951
Payment of lease incentive	(10,000)	0
Non-cash share-based compensation	3,740	7,576
Changes in operating assets and liabilities:
Other assets	(2,426)	(4,213)
Accounts payable and accrued expenses	1,317	(2,555)
Deferred income	(262)	712
Net cash provided by operating activities	131,247	138,983
Cash flows from investing activities:
Investments in mortgage and other notes receivable	(33,104)	(30,820)
Collections of mortgage and other notes receivable	11,231	117,973
Acquisitions of real estate	(38,081)	(4,876)
Proceeds from sales of real estate	51,542	168,957
Investments in existing real estate	(5,475)	(4,132)
Investments in equipment	(2,579)	(528)
Distributions from equity method investment	2,500	569
Net cash (used in) provided by investing activities	(13,966)	247,143
Cash flows from financing activities:
Proceeds from revolving credit facility	283,000	165,000
Payments on revolving credit facility	(120,000)	(155,000)
Borrowings on term loan	200,000	0
Payments on term loans	(365,304)	(135,290)
Debt issuance costs	(2,747)	(4,607)
Equity issuance costs	0	(21)
Distributions to noncontrolling interests	(1,004)	(757)
Dividends paid to stockholders	(117,169)	(122,721)
Taxes remitted on employee stock awards	0	(288)
Proceeds from noncontrolling interest	2,922	11,738
Payments to repurchase shares of common stock	0	(151,951)
Net cash used in financing activities	(120,302)	(393,897)
Decrease in cash and cash equivalents and restricted cash	(3,021)	(7,771)
Cash and cash equivalents and restricted cash, beginning of period	21,516	39,485
Cash and cash equivalents and restricted cash, end of period	18,495	31,714
Supplemental disclosure of cash flow information:
Interest paid, net of amounts capitalized	41,222	33,927
Supplemental disclosure of non-cash investing and financing activities:
Real estate acquired in exchange for mortgage notes receivable	14,200	9,071
Increase in notes receivable from sales of real estate	699	0
Change in other assets related to sales of real estate	0	102
Change in accounts payable related to investments in real estate construction	80	0
Change in accounts payable related to renovations of existing real estate	0	208
Change in accounts payable related to distributions to noncontrolling interests	(61)	6
Change in accounts payable related to equity issuance cost	0	64
Reclassification of prepaid equity issuance costs to capital in excess of par value	275	0
Operating equipment received in transfer of operations	0	1,287
Increase in accounts payable related to transfer of operations	$ 0	$ 300

Condensed Consolidated Statem_3

Condensed Consolidated Statement Of Equity - USD ($) $ in Thousands	Total	Total National Health Investors, Inc. Stockholders’ Equity	Common Stock	Capital in Excess of Par Value	Retained Earnings	Cumulative Dividends	Noncontrolling Interests
Beginning balance, common stock (in shares) at Dec. 31, 2021			45,850,599
Beginning balance at Dec. 31, 2021	$ 1,516,983	$ 1,507,083	$ 459	$ 1,591,182	$ 2,416,713	$ (2,501,271)	$ 9,900
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Shares issued on stock options exercised (in shares)	56,832
Ending balance, common stock (in shares) at Sep. 30, 2022			43,388,742
Ending balance at Sep. 30, 2022	$ 1,315,448	1,306,370	$ 434	1,598,385	2,329,327	(2,621,776)	9,078
Beginning balance, common stock (in shares) at Dec. 31, 2021			45,850,599
Beginning balance at Dec. 31, 2021	$ 1,516,983	1,507,083	$ 459	1,591,182	2,416,713	(2,501,271)	9,900
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Repurchases of common stock (in shares)	(2,468,354)
Repurchases of common stock	$ (151,600)
Ending balance, common stock (in shares) at Dec. 31, 2022	43,388,742		43,388,742
Ending balance at Dec. 31, 2022	$ 1,280,081	1,270,225	$ 434	1,599,427	2,331,190	(2,660,826)	9,856
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Shares issued on stock options exercised (in shares)	5,166
Ending balance, common stock (in shares) at Sep. 30, 2023	43,409,841		43,409,841
Ending balance at Sep. 30, 2023	$ 1,270,903	$ 1,260,111	$ 434	$ 1,602,892	$ 2,434,799	$ (2,778,014)	$ 10,792

Condensed Consolidated Statem_4

Condensed Consolidated Statement Of Equity (Parenthetical) - USD ($) $ in Thousands	3 Months Ended	6 Months Ended
	Sep. 30, 2022	Jun. 30, 2022
Statement of Stockholders' Equity [Abstract]
Distributions	$ 12	$ 24
Net loss	$ 278	$ (227)
Dividends to common stockholders (in dollars per share)	$ 0.90	$ 1.80

Organization and Nature of Busi

Organization and Nature of Business	9 Months Ended
	Sep. 30, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Organization and Nature of Business	Organization and Nature of Business National Health Investors, Inc. (“NHI,” the “Company,” “we,” “us,” or “our”), established in 1991 as a Maryland corporation, is a self-managed real estate investment trust (“REIT”) specializing in sale-leaseback, joint venture and mortgage and mezzanine financing of need-driven and discretionary senior housing and medical facility investments. We operate through two reportable segments: Real Estate Investments and Senior Housing Operating Portfolio (“SHOP”). Our Real Estate Investments segment consists of real estate investments and leases, mortgages and other notes receivable in independent living facilities (“ILF”), assisted living facilities (“ALF”), entrance-fee communities (“EFC”), senior living campuses (“SLC”), skilled nursing facilities (“SNF”) and a hospital (“HOSP”). As of September 30, 2023, we had gross investments of approximately $2.4 billion in 163 health care real estate properties located in 31 states and leased pursuant primarily to triple-net leases to 25 tenants consisting of 97 senior housing communities, 65 SNFs and one HOSP, excluding four properties classified as assets held for sale. Our portfolio of 14 mortgages along with other notes receivable totaled $258.8 million, excluding an allowance for expected credit losses of $15.8 million, as of September 30, 2023. Our SHOP segment is comprised of two ventures that own the operations of ILFs. As of September 30, 2023, we had gross investments of approximately $344.4 million in 15 properties with a combined 1,734 units located in eight states that are operated on behalf of the Company by independent managers pursuant to the terms of separate management agreements that commenced April 1, 2022. The third-party managers, or related parties of the managers, own equity interests in the respective ventures.

Basis of Presentation and Signi

Basis of Presentation and Significant Accounting Policies	9 Months Ended
	Sep. 30, 2023
Accounting Policies [Abstract]
Basis of Presentation and Significant Accounting Policies	Basis of Presentation and Significant Accounting Policies Basis of Presentation The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with United States generally accepted accounting principles (“GAAP”) for interim financial statements. In our opinion, the accompanying unaudited condensed consolidated financial statements reflect all adjustments consisting of normal recurring adjustments necessary for a fair presentation. Interim results of operations are not necessarily indicative of the results that may be achieved for a full year. The condensed consolidated financial statements and related notes do not include all information and footnotes required by GAAP for annual reports. These interim condensed consolidated financial statements should be read in conjunction with our audited consolidated financial statements and notes thereto as of and for the year ended December 31, 2022, included in our Annual Report on Form 10-K for the year ended December 31, 2022 filed with the Securities and Exchange Commission (the “SEC”). Principles of Consolidation The condensed consolidated financial statements include the accounts of the Company, and its wholly owned subsidiaries, joint ventures and subsidiaries in which we have a controlling interest. We also consolidate certain entities when control of such entities can be achieved through means other than voting rights (“variable interest entities” or “VIEs”) if the Company is deemed to be the primary beneficiary of such entities. All material intercompany transactions and balances are eliminated in consolidation. Effective April 1, 2022 and at September 30, 2023, our consolidated total assets and liabilities include two consolidated ventures comprising our SHOP activities, each formed with a separate partner - Merrill Gardens, L.L.C. (“Merrill”) and DSHI NHI Holiday LLC (the “Discovery member”), a related party of Discovery Senior Living (“Discovery”). We consider both ventures to be VIEs as the members of each, as a group, lack the characteristics of a controlling financial interest. We are deemed to be the primary beneficiary of each VIE because we have the ability to control the activities that most significantly impact each VIE’s economic performance. The assets of the ventures primarily consist of real estate properties, cash and cash equivalents, and resident fees and services (accounts receivable). The obligations of the ventures primarily consist of operating expenses of the ILFs (accounts payable and accrued expenses) and capital expenditures for the properties. Aggregate assets of the consolidated SHOP ventures that can be used only to settle obligations of each respective SHOP venture primarily include approximately $260.1 million of real estate properties, net, $6.0 million of cash and cash equivalents, $2.0 million of prepaid expenses and other, and $0.6 million of accounts receivable, net. Liabilities of the consolidated SHOP ventures for which creditors do not have recourse to the general credit of the Company are $5.0 million. Reference Notes 5 and 10 for further discussion of these ventures. We also consolidate two real estate partnerships formed with our partners, Discovery Senior Housing Investor XXIV, LLC, a related party of Discovery, beginning in June 2019, and LCS Timber Ridge LLC (“LCS”), beginning in January 2020, to invest in senior housing facilities. We consider both partnerships to be VIEs, as either the members, as a group, lack the characteristics of a controlling financial interest or the total equity at risk is insufficient to finance activities without additional subordinated financial support. NHI directs the activities that most significantly impact economic performance of these partnerships, subject to limited protective rights extended to our partners for specified business decisions. Because of our control of these partnerships, we include their assets, liabilities, noncontrolling interests and operations in our condensed consolidated financial statements. The aggregate assets of these consolidated real estate partnerships that can be used only to settle obligations of each respective partnership include approximately $254.5 million of real estate properties, net, $9.7 million in straight-line rents receivable, $8.5 million of other assets, net, and $2.6 million of cash and cash equivalents. Liabilities of these partnerships for which creditors do not have recourse to the general credit of the Company are not material. We use the equity method of accounting when we own an interest in an entity whereby we can exert significant influence over but cannot control the entity’s operations. We discontinue equity method accounting if our investment in an entity (and net advances) is reduced to zero unless we have guaranteed obligations of the entity or are otherwise committed to provide further financial support for the entity. Reference Note 6 for further discussion of our equity method investment. We structured our Timber Ridge OpCo, LLC (“Timber Ridge OpCo”) investment to be compliant with the provisions of the REIT Investment Diversification Empowerment Act of 2007 which permits us to receive rent payments through a triple-net lease between a property company and an operating company and allows us to receive distributions from the operating company to a taxable REIT subsidiary (“TRS”). Our TRS holds our equity interests in unconsolidated operating companies thus providing an organizational structure that allows the TRS to engage in a broad range of activities and share in revenues that are otherwise non-qualifying income under the REIT gross income tests. We have concluded that the Company is not the primary beneficiary for certain investments where we lack either directly or through related parties the power to direct the activities that most significantly impact their economic performance. Accordingly, we account for our transactions with these entities and their subsidiaries at either amortized cost or net realizable value for straight-line rents receivable, excluding our investments accounted for under the equity method. See Note 16 for information on unconsolidated VIEs. Noncontrolling Interests Contingently redeemable noncontrolling interests are recorded at their initial carrying amounts upon issuance and are subsequently adjusted to reflect their share of gains or losses and distributions attributable to the noncontrolling interests. In periods where they are or will become probable of redemption, an adjustment to the redemption value of the noncontrolling interests is also recognized through “ Capital in excess of par value ” on the Company’s Condensed Consolidated Balance Sheets and included in our computation of earnings per share. As of September 30, 2023, the Merrill SHOP venture noncontrolling interest was classified in mezzanine equity, as discussed further in Note 10. The noncontrolling interests associated with our two consolidated real estate partnerships and our Discovery member SHOP venture were classified in equity as of September 30, 2023. Cash and Cash Equivalents and Restricted Cash Cash equivalents consist of all highly liquid investments with an original maturity of three months or less. Restricted cash includes amounts required to be held on deposit or subject to an agreement ( e.g ., with a qualified intermediary subject to an exchange agreement pursuant to Section 1031 of the Internal Revenue Code of 1986, as amended (the “Internal Revenue Code”) or in accordance with agency agreements governing our mortgages). The following table sets forth our “ Cash and cash equivalents and restricted cash ” reported within the Company’s Condensed Consolidated Statements of Cash Flows ( $ in thousands ): September 30, September 30, Beginning of period: Cash and cash equivalents $ 19,291 $ 37,412 Restricted cash (included in Other assets, net) 2,225 2,073 Cash, cash equivalents, and restricted cash $ 21,516 $ 39,485 End of period: Cash and cash equivalents $ 16,579 $ 28,811 Restricted cash (included in Other assets, net) 1,916 2,903 Cash, cash equivalents, and restricted cash $ 18,495 $ 31,714 Concentration of Credit Risks Our credit risks primarily relate to cash and cash equivalents and investments in mortgage and other notes receivable. Cash and cash equivalents are primarily held in bank accounts and overnight investments. We maintain our bank deposit accounts with large financial institutions in amounts that may exceed federally insured limits. We have not experienced any losses in such accounts. Our mortgages and other notes receivable consist primarily of secured loans on facilities. Our financial instruments, principally our investments in notes receivable, are subject to the possibility of loss of the carrying values as a result of the failure of other parties to perform according to their contractual obligations which may make the instruments less valuable. We obtain collateral in the form of mortgage liens and other protective rights for notes receivable and continually monitor these rights in order to reduce such possibilities of loss. We evaluate the need to provide for reserves for potential losses on our financial instruments based on management’s periodic review of our portfolio on an instrument-by-instrument basis. Assets Held for Sale We consider properties to be assets held for sale when (1) management commits to a plan to sell the property; (2) it is unlikely that the disposal plan will be significantly modified or discontinued; (3) the property is available for immediate sale in its present condition; (4) actions required to complete the sale of the property have been initiated; (5) sale of the property is probable and we anticipate the completed sale will occur within one year; and (6) the property is actively being marketed for sale at a price that is reasonable given our estimate of current market value. Upon designation of a property as an asset held for sale, we record the property’s value at the lower of its carrying value or its estimated fair value, less estimated transaction costs. Depreciation and amortization of the property are discontinued. If a property subsequently no longer meets the criteria to be classified as held for sale, it is reclassified as held and used and measured at the lower of i) its original carrying amount before the asset was classified as held for sale, adjusted for any depreciation expense not recognized while it was classified as held for sale, and ii) its fair value. Impairment of Long-Lived Assets We evaluate the recoverability of the carrying amount of our long-lived assets when events or circumstances, including significant physical changes, significant adverse changes in general economic conditions or significant deterioration of the underlying cash flows of the long-lived assets, indicate that the carrying amount of the long-lived assets may not be recoverable. The need to recognize an impairment charge is based on estimated undiscounted future cash flows compared to the carrying amount. If recognition of an impairment charge is necessary, it is measured as the amount by which the carrying amount of the property exceeds the estimated fair value of the long-lived asset. During the three and nine months ended September 30, 2023, we recognized impairment charges of approximately $1.2 million and $1.6 million, respectively, included in “ Loan and realty losses ” in our Condensed Consolidated Statements of Income. Reference Note 3 for more discussion. Revenue Recognition Rental Income - Our leases generally provide for rent escalators throughout the term of the lease. Base rental income is recognized using the straight-line method over the term of the lease to the extent that lease payments are considered collectible and the lease provides for specific contractual escalators. Under certain leases, we receive additional contingent rent, which is calculated on the increase in revenues of the tenant over a base year or base quarter. We recognize contingent rent annually or quarterly based on the actual revenues of the tenant once the target threshold has been achieved. Lease payments that depend on a factor directly related to future use of the property, such as an increase in annual revenues over a base year, are considered to be contingent rent and are excluded from the schedule of minimum lease payments. The Company reviews its operating lease receivables for collectability on a regular basis, taking into consideration changes in factors such as the tenant’s payment history, the financial condition of the tenant, business conditions in which the tenant operates and economic conditions in the area where the property is located. In the event that collectability with respect to any tenant is not probable, a direct write-off of the receivable is made as an adjustment to rental income and any future rental revenue is recognized only when the tenant makes a rental payment. As of September 30, 2023, we had three tenants, including Bickford Senior Living (“Bickford”), on the cash basis of revenue recognition for their lease arrangements. Reference Note 3 for further discussion. Resident Fees and Services - Resident fee revenue associated with our SHOP activities is recognized as the related performance obligations are satisfied and includes resident room charges, community fees and other resident charges. Residency agreements are generally short term (30 days to one year), and entitle the resident to certain room and care services for a monthly fee billed in advance. Revenue for certain related services is billed monthly in arrears. The Company has elected the lessor practical expedient within Accounting Standards Codification (“ASC”) 842, Leases, not to separate the lease and nonlease components within our resident agreements as the timing and pattern of transfer to the resident are the same. The Company has determined that the nonlease component is the predominant component within the contract and will recognize revenue under ASC 606, Revenue Recognition from Contracts with Customers. Interest Income from Mortgage and Other Notes Receivable Interest income is recognized based on the interest rates and principal amounts outstanding on the notes receivable. We identify a mortgage note as non-performing based on various criteria including timeliness of required payments, compliance with other provisions under the related note agreement, and an evaluation of the borrower’s current financial condition for indicators that it is probable it cannot pay its contractual amounts. A non-performing loan is returned to accrual status at such time as the note becomes contractually current and management believes all future principal and interest will be received according to the contractual terms of the note. As of September 30, 2023, we have two mortgage note receivables and a mezzanine loan totaling an aggregate of $26.6 million with affiliates of two operators/borrowers, including Bickford, designated as non-performing. Income Taxes We intend at all times to qualify as a REIT under Sections 856 through 860 of the Internal Revenue Code. Accordingly, we will generally not be subject to U.S. federal income tax, provided that we continue to qualify as a REIT and make distributions to stockholders equal to or in excess of 90% our taxable income. A failure to qualify under the applicable REIT qualification rules and regulations would have a material adverse impact on our financial position, results of operations and cash flows. Certain activities that we undertake may be conducted by subsidiary entities that have elected to be treated as TRSs. TRSs are subject to federal, state, and local income taxes. Accordingly, a provision for income taxes has been made in the condensed consolidated financial statements. Segments We operate our business through two reportable segments: Real Estate Investments and SHOP. In our Real Estate Investments segment, we invest in (i) senior housing and healthcare real estate and lease those properties to healthcare operating companies under primarily triple-net leases that obligate tenants to pay all property-related expenses and (ii) mortgage and other notes receivable throughout the United States. Our SHOP segment is comprised of the operations of 15 ILFs located throughout the United States that are operated on behalf of the Company by independent managers pursuant to the terms of separate management agreements. Reference Notes 5 and 15 for additional information. Earnings Per Share Our unvested restricted stock awards contain non-forfeitable rights to dividends, and accordingly, these awards are deemed to be participating securities. Therefore, the Company applies the two-class method to calculate basic and diluted earnings. Under the two-class method, we allocate net income attributable to stockholders to common stockholders and holders of unvested restricted stock by using the weighted-average shares of each class outstanding for quarter-to-date and year-to-date periods, based on their respective participation rights to dividends declared and undistributed earnings. Basic earnings per common share is computed by dividing net income attributable to common stockholders by the weighted number of shares of common stock outstanding during the period. Diluted earnings per common share reflects the effect of dilutive securities. Reclassifications In prior years, the Company presented " Cumulative dividends in excess of net income " as a single line item on the Condensed Consolidated Balance Sheets and the Condensed Consolidated Statements of Equity. Beginning January 1, 2023, the Company separated this line item into two components, " Retained earnings " and " Cumulative dividends, " and reclassified prior year information to conform to the current period presentation.

Investment Activity

Investment Activity	9 Months Ended
	Sep. 30, 2023
Real Estate [Abstract]
Investment Activity	Investment Activity Asset Acquisitions Since January 1, 2023, we have completed the following real estate investments ( $ in thousands ): Operator Date Properties Asset Class Land Building and Improvements Total Silverado Senior Living Q1 2023 2 ALF $ 3,894 $ 33,599 $ 37,493 Bickford Q1 2023 1 ALF 1,746 15,542 17,288 $ 5,640 $ 49,141 $ 54,781 In February 2023, we acquired two memory care communities operated by Silverado Senior Living for approximately $37.5 million. The newly developed properties opened in 2022 and include a 60-unit community in Summerlin, Nevada and a 60-unit community in Frederick, Maryland. They are leased pursuant to 20-year leases with a first-year lease rate of 7.5% and annual escalators of 2.0%. In February 2023, we also acquired a 64-unit ALF in Chesapeake, Virginia from Bickford. The acquisition price was $17.3 million, including the satisfaction of an outstanding construction note receivable of $14.2 million including interest, cash consideration of $0.5 million and approximately $0.1 million in closing costs. The acquisition price also included a reduction of $2.5 million in Bickford’s outstanding pandemic-related rent deferrals that has been recognized in “ Rental income ” during the nine months ended September 30, 2023. We added the community to an existing master lease with Bickford at an initial rate of 8.0%. Asset Dispositions During the nine months ended September 30, 2023, we completed the following dispositions of real estate properties within our Real Estate Investments portfolio as described below ( $ in thousands ): Operator Date Properties Asset Class Net Proceeds Net Real Estate Investment Gain Impairment 2 BAKA Enterprises, LLC 1,3 Q1 2023 1 ALF $ 7,478 $ 7,505 $ — $ (27) Bickford 1 Q1 2023 1 ALF 2,553 1,421 1,132 — Chancellor Senior Living 1,3 Q2 2023 1 ALF 2,355 1,977 378 — Milestone Retirement 1,3,4 Q2 2023 2 ALF 3,803 3,934 — (131) Chancellor Senior Living 1,3 Q2 2023 1 ALF 7,633 6,140 1,493 — Milestone Retirement 1,3,4 Q2 2023 1 ALF 1,602 1,452 150 — Chancellor Senior Living Q2 2023 1 ALF 23,724 14,476 9,248 — Chancellor Senior Living 1,3 Q3 2023 1 ALF 2,923 2,292 631 — $ 52,071 $ 39,197 $ 13,032 $ (158) 1 Assets were previously classified as “ Assets held for sale ” in the Consolidated Balance Sheet at December 31, 2022. 2 Impairments are included in “ Loan and realty losses ” in the Condensed Consolidated Statements of Income for the three and nine months ended September 30, 2023. 3 Total impairment charges previously recognized on these properties were $16.4 million in the aggregate. 4 The Company provided aggregate financing of approximately $0.7 million, net of discounts, on these transactions in the form of notes receivable. Assets Held for Sale and Long-Lived Assets The following is a summary of our assets held for sale ( $ in thousands ): As of As of September 30, 2023 December 31, 2022 Number of properties 4 13 Real estate, net $10,875 $43,302 Rental income associated with assets held for sale at September 30, 2023 totaled $0.6 million and $1.9 million for the three and nine months ended September 30, 2023, respectively, and $0.6 million and $1.6 million for the three and nine months ended September 30, 2022, respectively. During the first quarter of 2023, one property in our Real Estate Investments portfolio was classified as held for sale with a net real estate balance of $5.0 million and two properties, previously classified as held for sale with an aggregate net real estate balance of $12.3 million, were reclassified as held for use. During the three months ended September 30, 2023, we recorded impairment charges of approximately $1.2 million for one property in our Real Estate Investments segment. During the nine months ended September 30, 2023, we recorded impairment charges of approximately $1.6 million for four properties in our Real Estate Investments segment, of which $0.5 million related to three properties either sold or classified as assets held for sale. The impairment charges are included in “ Loan and realty losses ” in the Condensed Consolidated Statements of Income. We reduce the carrying value of impaired properties to their estimated fair value or, with respect to the properties classified as held for sale, to estimated fair value less costs to sell. To estimate the fair values of the properties, we utilized a market approach which considered binding agreements for sales (Level 1 inputs), non-binding offers to purchase from unrelated third parties and/or broker quotes of estimated values (Level 3 inputs), and/or independent third-party valuations (Level 1 and 3 inputs). Fourth Quarter 2023 Dispositions During the fourth quarter of 2023, we sold three ALFs located in Florida for combined consideration of approximately $5.4 million in cash, net of transaction costs plus $1.6 million of seller financing in connection with one of the transactions. The properties were classified in assets held for sale on the Condensed Consolidated Balance Sheet as of September 30, 2023, with an aggregate book value of $5.9 million. Prior impairment charges recognized on the properties totaled $1.3 million. Tenant Concentration The following table contains information regarding concentration in our Real Estate Investments portfolio of tenants or affiliates of tenants, that exceed 10% of total revenues for the nine months ended September 30, 2023 and 2022, excluding $2.6 million for our corporate office, a credit loss reserve of $15.8 million and $344.4 million in real estate assets in the SHOP segment ( $ in thousands ): as of September 30, 2023 Revenues 1 Asset Gross Real Notes Nine Months Ended September 30, Class Estate Receivable 2023 2022 Senior Living Communities, LLC (“Senior Living”) EFC $ 573,631 $ 48,950 $ 38,466 16% $ 38,325 18% Bickford 2 ALF 429,043 16,827 29,280 12% N/A N/A National HealthCare Corporation (“NHC”) SNF 133,770 — 28,159 12% 27,875 13% All others, net Various 1,293,210 192,991 99,867 41% 109,766 53% Escrow funds received from tenants for property operating expenses Various — — 8,738 4% 7,553 4% $ 2,429,654 $ 258,768 204,510 183,519 Resident fees and services 3 35,860 15% 24,005 12% $ 240,370 $ 207,524 1 Includes interest income on notes receivable and rental income from properties classified as held for sale. 2 Revenues for the nine months ended September 30, 2022 are included in “All others, net” since they are less than 10% for that period. 3 There is no tenant concentration in “Resident fees and services” because these agreements are with individual residents. At September 30, 2023, the two states in which we had an investment concentration of 10% or more were South Carolina (12.1%) and Texas (10.7%). Senior Living As of September 30, 2023, we leased ten retirement communities to Senior Living. We recognized straight-line rent of $(0.9) million and $0.3 million from Senior Living for the nine months ended September 30, 2023 and 2022, respectively. NHC As of September 30, 2023, we leased three ILFs and 32 SNFs to NHC, a publicly held company, under a master lease (four of which are subleased to other parties for whom the lease payments are guaranteed to us by NHC). Straight-line rent of $(0.9) million and $(0.1) million was recognized for NHC for the nine months ended September 30, 2023 and 2022, respectively. Two of the members of our Board of Directors, including our chairman, are also members of NHC’s board of directors. Bickford As of September 30, 2023, we leased 39 facilities to Bickford under four leases. During the second quarter of 2022, we converted Bickford to the cash basis of revenue recognition based upon information obtained from Bickford regarding its financial condition that raised substantial doubt as to its ability to continue as a going concern. As a result, we wrote off approximately $18.1 million of straight-line rents receivable and $7.1 million of lease incentives, that were included in “ Other assets, net ” on the Condensed Consolidated Balance Sheet, to rental income in 2022. During the three and nine months ended September 30, 2023, Bickford repaid $0.8 million and $1.3 million, respectively, of its outstanding pandemic-related deferrals in addition to the reduction in deferrals of $2.5 million recognized in connection with the acquisition of the ALF located in Chesapeake, Virginia from Bickford. As of September 30, 2023, Bickford’s outstanding pandemic-related deferrals were $19.0 million. Cash Basis Operators Cash rent received from Bickford for the three and nine months ended September 30, 2023 was $8.6 million and $24.5 million, respectively, which excludes $2.5 million of rental income related to the reduction of pandemic-related rent deferrals recognized in connection with the acquisition of the ALF from Bickford in the first quarter of 2023 located in Chesapeake, Virginia (discussed above). We placed two additional operators on the cash basis of accounting for their leases during 2022. Rental income associated with these tenants totaled $3.4 million and $10.0 million for the three and nine months ended September 30, 2023, respectively. Tenant Purchase Options Certain of our leases contain purchase options allowing tenants to acquire the leased properties by a fixed base price plus a specified share in any appreciation or a fixed base price. At September 30, 2023, tenants had purchase options on three properties with an aggregate net investment of $58.8 million that will become exercisable between 2027 and 2028. Rental income from these properties with tenant purchase options was $1.8 million and $5.4 million for the three and nine months ended September 30, 2023, respectively, and $1.8 million and $5.3 million for the three and nine months ended September 30, 2022, respectively. We cannot reasonably estimate at this time the probability that any purchase options will be exercised in the future. Consideration to be received from the exercise of any tenant purchase option is expected to exceed our net investment in the leased property or properties. Future Minimum Base Rent Future minimum lease payments to be received by us under our operating leases at September 30, 2023, are as follows ( $ in thousands ): Remainder of 2023 $ 57,301 2024 237,531 2025 241,391 2026 246,792 2027 201,627 2028 195,138 Thereafter 679,952 $ 1,859,732 Variable Lease Payments Most of our existing leases contain annual escalators in rent payments. Some of our leases contain escalators that are determined annually based on a variable index or other factors that are indeterminable at the inception of the lease. The table below indicates the rental income recognized as a result of fixed and variable lease escalators ( $ in thousands ): Three Months Ended Nine Months Ended September 30, September 30, 2023 2022 2023 2022 Lease payments based on fixed escalators $ 57,200 $ 53,394 $ 169,675 $ 172,767 Lease payments based on variable escalators 1,830 1,224 5,879 2,452 Straight-line rent, net of write-offs 1,040 2,476 6,011 (11,360) Escrow funds received from tenants for property operating expenses 2,908 2,358 8,738 7,553 Amortization and write-off of lease incentives (723) (58) (1,798) (7,477) Rental income $ 62,255 $ 59,394 $ 188,505 $ 163,935

Mortgage And Other Notes Receiv

Mortgage And Other Notes Receivable	9 Months Ended
	Sep. 30, 2023
Mortgage and Other Notes Receivable [Abstract]
Mortgage and Other Notes Receivable	Mortgage and Other Notes ReceivableAt September 30, 2023, our investments in mortgage notes receivable totaled $159.4 million secured by real estate and other assets of the borrowers (e.g., Uniform Commercial Code liens on personal property) related to 14 facilities and in other notes receivable totaled $99.4 million, substantially all of which are guaranteed by significant parties to the notes or by cross-collateralization of properties with the same owner. These balances exclude a credit loss reserve of $15.8 million at September 30, 2023. Our loans designated as non-performing as of September 30, 2023 and December 31, 2022 include a mortgage note receivable of $10.0 million and a mezzanine loan of $14.5 million with affiliates of one operator/borrower. This operator/borrower is also one of the tenants on the cash basis of accounting for its leases. During the third quarter of 2023, we designated as non-performing a mortgage note receivable of $2.1 million due from Bickford. Interest income recognized, representing cash received, from these non-performing loans was $0.5 million and $1.4 million, respectively for the three and nine months ended September 30, 2023. Interest income recognized for the three and nine months ended September 30, 2022 was $0.5 million and $1.4 million, respectively. All other loans were on full accrual basis at September 30, 2023 and December 31, 2022. Capital Funding Group, Inc. Loan Extension On September 21, 2023, we amended a mezzanine loan with Capital Funding Group, Inc. Pursuant to the terms of the agreement, the loan increased from its balance at June 30, 2023 of $8.1 million to $25.0 million. The interest rate on the loan was increased to 10% and the maturity was extended to December 31, 2028. Montecito Medical Real Estate We have a $50.0 million mezzanine loan and security agreement with Montecito Medical Real Estate for a fund that invests in medical real estate, including medical office buildings, throughout the United States. As of September 30, 2023, we have funded $20.3 million of our commitment that was used to acquire nine medical office buildings for a combined purchase price of approximately $86.7 million. For both the three and nine months ended September 30, 2023 and 2022, we recognized interest income of $0.5 million and $1.4 million, respectively. The mezzanine loan and security agreement was modified in April 2022, such that the two real estate investments funded in the second quarter of 2022 accrue interest at an annual rate of 7.5% that is paid monthly in arrears plus an additional annual rate of 4.5% to be paid upon certain future events including repayments, sales of fund investments, and refinancings (the “Deferred Interest”). Prior borrowings under the mezzanine loan and security agreement bear interest at an annual rate of 9.5% and accrue an additional 2.5% in Deferred Interest. The Deferred Interest will be recognized as interest income upon receipt. Funds drawn in accordance with this agreement are required to be repaid on a per-investment basis five years from deployment of the funds for the applicable investment, subject to two one-year extensions. Bickford Construction and Mortgage Loans As of September 30, 2023, we had one fully funded construction loan of $14.7 million to Bickford. The construction loan is secured by a first mortgage lien on substantially all of the related real and personal property as well as a pledge of any and all leases or agreements which may grant a right of use to the property. Usual and customary covenants extend to the agreement, including the borrower’s obligation for payment of insurance and taxes. NHI has a fair market value purchase option on the property upon stabilization of the underlying operations. On certain development projects, Bickford is entitled to up to $2.0 million per project in incentives based on the achievement of predetermined operational milestones and, if funded, will increase NHI's future purchase price and eventual lease payments to NHI. At September 30, 2023, we hold a $12.7 million second mortgage as a component of the purchase price consideration in connection with the sale of six properties to Bickford in 2021. This second mortgage note receivable bears interest at a 10% annual rate and matures in April 2026. Interest income was $0.3 million and $1.0 million for the three and nine months ended September 30, 2023, respectively and $0.3 million and $1.0 million for the three and nine months ended September 30, 2022, respectively, related to the second mortgage. We did not include this note receivable in the determination of the gain recognized upon sale of the portfolio. Therefore, this note receivable is not reflected in “ Mortgage and other notes receivable, net ” in the Condensed Consolidated Balance Sheets as of September 30, 2023 and December 31, 2022. During the three and nine months ended September 30, 2023, Bickford repaid $0.1 million and $0.3 million of principal, respectively, on this note receivable which is reflected in “ Gains on sale of real estate, net ” in the Condensed Consolidated Statements of Income. As noted previously, we designated a mortgage note receivable of $2.1 million due from Bickford as non-performing during the third quarter of 2023. Senior Living We have provided a $20.0 million revolving line of credit to Senior Living whose borrowings under the revolver are to be used for working capital needs and to finance construction projects within its portfolio, including building additional units. Beginning January 1, 2025, availability under the revolver will reduce to $15.0 million. The revolver matures in December 2029 at the time of lease maturity. At September 30, 2023, the $16.3 million outstanding under the revolver bears interest at 8.0% per annum. The Company also has a mortgage loan of $32.7 million with Senior Living that originated in July 2019 for the acquisition of a 248-unit continuing care retirement community (“CCRC”) in Columbia, South Carolina. The mortgage loan is for a term of five years with two one-year extensions and carries an interest rate of 7.25%. Additionally, the loan conveys to NHI a purchase option at a stated minimum price of $38.3 million, subject to adjustment for market conditions. Credit Loss Reserve Our principal measures of credit quality, except for construction mortgages, are debt service coverage for amortizing loans and interest or fixed charge coverage for non-amortizing loans, collectively referred to as “Coverage.” A Coverage ratio provides a measure of the borrower’s ability to make scheduled principal and interest payments. The Coverage ratios presented in the table below have been calculated utilizing the most recent date for which data is available, June 30, 2023, using EBITDARM (earnings before interest, taxes, depreciation, amortization, rent and management fees) and the requisite debt service, interest service or fixed charges, as defined in the applicable loan agreement. We categorize Coverage into three levels: (i) more than 1.5x, (ii) between 1.0x and 1.5x, and (iii) less than 1.0x. We update the calculation of Coverage on a quarterly basis. Coverage is not a meaningful credit quality indicator for construction mortgages as either these developments are not generating any operating income, or they have insufficient operating income as occupancy levels necessary to stabilize the properties have not yet been achieved. We measure credit quality for these mortgages by considering the construction and stabilization timeline and the financial condition of the borrower as well as economic and market conditions. We consider the guidance in ASC 310-20, Receivables - Nonrefundable Fees and Other Costs, when determining whether a modification, extension or renewal constitutes a current period origination. The credit quality indicator as of September 30, 2023, is presented below for the amortized cost, net by year of origination ( $ in thousands ): 2023 2022 2021 2020 2019 Prior Total Mortgages more than 1.5x $ — $ 68,463 $ — $ 22,307 $ — $ 2,641 $ 93,411 between 1.0x and 1.5x — — — — 32,700 14,700 47,400 less than 1.0x — — — — 6,423 — 6,423 — 68,463 — 22,307 39,123 17,341 147,234 Mezzanine more than 1.5x 496 — 16,526 — — — 17,022 between 1.0x and 1.5x 216 — 23,943 — — — 24,159 less than 1.0x — — — — — 25,000 25,000 712 — 40,469 — — 25,000 66,181 Non-performing less than 1.0x — — — 2,127 — 24,500 26,627 — — — 2,127 — 24,500 26,627 Revolver between 1.0x and 1.5x 18,726 18,726 Credit loss reserve (15,808) $ 242,960 Due to the continuing challenges in financial markets and the potential impact on the collectability of our mortgages and other notes receivable, we forecasted a 20% increase in the probability of a default and a 20% increase in the amount of loss from a default on all loans, other than those designated as non-performing, resulting in an effective adjustment of 44%. The methodology for estimating the reserves for non-performing loans incorporates the sufficiency of the underlying collateral and the current conditions and forecasts of future economic conditions of these loans, including qualitative factors, which may differ from conditions existing in the historical period. The allowance for expected credit losses is presented in the following table for the nine months ended September 30, 2023 ( $ in thousands ): Beginning balance at January 1, 2023 $ 15,338 Provision for expected credit losses 470 Balance at September 30, 2023 $ 15,808

Senior Housing Operating Portfo

Senior Housing Operating Portfolio Formation Activities	9 Months Ended
	Sep. 30, 2023
Senior Housing Operating Portfolio Formation Activities [Abstract]
Senior Housing Operating Portfolio Formation Activities	Senior Housing Operating Portfolio Formation Activities Effective April 1, 2022 we transitioned the operations of 15 ILFs previously leased pursuant to a triple-net lease into two new ventures comprising our SHOP activities. These new ventures, consolidated by the Company, are structured to comply with REIT requirements and utilize the TRS for activities that would otherwise be non-qualifying for REIT purposes. The properties in each venture are operated by a property manager in exchange for a management fee. The equity structure of these ventures is comprised of preferred and common equity interests. The Company owns 100% of the preferred equity interests in these ventures with an annual fixed preferred return of approximately $10.2 million as of September 30, 2023. Additionally, the managers, or related parties of the managers, own common equity interests in their respective ventures. Each venture is discussed in more detail below. Merrill Managed Portfolio We transferred six ILFs located in California and Washington into a consolidated venture with Merrill. Merrill initially contributed $10.6 million in cash for its 20% common equity interest in the venture. In the second quarter of 2023, the members of this venture contributed an additional $4.6 million to fund additional capital expenditures, of which Merrill contributed $0.9 million in cash in accordance with its common equity interest percentage in the venture. The operating agreement for the venture provides for contingent distributions to the members based on the attainment of certain yields on investment calculated on an annual basis. The properties are managed by Merrill pursuant to a management agreement with an initial term through March 2032 that automatically renews on a year-to-year basis thereafter unless terminated by either party with notice. The management agreement entitles Merrill to a base management fee of 5% of net revenue and a real estate services fee of 5% of real estate costs incurred during any calendar year that exceed $1,000 times the number of units at each facility. Given certain provisions of the operating agreement, including provisions related to a Company change in control, the noncontrolling interest associated with the venture was determined to be contingently redeemable and classified in mezzanine equity, as discussed further in Note 10. Discovery Managed Portfolio We transferred nine ILFs located in Arkansas, Georgia, Ohio, Oklahoma, New Jersey, and South Carolina into a consolidated venture with the Discovery member, a related party of Discovery. The Discovery member contributed $1.1 million in cash for its 2% common equity interest in the venture. In October 2023, the members contributed an additional $2.6 million to fund additional capital expenditures, which was funded in cash in accordance with each member’s common equity interest percentage in the venture. The operating agreement for the venture provides for contingent distributions to the members based on the attainment of certain yields on investment calculated on an annual basis. The noncontrolling interest is included in “ Equity ” on the Condensed Consolidated Balance Sheets as of September 30, 2023 and December 31, 2022. The properties are managed by separate related parties of Discovery pursuant to management agreements, each with an initial term through March 2032 that automatically renews on a year-to-year basis thereafter unless terminated by either party with notice. The management agreements entitle the managers to a base management fee of 5% of net revenue.

Equity Method Investment

Equity Method Investment	9 Months Ended
	Sep. 30, 2023
Equity Method Investments and Joint Ventures [Abstract]
Equity Method Investment	Equity Method Investment Concurrently with the acquisition of a CCRC from LCS-Westminster Partnership III, LLP in January 2020, we invested $0.9 million in the operating company, Timber Ridge OpCo, representing a 25% equity interest. This investment is held by our TRS to be compliant with the provisions of the REIT Investment Diversification and Empowerment Act of 2007. As part of our investment, we provided Timber Ridge OpCo a revolving credit facility of up to $5.0 million of which no funds have been drawn. We account for our investment in Timber Ridge OpCo under the equity method and decrease the carrying value of our investment for losses in the entity and distributions to NHI for cumulative amounts up to and including our basis plus any guaranteed or implied commitments to fund operations. In February 2023, we received $2.5 million from Timber Ridge OpCo representing the Company’s proportionate share of the lease incentive earned, as discussed in Note 7, based on its equity interest in the entity. Our guaranteed and implied commitments are currently limited to the additional $5.0 million under the revolving credit facility and the $2.5 million lease incentive distribution received. As of September 30, 2023, we have recognized our share of Timber Ridge OpCo’s operating losses in excess of our initial investment. These cumulative losses of $5.0 million in excess of our original basis and the $2.5 million lease incentive distribution received are included in “ Accounts payable and accrued expenses ” in our Condensed Consolidated Balance Sheet as of September 30, 2023. Excess unrecognized equity method losses for the three and nine months ended September 30, 2023 were $0.6 million and $1.9 million, respectively, and $0.9 million and $2.6 million for the three and nine months ended September 30, 2022, respectively. Cumulative unrecognized losses were $7.8 million through September 30, 2023. We recognized gains of approximately $0.6 million, representing cash distributions received related to our investment in Timber Ridge OpCo for the nine months ended September 30, 2022. The Timber Ridge property is subject to early resident mortgages secured by a Deed of Trust and Indenture of Trust (the “Deed and Indenture”). As part of our acquisition, NHI-LCS JV I, LLC (“Timber Ridge PropCo”) acquired the Timber Ridge CCRC property and a subordination agreement was entered into pursuant to which the trustee acknowledged and confirmed that the security interests created under the Deed and Indenture were subordinate to any security interests granted in connection with the loan made by NHI to Timber Ridge PropCo. In addition, under the terms of the resident loan assumption agreement, during the term of the lease (seven years with two renewal options), Timber Ridge OpCo is to indemnify Timber Ridge PropCo for any repayment by Timber Ridge PropCo of these liabilities under the guarantee. As a result of the subordination agreement and the resident loan assumption agreements, no liability has been recorded as of September 30, 2023. The balance secured by the Deed and Indenture was $12.5 million at September 30, 2023.

Other Assets

Other Assets	9 Months Ended
	Sep. 30, 2023
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]
Other Assets	Other Assets Other assets, net consist of the following ( $ in thousands ): September 30, 2023 December 31, 2022 SHOP accounts receivable, net of allowance of $352 and $375, and other assets $ 792 $ 1,341 Real estate investments accounts receivable and prepaid expenses 4,383 3,621 Lease incentive payments, net 11,392 3,190 Regulatory escrows 6,208 6,208 Restricted cash 1,916 2,225 $ 24,691 $ 16,585 In February 2023, Timber Ridge PropCo, the consolidated senior housing partnership with LCS that owns the Timber Ridge CCRC, paid a $10.0 million lease incentive earned by Timber Ridge OpCo. The lease incentive is being amortized on a straight-line basis through the remaining initial lease term ending January 2027.

Debt

Debt	9 Months Ended
	Sep. 30, 2023
Debt Instruments [Abstract]
Debt	Debt Debt consists of the following ( $ in thousands ): September 30, December 31, Revolving credit facility - unsecured $ 205,000 $ 42,000 Bank term loans - unsecured 200,000 240,000 2031 Senior Notes - unsecured, net of discount of $2,358 and $2,600 397,642 397,400 Private placement notes - unsecured 275,000 400,000 Fannie Mae term loans - secured, non-recourse 76,345 76,649 Unamortized loan costs (9,549) (8,538) $ 1,144,438 $ 1,147,511 Aggregate principal maturities of debt as of September 30, 2023 are as follows ( $ in thousands ): Remainder of 2023 $ 50,104 2024 75,425 2025 325,816 2026 205,000 2027 100,000 2028 — Thereafter 400,000 1,156,345 Less: discount (2,358) Less: unamortized loan costs (9,549) $ 1,144,438 Unsecured revolving credit facility and bank term loans On March 31, 2022, we entered into an unsecured revolving credit agreement (the “2022 Credit Agreement”) providing us with a $700.0 million unsecured revolving credit facility, replacing our previous $550.0 million unsecured revolver. The 2022 Credit Agreement matures in March 2026, but may be extended at our option, subject to the satisfaction of certain conditions, for two additional six-month periods. Borrowings under the 2022 Credit Agreement bear interest, at our election, at one of the following (i) Term Secured Overnight Financing Rate (“SOFR”) (plus a credit spread adjustment) plus a margin ranging from 0.725% to 1.40%, (ii) Daily SOFR (plus a credit spread adjustment) plus a margin ranging from 0.725% to 1.40% or (iii) the base rate plus a margin ranging from 0.00% to 0.40%. In each election, the actual margin is determined according to our credit ratings. The base rate means, for any day, a fluctuating rate per annum equal to the highest of (i) the agent’s prime rate, (ii) the federal funds rate on such day plus 0.50% or (iii) the adjusted Term SOFR for a one-month tenor in effect on such day plus 1.0%. In addition, the 2022 Credit Agreement requires a facility fee equal to 0.125% to 0.30%, based on our credit rating. In the first quarter of 2023, we repaid $20.0 million of a term loan with a maturity of September 2023 (the “2023 Term Loan”). In June 2023, we entered into a two-year $200.0 million term loan agreement (the “2025 Term Loan”) bearing interest at a variable rate which is SOFR-based with a margin determined according to our credit ratings plus a 0.10% credit spread adjustment. The Company incurred approximately $2.7 million of deferred financing cost associated with this loan. The 2025 Term Loan proceeds were used to repay a portion of the remaining $220.0 million 2023 Term Loan balance, which was repaid in full in June 2023. The 2023 Term Loan accrued interest on borrowings consistent with the new 2025 Term Loan. Upon repayment, we expensed approximately $0.1 million of unamortized loan costs associated with this loan which are included in “ Loss on early retirement of debt ”. At September 30, 2023, we had $495.0 million available to draw on the revolving portion of our credit facility, subject to usual and customary covenants. Among other stipulations, the unsecured credit facility agreement requires that we maintain certain financial ratios within limits set by our creditors. At September 30, 2023, we were in compliance with these ratios. Pinnacle Bank is a participating member of our banking group. A member of NHI’s Board of Directors and chairperson of the Audit Committee of the Board of Directors is also the chairman of Pinnacle Financial Partners, Inc., the holding company for Pinnacle Bank. NHI’s local banking transactions are conducted primarily through Pinnacle Bank. 2031 Senior Notes In January 2021, we issued $400.0 million aggregate principal amount of 3.00% senior notes that mature on February 1, 2031 and pay interest semi-annually (the “2031 Senior Notes”). The 2031 Senior Notes were sold at an issue price of 99.196% of face value before the underwriters’ discount. Our net proceeds from the 2031 Senior Notes offering, after deducting underwriting discounts and expenses, were approximately $392.3 million. The 2031 Senior Notes are subject to affirmative and negative covenants, including financial covenants with which we were in compliance at September 30, 2023. Private Placement Notes In January 2023, we repaid the $125.0 million of the private placement notes due January 2023 primarily with proceeds from the revolving credit facility. Our remaining unsecured private placement notes as of September 30, 2023, payable interest-only, are summarized below ( $ in thousands ): Amount Inception Maturity Fixed Rate $ 50,000 November 2015 November 2023 3.99% 75,000 September 2016 September 2024 3.93% 50,000 November 2015 November 2025 4.33% 100,000 January 2015 January 2027 4.51% $ 275,000 In November 2023, the $50.0 million of private placement notes due November 2023 were repaid primarily with proceeds from the revolving credit facility. Covenants pertaining to the private placement notes are generally conformed with those governing our credit facility, except for specific debt-coverage ratios that are more restrictive. Our unsecured private placement notes include a rate increase provision that is effective if any rating agency lowers our credit rating on our senior unsecured debt below investment grade and our compliance leverage increases to 50% or more. Fannie Mae Term Loans As of September 30, 2023, we had $60.1 million in Fannie Mae term-debt financing, that originated in March 2015, requiring interest-only payments at an annual rate of 3.79% with a 10-year maturity. The mortgages are non-recourse and secured by 11 properties leased to Bickford. In a December 2017 acquisition, we assumed additional Fannie Mae debt that amortizes through 2025 when a balloon payment will be due, is subject to prepayment penalties until 2024, bears interest at a rate of 4.6%, and has a remaining balance of $16.2 million at September 30, 2023. Collectively, the Fannie Mae debt is secured by properties having a net book value of $101.7 million at September 30, 2023. Interest Expense The following table summarizes interest expense ($ in thousands ): Three Months Ended Nine Months Ended September 30, September 30, 2023 2022 2023 2022 Interest expense on debt at contractual rates $ 14,387 $ 10,821 $ 41,439 $ 30,640 Capitalized interest (21) (18) (61) (28) Amortization of debt issuance costs, debt discount and other 720 609 1,930 1,860 Total interest expense $ 15,086 $ 11,412 $ 43,308 $ 32,472

Commitments. Contingencies and

Commitments. Contingencies and Uncertainties	9 Months Ended
	Sep. 30, 2023
Commitments and Contingencies Disclosure [Abstract]
Commitments, Contingencies and Uncertainties	Commitments, Contingencies and Uncertainties In the normal course of business, we enter into a variety of commitments, typically consisting of funding revolving credit arrangements, construction and mezzanine loans to our operators to conduct expansions and acquisitions for their own account, and commitments for the funding of construction for expansion or renovation to our existing properties under lease. In our leasing operations, we offer to our tenants and to sellers of newly acquired properties a variety of inducements that originate contractually as contingencies but which may become commitments upon the satisfaction of the contingent event. Contingent payments earned will be included in the respective lease bases when funded. As of September 30, 2023, we had working capital, construction and mezzanine loan commitments to six operators or borrowers for an aggregate of $145.4 million, of which we had funded $102.0 million toward these commitments. Loan funded amounts do not reflect the effects of discounts or commitment fees. As of September 30, 2023, we had $23.2 million of development commitments for construction and renovation for seven properties of which we had funded $18.8 million toward these commitments. One of our consolidated real estate partnerships, NHI REIT of DSL PropCo, LLC, has committed to fund up to $2.0 million toward the purchase of condominium units located at one of the facilities of which $1.0 million had been funded as of September 30, 2023. As of September 30, 2023, we had an aggregate of $13.9 million in remaining contingent lease inducement commitments in five lease agreements which are generally based on the performance of facility operations and may or may not be met by the tenant. In the nine months ended September 30, 2023, we funded $10.0 million to Timber Ridge OpCo based upon the achievement of all performance conditions as discussed in Note 7. The credit loss liability for unfunded loan commitments is estimated using the same methodology as used for our funded mortgage and other notes receivable based on the estimated amount that we expect to fund. We applied the same market adjustments as discussed in Note 4. The liability for expected credit losses on our unfunded loans reflected in “ Accounts payable and accrued expenses ” on the Condensed Consolidated Balance Sheets as of September 30, 2023 and December 31, 2022 is presented in the following table for the nine months ended September 30, 2023 ( $ in thousands ): Beginning balance January 1, 2023 $ 683 Provision for expected credit losses (385) Balance at September 30, 2023 $ 298 The disposal transactions for three Bickford properties in 2022 included $2.4 million in contingent consideration representing cash placed in escrow to be returned to the buyers to the extent the sold properties generate negative monthly cash flows over the twelve months following the dates of sale. As of September 30, 2023, all the escrowed funds were returned to the buyers. COVID-19 Pandemic Contingencies Rental income for the three and nine months ended September 30, 2023 includes $2.1 million and $5.5 million, respectively, related to repayments and other reductions of pandemic-related rent deferrals. Rental income for the nine months ended September 30, 2023 includes the $2.5 million in reduced pandemic-related rent deferrals in connection with the acquisition in the first quarter of 2023 of the ALF located in Chesapeake, Virginia discussed in Note 3. There were no pandemic-related rent concessions granted for the three and nine months ended September 30, 2023. As of September 30, 2023, aggregate pandemic-related rent concessions granted to tenants that were initially accounted for as variable lease payments totaled approximately $26.9 million, net of cumulative repayments and other reductions of $9.2 million and excluding any interest accrued. There were no pandemic-related rent concessions granted for the three months ended September 30, 2022. Pandemic-related rent concessions granted for the nine months ended September 30, 2022 totaled approximately $10.7 million, of which Bickford accounted for approximately $5.5 million.

Redeemable Noncontrolling Inter

Redeemable Noncontrolling Interests	9 Months Ended
	Sep. 30, 2023
Noncontrolling Interest [Abstract]
Redeemable Noncontrolling Interests	Redeemable Noncontrolling Interest The interest held by Merrill in its SHOP venture was classified as a “ Redeemable noncontrolling interest ” in the mezzanine section between “ Total liabilities” and “ Stockholders’ equity ” on our Condensed Consolidated Balance Sheets as of September 30, 2023 and December 31, 2022. Certain provisions within the operating agreement of the Merrill venture provide Merrill with put rights upon certain contingent events that are not solely within the control of the Company. Therefore, Merrill’s noncontrolling interest was determined to be contingently redeemable. The redeemable noncontrolling interest is not currently redeemable and we concluded a contingent redemption event is not probable to occur as of September 30, 2023. Consequently, the noncontrolling interest will not be subsequently remeasured to its redemption amount until such contingent event and the related redemption are probable to occur. We will continue to reflect the attribution of gains or losses to the redeemable noncontrolling interest each period. The following table presents the change in “ Redeemable noncontrolling interest” for the nine months ended September 30, 2023 ( $ in thousands ): Nine Months Ended September 30, 2023 Balance at January 1, $ 9,825 Contributions 922 Net loss (825) Balance at September 30, $ 9,922

Equity and Dividends

Equity and Dividends	9 Months Ended
	Sep. 30, 2023
Equity [Abstract]
Equity and Dividends	Equity and Dividends Share Repurchase Plan On February 17, 2023, our Board of Directors authorized a revised stock repurchase program (the “Revised Repurchase Plan”) pursuant to which we may purchase up to $160.0 million in shares of our issued and outstanding common stock, par value $0.01 per share. The Revised Repurchase Plan is effective for a period of one year and does not require us to repurchase any specific number of shares. The Revised Repurchase Plan may be suspended or discontinued at any time. Shares may be repurchased from time-to-time in open market transactions at prevailing market prices, in privately negotiated transactions or by other means in accordance with the terms of Rule 10b-18 of the Securities Exchange Act of 1934, as amended, and repurchases shall be made in accordance with all applicable laws and regulations in effect. The timing and number of shares repurchased, if any, will depend on a variety of factors, including price, general market and economic conditions, alternative investment opportunities and other corporate considerations. No common stock was repurchased during the three and nine months ended September 30, 2023. During 2022, cumulative repurchases through open market transactions totaled 2,468,354 shares of common stock for approximately $151.6 million. All shares received were constructively retired upon receipt, and reflected as a reduction to “ Retained earnings ” in the Condensed Consolidated Balance Sheet as of December 31, 2022. In March 2023, we renewed our automatic “shelf” registration statement on Form S-3 and concurrently entered into a new equity distribution agreement whereby we can sell up to $500.0 million in common stock through an at-the-market (“ATM”) equity program. We incurred approximately $0.5 million in costs for these programs. Dividends The following table summarizes dividends declared by the Board of Directors or paid during the nine months ended September 30, 2023 and 2022: Nine Months Ended September 30, 2023 Date of Declaration Date of Record Date Paid/Payable Quarterly Dividend November 6, 2022 December 30, 2022 January 27, 2023 $0.90 February 17, 2023 March 31, 2023 May 5, 2023 $0.90 May 5, 2023 June 30, 2023 August 4, 2023 $0.90 August 4, 2023 September 29, 2023 November 3, 2023 $0.90 Nine Months Ended September 30, 2022 Date of Declaration Date of Record Date Paid/Payable Quarterly Dividend November 5, 2021 December 31, 2021 January 31, 2022 $0.90 February 16, 2022 March 31, 2022 May 6, 2022 $0.90 May 6, 2022 June 30, 2022 August 5, 2022 $0.90 August 5, 2022 September 30, 2022 November 4, 2022 $0.90 On November 3, 2023, the Board of Directors declared a $0.90 per share dividend payable to common stockholders of record on December 29, 2023, payable on January 26, 2024.

Share-Based Compensation

Share-Based Compensation	9 Months Ended
	Sep. 30, 2023
Share-Based Payment Arrangement [Abstract]
Stock-Based Compensation	Share-Based Compensation The Company’s outstanding stock incentive awards have been granted under two incentive plans – the 2012 Stock Incentive Plan and the 2019 Stock Incentive Plan, which was amended and restated in May 2023 (collectively, the “2019 Plan”). During the nine months ended September 30, 2023, we granted options to purchase 385,500 shares of common stock under the 2019 Plan. The amendment and restatement of the 2019 Plan, which was approved by stockholders in May 2023, increased the number of shares of common stock authorized for issuance under the 2019 Plan from 3,000,000 to 6,000,000 and added the ability of the Company to award shares of restricted stock and restricted stock units subject to such conditions and restrictions as the Company may determine. In May 2023, 21,000 shares of restricted stock were issued to executive officers with a grant date fair value of $49.30 per share based on the market value of our common stock on the date of grant. The restricted stock will vest over five years, with 20% vesting on each anniversary of the date of grant. The restricted stock awards contain non-forfeitable rights to dividends or dividend equivalents during the vesting periods. The weighted average fair value of options granted during the nine months ended September 30, 2023 and 2022 was $10.56 and $11.92 per option, respectively. The fair value of each grant is estimated on the date of grant using the Black-Scholes option-pricing model with the following weighted average assumptions: 2023 2022 Dividend yield 6.9% 7.0% Expected volatility 39.0% 49.3% Expected lives 2.9 years 2.9 years Risk-free interest rate 4.56% 1.75% The following table summarizes our outstanding stock options: Weighted Average Number Weighted Average Remaining of Shares Exercise Price Contractual Life (Years) Options outstanding, January 1, 2022 1,652,505 $78.10 Options granted 718,000 $53.62 Options exercised (56,832) $53.41 Options forfeited (23,000) $62.33 Options expired (74,498) $77.93 Options outstanding, September 30, 2022 2,216,175 $70.97 Exercisable at September 30, 2022 1,695,155 $74.73 Options outstanding, January 1, 2023 2,216,175 $70.97 Options granted 385,500 $54.73 Options exercised (5,166) $53.41 Options forfeited (61,168) $66.44 Options expired (88,170) $64.33 Options outstanding, September 30, 2023 2,447,171 $68.80 2.51 Exercisable at September 30, 2023 2,078,827 $71.40 2.25 At September 30, 2023, there was no intrinsic value of stock options outstanding and exercisable. The aggregate intrinsic value of stock options exercised during the nine months ended September 30, 2023 and 2022 was $1.23 per share or less than $0.1 million and $4.94 per share or $0.1 million, respectively. The following is a summary of share-based compensation expense, net of any forfeitures, included in “ General and administrative expenses ” in the Condensed Consolidated Statements of Income ( $ in thousands ): Three Months Ended Nine Months Ended September 30, September 30, 2023 2022 2023 2022 Share-based compensation components: Restricted stock expense $ 119 $ — $ 191 $ — Stock option expense 747 1,065 3,549 7,576 Total share-based compensation expense $ 866 $ 1,065 $ 3,740 $ 7,576 As of September 30, 2023, unrecognized compensation expense totaling $2.7 million associated with stock-based awards is expected to be recognized over the following periods: remainder of 2023 - $0.9 million, 2024 - $1.3 million, 2025 - $0.3 million, 2026 - $0.1 million, and thereafter - $0.1 million.

Earnings Per Common Share

Earnings Per Common Share	9 Months Ended
	Sep. 30, 2023
Earnings Per Share [Abstract]
Earnings Per Common Share	Earnings Per Common Share The following table summarizes the average number of common shares and the net income used in the calculation of basic and diluted earnings per common share ($ in thousands, except share and per share amounts) : Three Months Ended Nine Months Ended September 30, September 30, 2023 2022 2023 2022 Net income $ 29,033 $ 34,229 $ 102,662 $ 63,941 Add: net loss attributable to noncontrolling interests 313 239 946 599 Net income attributable to stockholders 29,346 34,468 103,608 64,540 Less: net income attributable to unvested restricted stock awards (19) — (38) — Net income attributable to common stockholders - basic $ 29,327 $ 34,468 $ 103,570 $ 64,540 BASIC: Weighted average common shares outstanding 43,388,841 44,339,975 43,388,779 45,236,696 DILUTED: Weighted average common shares outstanding 43,388,841 44,339,975 43,388,779 45,236,696 Stock options — 62,607 896 24,427 Weighted average dilutive common shares outstanding 43,388,841 44,402,582 43,389,675 45,261,123 Earnings per common share - basic $ 0.68 $ 0.78 $ 2.39 $ 1.43 Earnings per common share - diluted $ 0.68 $ 0.78 $ 2.39 $ 1.43 Incremental anti-dilutive shares excluded: Net share effect of stock options with an exercise price in excess of the average market price for our common shares 816,353 390,159 781,727 501,183 Regular dividends declared per common share $ 0.90 $ 0.90 $ 2.70 $ 2.70

Fair Value of Financial Instrum

Fair Value of Financial Instruments	9 Months Ended
	Sep. 30, 2023
Fair Value Disclosures [Abstract]
Fair Value of Financial Instruments	Fair Value of Financial Instruments Carrying amounts and fair values of financial instruments that are not carried at fair value at September 30, 2023 and December 31, 2022 in the Condensed Consolidated Balance Sheets are as follows ($ in thousands ): Carrying Amount Fair Value Measurement September 30, 2023 December 31, 2022 September 30, 2023 December 31, 2022 Level 2 Variable rate debt $ 399,233 $ 277,699 $ 405,000 $ 282,000 Fixed rate debt $ 745,205 $ 869,812 $ 642,539 $ 773,994 Level 3 Mortgage and other notes receivable, net $ 242,960 $ 233,141 $ 228,282 $ 227,611 Fixed rate debt. Fixed rate debt is classified as Level 2 and its fair value is based on quoted prices for similar instruments or calculated utilizing model derived valuations in which significant inputs are observable in active markets. Variable rate debt. Variable rate debt is classified as Level 2 and the fair values of our borrowings under our revolving credit facility and other variable rate debt are reasonably estimated at their notional amounts due to the predominance of floating interest rates, which generally reflect market conditions. Mortgage and other notes receivable. The fair value of mortgage and other notes receivable is based on credit risk and discount rates that are not observable in the marketplace and therefore represents a Level 3 measurement.

Segment Reporting

Segment Reporting	9 Months Ended
	Sep. 30, 2023
Segment Reporting [Abstract]
Segment Reporting	Segment Reporting We evaluate our business and make resource allocations on our two operating segments: Real Estate Investments and SHOP. Our Real Estate Investments segment includes leases, mortgages and other note investments in ILFs, ALFs, EFCs, SLCs, SNFs and a HOSP. Under the Real Estate Investments segment, we invest in senior 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 properties. The SHOP segment includes multi-tenant ILFs. The SHOP properties and related operations are controlled by the Company and are operated by property managers in exchange for a management fee. See Note 5 for further discussion. We formed the SHOP segment effective April 1, 2022 upon termination of the triple-net lease for the legacy Holiday Retirement portfolio at which time the operations and properties of 15 ILFs were transferred into two separate ventures, as discussed further in Note 5. The results associated with the prior triple-net lease structure for these properties are included in the Real Estate Investments segment and the results from operating these SHOP properties after the transition are included in our SHOP segment. There is no impact to the prior year’s presentation. Our chief operating decision maker evaluates performance based upon segment net operating income (“NOI”). We define NOI as total revenues, less tenant reimbursements and property operating expenses. We use NOI to make decisions about resource allocations and to assess the property level performance of our properties. There were no intersegment transactions for either the three or nine months ended September 30, 2023 and 2022. Capital expenditures for the nine months ended September 30, 2023 were approximately $56.5 million for the Real Estate Investments segment and $6.3 million for the SHOP segment. Capital expenditures for the nine months ended September 30, 2022 were approximately $7.6 million for the Real Estate Investments segment and $1.8 million for the SHOP segment. Non-segment revenue consists mainly of 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 discussed in Note 2. 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. Summary information for the reportable segments during the three and nine months ended September 30, 2023 and 2022 is as follows ( $ in thousands ): For the three months ended September 30, 2023: Real Estate Investments SHOP Non-segment/Corporate Total Rental income $ 62,255 $ — $ — $ 62,255 Resident fees and services — 12,367 — 12,367 Interest income and other 5,337 — 147 5,484 Total revenues 67,592 12,367 147 80,106 Senior housing operating expenses — 10,045 — 10,045 Taxes and insurance on leased properties 2,908 — — 2,908 NOI 64,684 2,322 147 67,153 Depreciation 15,211 2,292 12 17,515 Interest 773 — 14,313 15,086 Legal — — 67 67 Franchise, excise and other taxes — — 2 2 General and administrative — — 4,430 4,430 Loan and realty losses 1,959 — — 1,959 Gains on sales of real estate, net (737) — — (737) Other non-operating income (202) — — (202) Net income (loss) $ 47,680 $ 30 $ (18,677) $ 29,033 Total assets $ 2,218,699 $ 277,014 $ 3,377 $ 2,499,090 For the three months ended September 30, 2022: Real Estate Investments SHOP Non-segment/Corporate Total Rental income $ 59,394 $ — $ — $ 59,394 Resident fees and services — 12,013 — 12,013 Interest income and other 4,820 — 71 4,891 Total revenues 64,214 12,013 71 76,298 Senior housing operating expenses — 9,239 — 9,239 Taxes and insurance on leased properties 2,358 — — 2,358 NOI 61,856 2,774 71 64,701 Depreciation 15,390 2,129 14 17,533 Interest 837 — 10,575 11,412 Legal — — 88 88 Franchise, excise and other taxes — — 225 225 General and administrative — — 4,744 4,744 Loan and realty losses 11,329 — — 11,329 Gains on sales of real estate, net (14,840) — — (14,840) Gain on operations transfer, net (19) — — (19) Net income (loss) $ 49,159 $ 645 $ (15,575) $ 34,229 Total assets $ 2,214,475 $ 290,708 $ 3,602 $ 2,508,785 For the nine months ended September 30, 2023: Real Estate Investments SHOP Non-segment/Corporate Total Rental income $ 188,505 $ — $ — $ 188,505 Resident fees and services — 35,860 — 35,860 Interest income and other 15,727 — 278 16,005 Total revenues 204,232 35,860 278 240,370 Senior housing operating expenses — 29,525 — 29,525 Taxes and insurance on leased properties 8,738 — — 8,738 NOI 195,494 6,335 278 202,107 Depreciation 46,064 6,757 41 52,862 Interest 2,298 — 41,010 43,308 Legal — — 364 364 Franchise, excise and other taxes — — 443 443 General and administrative — — 14,390 14,390 Loan and realty losses 1,727 — — 1,727 Gains on sales of real estate, net (13,500) — — (13,500) Gain on operations transfer, net (20) — — (20) Other non-operating income (202) — — (202) Loss on early retirement of debt — — 73 73 Net income (loss) $ 159,127 $ (422) $ (56,043) $ 102,662 For the nine months ended September 30, 2022: Real Estate Investments SHOP Non-segment/Corporate Total Rental income $ 163,935 $ — $ — $ 163,935 Resident fees and services — 24,005 — 24,005 Interest income and other 19,362 — 222 19,584 Total revenues 183,297 24,005 222 207,524 Senior housing operating expenses — 18,352 — 18,352 Taxes and insurance on leased properties 7,553 — — 7,553 NOI 175,744 5,653 222 181,619 Depreciation 49,282 4,245 50 53,577 Interest 2,371 — 30,101 32,472 Legal — — 2,254 2,254 Franchise, excise and other taxes — — 694 694 General and administrative — — 17,893 17,893 Loan and realty losses 39,951 — — 39,951 Gains on sales of real estate, net (28,342) — — (28,342) Loss on operations transfer, net 710 — — 710 Gain on note receivable payoff (1,113) — — (1,113) Loss on early retirement of debt — — 151 151 Gains from equity method investment (569) — — (569) Net income (loss) $ 113,454 $ 1,408 $ (50,921) $ 63,941

Unconsolidated Variable Interes

Unconsolidated Variable Interest Entities	9 Months Ended
	Sep. 30, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Unconsolidated Variable Interest Entities	Unconsolidated Variable Interest EntitiesThe Company’s unconsolidated VIEs are summarized below by date of initial involvement. For further discussion of the nature of the relationships, including the sources of exposure to these VIEs, see the notes to our condensed consolidated financial statements cross-referenced below ( $ in thousands ). Date Name Source of Exposure Carrying Amount Maximum Exposure to Loss Note Reference 2014 Senior Living Notes and straight-line receivable $ 89,728 $ 93,478 Notes 3, 4 2016 Senior Living Management Notes $ 24,500 $ 24,500 — 2018 Bickford Notes and funding commitment $ 17,108 $ 29,816 Notes 3, 4 2019 Encore Senior Living Various 1 $ 54,161 $ 56,536 — 2020 Timber Ridge OpCo Various 2 $ 1,977 $ 6,977 Notes 6, 7 2020 Watermark Retirement Notes and straight-line receivable $ 8,921 $ 11,445 — 2021 Montecito Medical Real Estate Notes and funding commitment $ 20,514 $ 50,260 Note 4 2021 Vizion Health Notes and straight-line receivable $ 17,948 $ 17,948 — 2021 Navion Senior Solutions Various 3 $ 8,025 $ 8,025 — 2023 Kindcare Senior Living Notes 4 $ 733 $ 733 — 1 Notes, straight-line rents receivable, and lease receivables 2 Loan commitment, equity method investment, straight-line rents receivable and unamortized lease incentive 3 Notes, loan commitments, straight-line rents receivable, and unamortized lease incentive 4 Represents two mezzanine loans originated from the sales of real estate We are not obligated to provide support beyond our stated commitments to these tenants and borrowers whom we classify as VIEs, and accordingly, our maximum exposure to loss as a result of these relationships is limited to the amount of our commitments, as shown above and discussed in the notes. Economic loss on a lease, in excess of what is presented in the table above, if any, would be limited to that resulting from any period of non-payment of rent before we are able to take effective remedial action, as well as costs incurred in transitioning the lease to a new tenant. The potential extent of such loss would be dependent upon individual facts and circumstances, and is therefore not included in the table above. In the future, NHI may be deemed the primary beneficiary of the operations if the tenants or borrowers do not have adequate liquidity to accept the risks and rewards as the tenants and operators of the properties and NHI may be required to consolidate the financial position and results of operations of the tenants or borrowers into our condensed consolidated financial statements.

Pay vs Performance Disclosure

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Pay vs Performance Disclosure
Net income attributable to stockholders	$ 29,346	$ 34,468	$ 103,608	$ 64,540

Insider Trading Arrangements

Insider Trading Arrangements	3 Months Ended
	Sep. 30, 2023
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false

Basis of Presentation and Sig_2

Basis of Presentation and Significant Accounting Policies (Policy)	9 Months Ended
	Sep. 30, 2023
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with United States generally accepted accounting principles (“GAAP”) for interim financial statements. In our opinion, the accompanying unaudited condensed consolidated financial statements reflect all adjustments consisting of normal recurring adjustments necessary for a fair presentation. Interim results of operations are not necessarily indicative of the results that may be achieved for a full year. The condensed consolidated financial statements and related notes do not include all information and footnotes required by GAAP for annual reports. These interim condensed consolidated financial statements should be read in conjunction with our audited consolidated financial statements and notes thereto as of and for the year ended December 31, 2022, included in our Annual Report on Form 10-K for the year ended December 31, 2022 filed with the Securities and Exchange Commission (the “SEC”).
Principles of Consolidation	Principles of Consolidation The condensed consolidated financial statements include the accounts of the Company, and its wholly owned subsidiaries, joint ventures and subsidiaries in which we have a controlling interest. We also consolidate certain entities when control of such entities can be achieved through means other than voting rights (“variable interest entities” or “VIEs”) if the Company is deemed to be the primary beneficiary of such entities. All material intercompany transactions and balances are eliminated in consolidation. Effective April 1, 2022 and at September 30, 2023, our consolidated total assets and liabilities include two consolidated ventures comprising our SHOP activities, each formed with a separate partner - Merrill Gardens, L.L.C. (“Merrill”) and DSHI NHI Holiday LLC (the “Discovery member”), a related party of Discovery Senior Living (“Discovery”). We consider both ventures to be VIEs as the members of each, as a group, lack the characteristics of a controlling financial interest. We are deemed to be the primary beneficiary of each VIE because we have the ability to control the activities that most significantly impact each VIE’s economic performance. The assets of the ventures primarily consist of real estate properties, cash and cash equivalents, and resident fees and services (accounts receivable). The obligations of the ventures primarily consist of operating expenses of the ILFs (accounts payable and accrued expenses) and capital expenditures for the properties. Aggregate assets of the consolidated SHOP ventures that can be used only to settle obligations of each respective SHOP venture primarily include approximately $260.1 million of real estate properties, net, $6.0 million of cash and cash equivalents, $2.0 million of prepaid expenses and other, and $0.6 million of accounts receivable, net. Liabilities of the consolidated SHOP ventures for which creditors do not have recourse to the general credit of the Company are $5.0 million. Reference Notes 5 and 10 for further discussion of these ventures. We also consolidate two real estate partnerships formed with our partners, Discovery Senior Housing Investor XXIV, LLC, a related party of Discovery, beginning in June 2019, and LCS Timber Ridge LLC (“LCS”), beginning in January 2020, to invest in senior housing facilities. We consider both partnerships to be VIEs, as either the members, as a group, lack the characteristics of a controlling financial interest or the total equity at risk is insufficient to finance activities without additional subordinated financial support. NHI directs the activities that most significantly impact economic performance of these partnerships, subject to limited protective rights extended to our partners for specified business decisions. Because of our control of these partnerships, we include their assets, liabilities, noncontrolling interests and operations in our condensed consolidated financial statements. The aggregate assets of these consolidated real estate partnerships that can be used only to settle obligations of each respective partnership include approximately $254.5 million of real estate properties, net, $9.7 million in straight-line rents receivable, $8.5 million of other assets, net, and $2.6 million of cash and cash equivalents. Liabilities of these partnerships for which creditors do not have recourse to the general credit of the Company are not material. We use the equity method of accounting when we own an interest in an entity whereby we can exert significant influence over but cannot control the entity’s operations. We discontinue equity method accounting if our investment in an entity (and net advances) is reduced to zero unless we have guaranteed obligations of the entity or are otherwise committed to provide further financial support for the entity. Reference Note 6 for further discussion of our equity method investment. We structured our Timber Ridge OpCo, LLC (“Timber Ridge OpCo”) investment to be compliant with the provisions of the REIT Investment Diversification Empowerment Act of 2007 which permits us to receive rent payments through a triple-net lease between a property company and an operating company and allows us to receive distributions from the operating company to a taxable REIT subsidiary (“TRS”). Our TRS holds our equity interests in unconsolidated operating companies thus providing an organizational structure that allows the TRS to engage in a broad range of activities and share in revenues that are otherwise non-qualifying income under the REIT gross income tests. We have concluded that the Company is not the primary beneficiary for certain investments where we lack either directly or through related parties the power to direct the activities that most significantly impact their economic performance. Accordingly, we account for our transactions with these entities and their subsidiaries at either amortized cost or net realizable value for straight-line rents receivable, excluding our investments accounted for under the equity method. See Note 16 for information on unconsolidated VIEs.
Noncontrolling Interests	Noncontrolling Interests Contingently redeemable noncontrolling interests are recorded at their initial carrying amounts upon issuance and are subsequently adjusted to reflect their share of gains or losses and distributions attributable to the noncontrolling interests. In periods where they are or will become probable of redemption, an adjustment to the redemption value of the noncontrolling interests is also recognized through “ Capital in excess of par value
Cash and Cash Equivalents and Restricted Cash	Cash and Cash Equivalents and Restricted Cash Cash equivalents consist of all highly liquid investments with an original maturity of three months or less. Restricted cash includes amounts required to be held on deposit or subject to an agreement ( e.g ., with a qualified intermediary subject to an exchange agreement pursuant to Section 1031 of the Internal Revenue Code of 1986, as amended (the “Internal Revenue Code”) or in accordance with agency agreements governing our mortgages).
Concentration of Credit Risks	Concentration of Credit Risks Our credit risks primarily relate to cash and cash equivalents and investments in mortgage and other notes receivable. Cash and cash equivalents are primarily held in bank accounts and overnight investments. We maintain our bank deposit accounts with large financial institutions in amounts that may exceed federally insured limits. We have not experienced any losses in such accounts. Our mortgages and other notes receivable consist primarily of secured loans on facilities. Our financial instruments, principally our investments in notes receivable, are subject to the possibility of loss of the carrying values as a result of the failure of other parties to perform according to their contractual obligations which may make the instruments less valuable. We obtain collateral in the form of mortgage liens and other protective rights for notes receivable and continually monitor these rights in order to reduce such possibilities of loss. We evaluate the need to provide for reserves for potential losses on our financial instruments based on management’s periodic review of our portfolio on an instrument-by-instrument basis.
Assets Held for Sale	Assets Held for Sale We consider properties to be assets held for sale when (1) management commits to a plan to sell the property; (2) it is unlikely that the disposal plan will be significantly modified or discontinued; (3) the property is available for immediate sale in its present condition; (4) actions required to complete the sale of the property have been initiated; (5) sale of the property is probable and we anticipate the completed sale will occur within one year; and (6) the property is actively being marketed for sale at a price that is reasonable given our estimate of current market value. Upon designation of a property as an asset held for sale, we record the property’s value at the lower of its carrying value or its estimated fair value, less estimated transaction costs. Depreciation and amortization of the property are discontinued. If a property subsequently no longer meets the criteria to be classified as held for sale, it is reclassified as held and used and measured at the lower of i) its original carrying amount before the asset was classified as held for sale, adjusted for any depreciation expense not recognized while it was classified as held for sale, and ii) its fair value.
Impairment of Long-Lived Assets	Impairment of Long-Lived Assets We evaluate the recoverability of the carrying amount of our long-lived assets when events or circumstances, including significant physical changes, significant adverse changes in general economic conditions or significant deterioration of the underlying cash flows of the long-lived assets, indicate that the carrying amount of the long-lived assets may not be recoverable. The need to recognize an impairment charge is based on estimated undiscounted future cash flows compared to the carrying amount. If recognition of an impairment charge is necessary, it is measured as the amount by which the carrying amount of the property exceeds the estimated fair value of the long-lived asset.
Revenue Recognition	Revenue Recognition Rental Income - Our leases generally provide for rent escalators throughout the term of the lease. Base rental income is recognized using the straight-line method over the term of the lease to the extent that lease payments are considered collectible and the lease provides for specific contractual escalators. Under certain leases, we receive additional contingent rent, which is calculated on the increase in revenues of the tenant over a base year or base quarter. We recognize contingent rent annually or quarterly based on the actual revenues of the tenant once the target threshold has been achieved. Lease payments that depend on a factor directly related to future use of the property, such as an increase in annual revenues over a base year, are considered to be contingent rent and are excluded from the schedule of minimum lease payments. The Company reviews its operating lease receivables for collectability on a regular basis, taking into consideration changes in factors such as the tenant’s payment history, the financial condition of the tenant, business conditions in which the tenant operates and economic conditions in the area where the property is located. In the event that collectability with respect to any tenant is not probable, a direct write-off of the receivable is made as an adjustment to rental income and any future rental revenue is recognized only when the tenant makes a rental payment. As of September 30, 2023, we had three tenants, including Bickford Senior Living (“Bickford”), on the cash basis of revenue recognition for their lease arrangements. Reference Note 3 for further discussion. Resident Fees and Services - Resident fee revenue associated with our SHOP activities is recognized as the related performance obligations are satisfied and includes resident room charges, community fees and other resident charges. Residency agreements are generally short term (30 days to one year), and entitle the resident to certain room and care services for a monthly fee billed in advance. Revenue for certain related services is billed monthly in arrears. The Company has elected the lessor practical expedient within Accounting Standards Codification (“ASC”) 842, Leases, not to separate the lease and nonlease components within our resident agreements as the timing and pattern of transfer to the resident are the same. The Company has determined that the nonlease component is the predominant component within the contract and will recognize revenue under ASC 606, Revenue Recognition from Contracts with Customers.
Interest Income from Mortgage and Other Notes Receivable	Interest Income from Mortgage and Other Notes Receivable
Income Tax	Income Taxes We intend at all times to qualify as a REIT under Sections 856 through 860 of the Internal Revenue Code. Accordingly, we will generally not be subject to U.S. federal income tax, provided that we continue to qualify as a REIT and make distributions to stockholders equal to or in excess of 90% our taxable income. A failure to qualify under the applicable REIT qualification rules and regulations would have a material adverse impact on our financial position, results of operations and cash flows.
Segments	Segments We operate our business through two reportable segments: Real Estate Investments and SHOP. In our Real Estate Investments segment, we invest in (i) senior housing and healthcare real estate and lease those properties to healthcare operating companies under primarily triple-net leases that obligate tenants to pay all property-related expenses and (ii) mortgage and other notes receivable throughout the United States. Our SHOP segment is comprised of the operations of 15 ILFs located throughout the United States that are operated on behalf of the Company by independent managers pursuant to the terms of separate management agreements. Reference Notes 5 and 15 for additional information.
Earnings Per Share	Earnings Per Share Our unvested restricted stock awards contain non-forfeitable rights to dividends, and accordingly, these awards are deemed to be participating securities. Therefore, the Company applies the two-class method to calculate basic and diluted earnings. Under the two-class method, we allocate net income attributable to stockholders to common stockholders and holders of unvested
Reclassifications	Reclassifications In prior years, the Company presented " Cumulative dividends in excess of net income " as a single line item on the Condensed Consolidated Balance Sheets and the Condensed Consolidated Statements of Equity. Beginning January 1, 2023, the Company separated this line item into two components, " Retained earnings " and " Cumulative dividends, " and reclassified prior year information to conform to the current period presentation.

Basis of Presentation and Sig_3

Basis of Presentation and Significant Accounting Policies (Tables)	9 Months Ended
	Sep. 30, 2023
Accounting Policies [Abstract]
Schedule of Cash and Cash Equivalents	The following table sets forth our “ Cash and cash equivalents and restricted cash ” reported within the Company’s Condensed Consolidated Statements of Cash Flows ( $ in thousands ): September 30, September 30, Beginning of period: Cash and cash equivalents $ 19,291 $ 37,412 Restricted cash (included in Other assets, net) 2,225 2,073 Cash, cash equivalents, and restricted cash $ 21,516 $ 39,485 End of period: Cash and cash equivalents $ 16,579 $ 28,811 Restricted cash (included in Other assets, net) 1,916 2,903 Cash, cash equivalents, and restricted cash $ 18,495 $ 31,714
Restrictions on Cash and Cash Equivalents	The following table sets forth our “ Cash and cash equivalents and restricted cash ” reported within the Company’s Condensed Consolidated Statements of Cash Flows ( $ in thousands ): September 30, September 30, Beginning of period: Cash and cash equivalents $ 19,291 $ 37,412 Restricted cash (included in Other assets, net) 2,225 2,073 Cash, cash equivalents, and restricted cash $ 21,516 $ 39,485 End of period: Cash and cash equivalents $ 16,579 $ 28,811 Restricted cash (included in Other assets, net) 1,916 2,903 Cash, cash equivalents, and restricted cash $ 18,495 $ 31,714

Investment Activity (Tables)

Investment Activity (Tables)	9 Months Ended
	Sep. 30, 2023
Real Estate [Abstract]
Schedule of Business Acquisitions, by Acquisition	Since January 1, 2023, we have completed the following real estate investments ( $ in thousands ): Operator Date Properties Asset Class Land Building and Improvements Total Silverado Senior Living Q1 2023 2 ALF $ 3,894 $ 33,599 $ 37,493 Bickford Q1 2023 1 ALF 1,746 15,542 17,288 $ 5,640 $ 49,141 $ 54,781
Schedule of Asset Disposition	During the nine months ended September 30, 2023, we completed the following dispositions of real estate properties within our Real Estate Investments portfolio as described below ( $ in thousands ): Operator Date Properties Asset Class Net Proceeds Net Real Estate Investment Gain Impairment 2 BAKA Enterprises, LLC 1,3 Q1 2023 1 ALF $ 7,478 $ 7,505 $ — $ (27) Bickford 1 Q1 2023 1 ALF 2,553 1,421 1,132 — Chancellor Senior Living 1,3 Q2 2023 1 ALF 2,355 1,977 378 — Milestone Retirement 1,3,4 Q2 2023 2 ALF 3,803 3,934 — (131) Chancellor Senior Living 1,3 Q2 2023 1 ALF 7,633 6,140 1,493 — Milestone Retirement 1,3,4 Q2 2023 1 ALF 1,602 1,452 150 — Chancellor Senior Living Q2 2023 1 ALF 23,724 14,476 9,248 — Chancellor Senior Living 1,3 Q3 2023 1 ALF 2,923 2,292 631 — $ 52,071 $ 39,197 $ 13,032 $ (158) 1 Assets were previously classified as “ Assets held for sale ” in the Consolidated Balance Sheet at December 31, 2022. 2 Impairments are included in “ Loan and realty losses ” in the Condensed Consolidated Statements of Income for the three and nine months ended September 30, 2023. 3 Total impairment charges previously recognized on these properties were $16.4 million in the aggregate. 4 The Company provided aggregate financing of approximately $0.7 million, net of discounts, on these transactions in the form of notes receivable.
Disclosure of Long-Lived Assets Held-for-sale	The following is a summary of our assets held for sale ( $ in thousands ): As of As of September 30, 2023 December 31, 2022 Number of properties 4 13 Real estate, net $10,875 $43,302
Schedule of Tenant Concentrations	The following table contains information regarding concentration in our Real Estate Investments portfolio of tenants or affiliates of tenants, that exceed 10% of total revenues for the nine months ended September 30, 2023 and 2022, excluding $2.6 million for our corporate office, a credit loss reserve of $15.8 million and $344.4 million in real estate assets in the SHOP segment ( $ in thousands ): as of September 30, 2023 Revenues 1 Asset Gross Real Notes Nine Months Ended September 30, Class Estate Receivable 2023 2022 Senior Living Communities, LLC (“Senior Living”) EFC $ 573,631 $ 48,950 $ 38,466 16% $ 38,325 18% Bickford 2 ALF 429,043 16,827 29,280 12% N/A N/A National HealthCare Corporation (“NHC”) SNF 133,770 — 28,159 12% 27,875 13% All others, net Various 1,293,210 192,991 99,867 41% 109,766 53% Escrow funds received from tenants for property operating expenses Various — — 8,738 4% 7,553 4% $ 2,429,654 $ 258,768 204,510 183,519 Resident fees and services 3 35,860 15% 24,005 12% $ 240,370 $ 207,524 1 Includes interest income on notes receivable and rental income from properties classified as held for sale. 2 Revenues for the nine months ended September 30, 2022 are included in “All others, net” since they are less than 10% for that period. 3 There is no tenant concentration in “Resident fees and services” because these agreements are with individual residents.
Schedule of Future Minimum Base Rent	Future minimum lease payments to be received by us under our operating leases at September 30, 2023, are as follows ( $ in thousands ): Remainder of 2023 $ 57,301 2024 237,531 2025 241,391 2026 246,792 2027 201,627 2028 195,138 Thereafter 679,952 $ 1,859,732
Schedule of Fixed and Variable Lease Payments	The table below indicates the rental income recognized as a result of fixed and variable lease escalators ( $ in thousands ): Three Months Ended Nine Months Ended September 30, September 30, 2023 2022 2023 2022 Lease payments based on fixed escalators $ 57,200 $ 53,394 $ 169,675 $ 172,767 Lease payments based on variable escalators 1,830 1,224 5,879 2,452 Straight-line rent, net of write-offs 1,040 2,476 6,011 (11,360) Escrow funds received from tenants for property operating expenses 2,908 2,358 8,738 7,553 Amortization and write-off of lease incentives (723) (58) (1,798) (7,477) Rental income $ 62,255 $ 59,394 $ 188,505 $ 163,935

Mortgage And Other Notes Rece_2

Mortgage And Other Notes Receivable (Tables)	9 Months Ended
	Sep. 30, 2023
Mortgage and Other Notes Receivable [Abstract]
Schedule of Financing Receivable Credit Quality Indicators	The credit quality indicator as of September 30, 2023, is presented below for the amortized cost, net by year of origination ( $ in thousands ): 2023 2022 2021 2020 2019 Prior Total Mortgages more than 1.5x $ — $ 68,463 $ — $ 22,307 $ — $ 2,641 $ 93,411 between 1.0x and 1.5x — — — — 32,700 14,700 47,400 less than 1.0x — — — — 6,423 — 6,423 — 68,463 — 22,307 39,123 17,341 147,234 Mezzanine more than 1.5x 496 — 16,526 — — — 17,022 between 1.0x and 1.5x 216 — 23,943 — — — 24,159 less than 1.0x — — — — — 25,000 25,000 712 — 40,469 — — 25,000 66,181 Non-performing less than 1.0x — — — 2,127 — 24,500 26,627 — — — 2,127 — 24,500 26,627 Revolver between 1.0x and 1.5x 18,726 18,726 Credit loss reserve (15,808) $ 242,960
Schedule of Financing Receivable, Allowance for Credit Loss	The allowance for expected credit losses is presented in the following table for the nine months ended September 30, 2023 ( $ in thousands ): Beginning balance at January 1, 2023 $ 15,338 Provision for expected credit losses 470 Balance at September 30, 2023 $ 15,808

Other Assets (Tables)

Other Assets (Tables)	9 Months Ended
	Sep. 30, 2023
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]
Schedule of Other Assets	Other assets, net consist of the following ( $ in thousands ): September 30, 2023 December 31, 2022 SHOP accounts receivable, net of allowance of $352 and $375, and other assets $ 792 $ 1,341 Real estate investments accounts receivable and prepaid expenses 4,383 3,621 Lease incentive payments, net 11,392 3,190 Regulatory escrows 6,208 6,208 Restricted cash 1,916 2,225 $ 24,691 $ 16,585

Debt (Tables)

Debt (Tables)	9 Months Ended
	Sep. 30, 2023
Debt Instruments [Abstract]
Schedule of Debt	Debt consists of the following ( $ in thousands ): September 30, December 31, Revolving credit facility - unsecured $ 205,000 $ 42,000 Bank term loans - unsecured 200,000 240,000 2031 Senior Notes - unsecured, net of discount of $2,358 and $2,600 397,642 397,400 Private placement notes - unsecured 275,000 400,000 Fannie Mae term loans - secured, non-recourse 76,345 76,649 Unamortized loan costs (9,549) (8,538) $ 1,144,438 $ 1,147,511
Schedule of Maturities of Long-term Debt	Aggregate principal maturities of debt as of September 30, 2023 are as follows ( $ in thousands ): Remainder of 2023 $ 50,104 2024 75,425 2025 325,816 2026 205,000 2027 100,000 2028 — Thereafter 400,000 1,156,345 Less: discount (2,358) Less: unamortized loan costs (9,549) $ 1,144,438
Schedule of Unsecured Term Loans	Our remaining unsecured private placement notes as of September 30, 2023, payable interest-only, are summarized below ( $ in thousands ): Amount Inception Maturity Fixed Rate $ 50,000 November 2015 November 2023 3.99% 75,000 September 2016 September 2024 3.93% 50,000 November 2015 November 2025 4.33% 100,000 January 2015 January 2027 4.51% $ 275,000
Schedule of Interest Expense	The following table summarizes interest expense ($ in thousands ): Three Months Ended Nine Months Ended September 30, September 30, 2023 2022 2023 2022 Interest expense on debt at contractual rates $ 14,387 $ 10,821 $ 41,439 $ 30,640 Capitalized interest (21) (18) (61) (28) Amortization of debt issuance costs, debt discount and other 720 609 1,930 1,860 Total interest expense $ 15,086 $ 11,412 $ 43,308 $ 32,472

Commitments. Contingencies an_2

Commitments. Contingencies and Uncertainties (Tables)	9 Months Ended
	Sep. 30, 2023
Commitments and Contingencies Disclosure [Abstract]
Off Balance Sheet, Credit Loss, Liability, Roll Forward	The liability for expected credit losses on our unfunded loans reflected in “ Accounts payable and accrued expenses ” on the Condensed Consolidated Balance Sheets as of September 30, 2023 and December 31, 2022 is presented in the following table for the nine months ended September 30, 2023 ( $ in thousands ): Beginning balance January 1, 2023 $ 683 Provision for expected credit losses (385) Balance at September 30, 2023 $ 298

Redeemable Noncontrolling Int_2

Redeemable Noncontrolling Interest (Tables)	9 Months Ended
	Sep. 30, 2023
Noncontrolling Interest [Abstract]
Schedule of Redeemable Noncontrolling Interest	The following table presents the change in “ Redeemable noncontrolling interest” for the nine months ended September 30, 2023 ( $ in thousands ): Nine Months Ended September 30, 2023 Balance at January 1, $ 9,825 Contributions 922 Net loss (825) Balance at September 30, $ 9,922

Equity and Dividends (Tables)

Equity and Dividends (Tables)	9 Months Ended
	Sep. 30, 2023
Equity [Abstract]
Schedule of Dividends Declared	The following table summarizes dividends declared by the Board of Directors or paid during the nine months ended September 30, 2023 and 2022: Nine Months Ended September 30, 2023 Date of Declaration Date of Record Date Paid/Payable Quarterly Dividend November 6, 2022 December 30, 2022 January 27, 2023 $0.90 February 17, 2023 March 31, 2023 May 5, 2023 $0.90 May 5, 2023 June 30, 2023 August 4, 2023 $0.90 August 4, 2023 September 29, 2023 November 3, 2023 $0.90 Nine Months Ended September 30, 2022 Date of Declaration Date of Record Date Paid/Payable Quarterly Dividend November 5, 2021 December 31, 2021 January 31, 2022 $0.90 February 16, 2022 March 31, 2022 May 6, 2022 $0.90 May 6, 2022 June 30, 2022 August 5, 2022 $0.90 August 5, 2022 September 30, 2022 November 4, 2022 $0.90

Share-Based Compensation (Table

Share-Based Compensation (Tables)	9 Months Ended
	Sep. 30, 2023
Share-Based Payment Arrangement [Abstract]
Schedule of Share-based Payment Award, Stock Options, Valuation Assumptions	The fair value of each grant is estimated on the date of grant using the Black-Scholes option-pricing model with the following weighted average assumptions: 2023 2022 Dividend yield 6.9% 7.0% Expected volatility 39.0% 49.3% Expected lives 2.9 years 2.9 years Risk-free interest rate 4.56% 1.75%
Schedule of Stock Option Activity	The following table summarizes our outstanding stock options: Weighted Average Number Weighted Average Remaining of Shares Exercise Price Contractual Life (Years) Options outstanding, January 1, 2022 1,652,505 $78.10 Options granted 718,000 $53.62 Options exercised (56,832) $53.41 Options forfeited (23,000) $62.33 Options expired (74,498) $77.93 Options outstanding, September 30, 2022 2,216,175 $70.97 Exercisable at September 30, 2022 1,695,155 $74.73 Options outstanding, January 1, 2023 2,216,175 $70.97 Options granted 385,500 $54.73 Options exercised (5,166) $53.41 Options forfeited (61,168) $66.44 Options expired (88,170) $64.33 Options outstanding, September 30, 2023 2,447,171 $68.80 2.51 Exercisable at September 30, 2023 2,078,827 $71.40 2.25
Schedule of Disclosure of Share-Based Compensation Arrangements by Share-Based Payment Award	The following is a summary of share-based compensation expense, net of any forfeitures, included in “ General and administrative expenses ” in the Condensed Consolidated Statements of Income ( $ in thousands ): Three Months Ended Nine Months Ended September 30, September 30, 2023 2022 2023 2022 Share-based compensation components: Restricted stock expense $ 119 $ — $ 191 $ — Stock option expense 747 1,065 3,549 7,576 Total share-based compensation expense $ 866 $ 1,065 $ 3,740 $ 7,576

Earnings Per Common Share (Tabl

Earnings Per Common Share (Tables)	9 Months Ended
	Sep. 30, 2023
Earnings Per Share [Abstract]
Schedule of Earnings Per Share, Basic and Diluted	The following table summarizes the average number of common shares and the net income used in the calculation of basic and diluted earnings per common share ($ in thousands, except share and per share amounts) : Three Months Ended Nine Months Ended September 30, September 30, 2023 2022 2023 2022 Net income $ 29,033 $ 34,229 $ 102,662 $ 63,941 Add: net loss attributable to noncontrolling interests 313 239 946 599 Net income attributable to stockholders 29,346 34,468 103,608 64,540 Less: net income attributable to unvested restricted stock awards (19) — (38) — Net income attributable to common stockholders - basic $ 29,327 $ 34,468 $ 103,570 $ 64,540 BASIC: Weighted average common shares outstanding 43,388,841 44,339,975 43,388,779 45,236,696 DILUTED: Weighted average common shares outstanding 43,388,841 44,339,975 43,388,779 45,236,696 Stock options — 62,607 896 24,427 Weighted average dilutive common shares outstanding 43,388,841 44,402,582 43,389,675 45,261,123 Earnings per common share - basic $ 0.68 $ 0.78 $ 2.39 $ 1.43 Earnings per common share - diluted $ 0.68 $ 0.78 $ 2.39 $ 1.43 Incremental anti-dilutive shares excluded: Net share effect of stock options with an exercise price in excess of the average market price for our common shares 816,353 390,159 781,727 501,183 Regular dividends declared per common share $ 0.90 $ 0.90 $ 2.70 $ 2.70

Fair Value of Financial Instr_2

Fair Value of Financial Instruments (Tables)	9 Months Ended
	Sep. 30, 2023
Fair Value Disclosures [Abstract]
Schedule of Fair Value Measurements, Nonrecurring	Carrying amounts and fair values of financial instruments that are not carried at fair value at September 30, 2023 and December 31, 2022 in the Condensed Consolidated Balance Sheets are as follows ($ in thousands ): Carrying Amount Fair Value Measurement September 30, 2023 December 31, 2022 September 30, 2023 December 31, 2022 Level 2 Variable rate debt $ 399,233 $ 277,699 $ 405,000 $ 282,000 Fixed rate debt $ 745,205 $ 869,812 $ 642,539 $ 773,994 Level 3 Mortgage and other notes receivable, net $ 242,960 $ 233,141 $ 228,282 $ 227,611

Segment Reporting (Tables)

Segment Reporting (Tables)	9 Months Ended
	Sep. 30, 2023
Segment Reporting [Abstract]
Schedule of Segment Reporting Information, by Segment	Summary information for the reportable segments during the three and nine months ended September 30, 2023 and 2022 is as follows ( $ in thousands ): For the three months ended September 30, 2023: Real Estate Investments SHOP Non-segment/Corporate Total Rental income $ 62,255 $ — $ — $ 62,255 Resident fees and services — 12,367 — 12,367 Interest income and other 5,337 — 147 5,484 Total revenues 67,592 12,367 147 80,106 Senior housing operating expenses — 10,045 — 10,045 Taxes and insurance on leased properties 2,908 — — 2,908 NOI 64,684 2,322 147 67,153 Depreciation 15,211 2,292 12 17,515 Interest 773 — 14,313 15,086 Legal — — 67 67 Franchise, excise and other taxes — — 2 2 General and administrative — — 4,430 4,430 Loan and realty losses 1,959 — — 1,959 Gains on sales of real estate, net (737) — — (737) Other non-operating income (202) — — (202) Net income (loss) $ 47,680 $ 30 $ (18,677) $ 29,033 Total assets $ 2,218,699 $ 277,014 $ 3,377 $ 2,499,090 For the three months ended September 30, 2022: Real Estate Investments SHOP Non-segment/Corporate Total Rental income $ 59,394 $ — $ — $ 59,394 Resident fees and services — 12,013 — 12,013 Interest income and other 4,820 — 71 4,891 Total revenues 64,214 12,013 71 76,298 Senior housing operating expenses — 9,239 — 9,239 Taxes and insurance on leased properties 2,358 — — 2,358 NOI 61,856 2,774 71 64,701 Depreciation 15,390 2,129 14 17,533 Interest 837 — 10,575 11,412 Legal — — 88 88 Franchise, excise and other taxes — — 225 225 General and administrative — — 4,744 4,744 Loan and realty losses 11,329 — — 11,329 Gains on sales of real estate, net (14,840) — — (14,840) Gain on operations transfer, net (19) — — (19) Net income (loss) $ 49,159 $ 645 $ (15,575) $ 34,229 Total assets $ 2,214,475 $ 290,708 $ 3,602 $ 2,508,785 For the nine months ended September 30, 2023: Real Estate Investments SHOP Non-segment/Corporate Total Rental income $ 188,505 $ — $ — $ 188,505 Resident fees and services — 35,860 — 35,860 Interest income and other 15,727 — 278 16,005 Total revenues 204,232 35,860 278 240,370 Senior housing operating expenses — 29,525 — 29,525 Taxes and insurance on leased properties 8,738 — — 8,738 NOI 195,494 6,335 278 202,107 Depreciation 46,064 6,757 41 52,862 Interest 2,298 — 41,010 43,308 Legal — — 364 364 Franchise, excise and other taxes — — 443 443 General and administrative — — 14,390 14,390 Loan and realty losses 1,727 — — 1,727 Gains on sales of real estate, net (13,500) — — (13,500) Gain on operations transfer, net (20) — — (20) Other non-operating income (202) — — (202) Loss on early retirement of debt — — 73 73 Net income (loss) $ 159,127 $ (422) $ (56,043) $ 102,662 For the nine months ended September 30, 2022: Real Estate Investments SHOP Non-segment/Corporate Total Rental income $ 163,935 $ — $ — $ 163,935 Resident fees and services — 24,005 — 24,005 Interest income and other 19,362 — 222 19,584 Total revenues 183,297 24,005 222 207,524 Senior housing operating expenses — 18,352 — 18,352 Taxes and insurance on leased properties 7,553 — — 7,553 NOI 175,744 5,653 222 181,619 Depreciation 49,282 4,245 50 53,577 Interest 2,371 — 30,101 32,472 Legal — — 2,254 2,254 Franchise, excise and other taxes — — 694 694 General and administrative — — 17,893 17,893 Loan and realty losses 39,951 — — 39,951 Gains on sales of real estate, net (28,342) — — (28,342) Loss on operations transfer, net 710 — — 710 Gain on note receivable payoff (1,113) — — (1,113) Loss on early retirement of debt — — 151 151 Gains from equity method investment (569) — — (569) Net income (loss) $ 113,454 $ 1,408 $ (50,921) $ 63,941

Unconsolidated Variable Inter_2

Unconsolidated Variable Interest Entities (Tables)	9 Months Ended
	Sep. 30, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Schedule of Variable Interest Entities	The Company’s unconsolidated VIEs are summarized below by date of initial involvement. For further discussion of the nature of the relationships, including the sources of exposure to these VIEs, see the notes to our condensed consolidated financial statements cross-referenced below ( $ in thousands ). Date Name Source of Exposure Carrying Amount Maximum Exposure to Loss Note Reference 2014 Senior Living Notes and straight-line receivable $ 89,728 $ 93,478 Notes 3, 4 2016 Senior Living Management Notes $ 24,500 $ 24,500 — 2018 Bickford Notes and funding commitment $ 17,108 $ 29,816 Notes 3, 4 2019 Encore Senior Living Various 1 $ 54,161 $ 56,536 — 2020 Timber Ridge OpCo Various 2 $ 1,977 $ 6,977 Notes 6, 7 2020 Watermark Retirement Notes and straight-line receivable $ 8,921 $ 11,445 — 2021 Montecito Medical Real Estate Notes and funding commitment $ 20,514 $ 50,260 Note 4 2021 Vizion Health Notes and straight-line receivable $ 17,948 $ 17,948 — 2021 Navion Senior Solutions Various 3 $ 8,025 $ 8,025 — 2023 Kindcare Senior Living Notes 4 $ 733 $ 733 — 1 Notes, straight-line rents receivable, and lease receivables 2 Loan commitment, equity method investment, straight-line rents receivable and unamortized lease incentive 3 Notes, loan commitments, straight-line rents receivable, and unamortized lease incentive 4 Represents two mezzanine loans originated from the sales of real estate

Organization and Nature of Bu_2

Organization and Nature of Business (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2023 USD ($) segment	Sep. 30, 2023 property	Sep. 30, 2023 state	Sep. 30, 2023 tenant	Sep. 30, 2023 mortgage	Sep. 30, 2023 bedOrUnitInTheProperty	Sep. 30, 2023 jointVenture	Mar. 31, 2023 property	Dec. 31, 2022 USD ($) property	Apr. 01, 2022 property
Real Estate Properties [Line Items]
Number of reportable segments | segment	2
Number of lessees | tenant				3
Number of properties		4							13
Number of health care properties related to mortgage notes receivables		14			14
Loans and leases receivable, gross | $	$ 258,768
Credit loss reserve | $	(15,808)								$ (15,338)
Number of joint ventures | jointVenture							2
Real Estate
Real Estate Properties [Line Items]
Real estate investment property, portfolio assets | $	2,400,000
Properties		163
Number of states in which entity operates | state			31
Number of lessees | tenant				25
Number of properties								1
Senior Housing Community | Real Estate
Real Estate Properties [Line Items]
Properties		97
Skilled Nursing Facility
Real Estate Properties [Line Items]
Properties		32
Skilled Nursing Facility | Real Estate
Real Estate Properties [Line Items]
Properties		65
Hospital | Real Estate
Real Estate Properties [Line Items]
Properties		1
Independent Living Facility
Real Estate Properties [Line Items]
Properties		3
Number of states in which entity operates | state			8
Number of joint ventures | jointVenture							2
Independent Living Facility | SHOP
Real Estate Properties [Line Items]
Real estate investment property, portfolio assets | $	$ 344,400
Properties		15								15
Number of units acquired in a assisted living facility | bedOrUnitInTheProperty						1,734

Basis of Presentation and Sig_4

Basis of Presentation and Significant Accounting Policies (Narrative) (Details) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023 USD ($)	Sep. 30, 2022 USD ($)	Sep. 30, 2023 USD ($) mortgage segment	Sep. 30, 2022 USD ($)	Sep. 30, 2023 tenant	Sep. 30, 2023 jointVenture	Sep. 30, 2023 realEstatePartnership	Sep. 30, 2023 property	Sep. 30, 2023 operator	Dec. 31, 2022 USD ($)
Property, Plant and Equipment [Line Items]
Number of joint ventures | jointVenture						2
Real estate properties, net	$ 2,120,436		$ 2,120,436							$ 2,118,210
Cash and cash equivalents	16,579		16,579							19,291
Number of real estate partnerships							2	2
Other assets, net	24,691		24,691							$ 16,585
Rental income	62,255	$ 59,394	188,505	$ 163,935
Impairment of real estate	1,200
Number of lessees | tenant					3
Loans and leases receivable, gross	258,768		$ 258,768
Number of reportable segments | segment			2
Subsidiaries
Property, Plant and Equipment [Line Items]
Real estate properties, net	254,500		$ 254,500
Cash and cash equivalents	2,600		2,600
Straight line receivables	9,700		9,700
Other assets, net	8,500		$ 8,500
Non-performing
Property, Plant and Equipment [Line Items]
Mortgage note receivables | mortgage			2
Number of operators/borrowers | operator									1
Non-performing | Mortgage Receivable And Mezzanine Loan
Property, Plant and Equipment [Line Items]
Loans and leases receivable, gross	26,600		$ 26,600
Number of operators/borrowers | operator									2
Independent Living Facility
Property, Plant and Equipment [Line Items]
Number of joint ventures | jointVenture						2
SHOP
Property, Plant and Equipment [Line Items]
Real estate properties, net	260,100		260,100
Cash and cash equivalents	6,000		6,000
Prepaid expense	2,000		2,000
Accounts receivable, net	$ 600		600
Credit liabilities of SHOP			$ (5,000)
Minimum
Property, Plant and Equipment [Line Items]
Residency agreement, term			30 days
Maximum
Property, Plant and Equipment [Line Items]
Residency agreement, term			1 year

Basis of Presentation and Sig_5

Basis of Presentation and Significant Accounting Policies (Schedule of Cash and Cash Equivalents and Restricted Cash) (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022	Sep. 30, 2022	Dec. 31, 2021
Accounting Policies [Abstract]
Cash and cash equivalents	$ 16,579	$ 19,291	$ 28,811	$ 37,412
Restricted cash (included in Other assets, net)	1,916	2,225	2,903	2,073
Cash and cash equivalents and restricted cash	$ 18,495	$ 21,516	$ 31,714	$ 39,485

Investment Activity - Asset Acq

Investment Activity - Asset Acquisition Schedule (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2023 USD ($) property
Silverado Senior Living
Real Estate [Line Items]
Properties | property	2
Total	$ 37,493
Silverado Senior Living | Land
Real Estate [Line Items]
Total	3,894
Silverado Senior Living | Building and Improvements
Real Estate [Line Items]
Total	$ 33,599
Bickford
Real Estate [Line Items]
Properties | property	1
Total	$ 17,288
Bickford | Land
Real Estate [Line Items]
Total	1,746
Bickford | Building and Improvements
Real Estate [Line Items]
Total	15,542
Current Period Real Estate Acquisition
Real Estate [Line Items]
Total	54,781
Current Period Real Estate Acquisition | Land
Real Estate [Line Items]
Total	5,640
Current Period Real Estate Acquisition | Building and Improvements
Real Estate [Line Items]
Total	$ 49,141

Investment Activity (Asset Acqu

Investment Activity (Asset Acquisition) (Details) $ in Millions	1 Months Ended
	Feb. 28, 2023 USD ($) bedOrUnitInTheProperty property
Real Estate [Line Items]
Full payment of an outstanding construction note receivable	$ 14.2
Silverado Senior Living
Real Estate [Line Items]
Number of units acquired in a assisted living facility | property	2
Master lease, term	20 years
Initial lease rate	7.50%
Annual escalator of lease	2%
Silverado Senior Living, Summerlin, NE
Real Estate [Line Items]
Number of units acquired in a assisted living facility | bedOrUnitInTheProperty	60
Acquisition price	$ 37.5
Silverado Senior Living, Frederick, MD
Real Estate [Line Items]
Number of units acquired in a assisted living facility | bedOrUnitInTheProperty	60
Bickford | Bickford
Real Estate [Line Items]
Number of units acquired in a assisted living facility | bedOrUnitInTheProperty	64
Acquisition price	$ 17.3
Asset acquisition, receivable cancellation	0.5
Asset purchase transaction costs	$ 0.1
Asset acquisition, initial lease rate	8%

Investment Activity (Asset Disp

Investment Activity (Asset Disposition Schedule) (Details) $ in Thousands	3 Months Ended				9 Months Ended
	Sep. 30, 2023 USD ($) property	Jun. 30, 2023 USD ($) property	Mar. 31, 2023 USD ($) property	Sep. 30, 2022 USD ($)	Sep. 30, 2023 USD ($) property	Sep. 30, 2022 USD ($)
Property, Plant and Equipment [Line Items]
Proceeds from sales of real estate					$ 51,542	$ 168,957
Gain	$ 737			$ 14,840	13,500	$ 28,342
Impairment of real estate	(1,200)
BAKA Enterprises, LLC
Property, Plant and Equipment [Line Items]
Accumulated impaired real estate	16,400				16,400
Milestone Retirement 1 and 2
Property, Plant and Equipment [Line Items]
Mortgage and other notes receivable, net	700				700
Disposal Group, Disposed of by Sale, Not Discontinued Operations
Property, Plant and Equipment [Line Items]
Proceeds from sales of real estate					52,071
Net Real Estate Investment	$ 39,197				39,197
Gain					13,032
Impairment of real estate					$ (158)
Disposal Group, Disposed of by Sale, Not Discontinued Operations | BAKA Enterprises, LLC
Property, Plant and Equipment [Line Items]
Properties | property			1
Proceeds from sales of real estate			$ 7,478
Net Real Estate Investment			7,505
Gain			0
Impairment of real estate			$ (27)
Disposal Group, Disposed of by Sale, Not Discontinued Operations | Bickford
Property, Plant and Equipment [Line Items]
Properties | property			1
Proceeds from sales of real estate			$ 2,553
Net Real Estate Investment			1,421
Gain			1,132
Impairment of real estate			$ 0
Disposal Group, Disposed of by Sale, Not Discontinued Operations | Chancellor Senior Living
Property, Plant and Equipment [Line Items]
Properties | property		1
Proceeds from sales of real estate		$ 2,355
Net Real Estate Investment		1,977
Gain		378
Impairment of real estate		$ 0
Disposal Group, Disposed of by Sale, Not Discontinued Operations | Milestone Retirement
Property, Plant and Equipment [Line Items]
Properties | property		2
Proceeds from sales of real estate		$ 3,803
Net Real Estate Investment		3,934
Gain		0
Impairment of real estate		$ (131)
Disposal Group, Disposed of by Sale, Not Discontinued Operations | Chancellor Senior Living
Property, Plant and Equipment [Line Items]
Properties | property		1
Proceeds from sales of real estate		$ 7,633
Net Real Estate Investment		6,140
Gain		1,493
Impairment of real estate		$ 0
Disposal Group, Disposed of by Sale, Not Discontinued Operations | Milestone Retirement
Property, Plant and Equipment [Line Items]
Properties | property		1
Proceeds from sales of real estate		$ 1,602
Net Real Estate Investment		1,452
Gain		150
Impairment of real estate		$ 0
Disposal Group, Disposed of by Sale, Not Discontinued Operations | Chancellor Senior Living
Property, Plant and Equipment [Line Items]
Properties | property		1
Proceeds from sales of real estate		$ 23,724
Net Real Estate Investment		14,476
Gain		9,248
Impairment of real estate		$ 0
Disposal Group, Disposed of by Sale, Not Discontinued Operations | Chancellor Senior Living
Property, Plant and Equipment [Line Items]
Properties | property	1				1
Proceeds from sales of real estate	$ 2,923
Net Real Estate Investment	2,292				$ 2,292
Gain	631
Impairment of real estate	$ 0

Investment Activity (Asset Held

Investment Activity (Asset Held For Sale Schedule) (Details) $ in Thousands	Sep. 30, 2023 USD ($) property	Dec. 31, 2022 USD ($) property
Property, Plant and Equipment [Abstract]
Number of properties | property	4	13
Real estate, net | $	$ 10,875	$ 43,302

Investment Activity (Held For S

Investment Activity (Held For Sale Narrative) (Details) $ in Thousands		3 Months Ended		9 Months Ended
	Nov. 07, 2023 USD ($) bedOrUnitInTheProperty	Sep. 30, 2023 USD ($) property	Sep. 30, 2022 USD ($)	Sep. 30, 2023 USD ($) property	Sep. 30, 2022 USD ($)	Mar. 31, 2023 USD ($) property	Dec. 31, 2022 USD ($) property
Real Estate [Line Items]
Rental income		$ 62,255	$ 59,394	$ 188,505	$ 163,935
Number of properties | property		4		4			13
Real estate, net		$ 10,875		$ 10,875			$ 43,302
Number of real estate properties, impaired, sold or classified as held for sale | property				3
Impairment of real estate		1,200
Real estate assets held for development and sale		500		$ 500
Assisted Living Facility | O R
Real Estate [Line Items]
Impairment of real estate				1,300
Net real estate balance		5,900		$ 5,900
Assisted Living Facility | O R | Subsequent Event
Real Estate [Line Items]
Properties | bedOrUnitInTheProperty	3
Amount of real estate sold in cash consideration	$ 5,400
Asset disposition transaction cost	$ (1,600)
Real Estate
Real Estate [Line Items]
Number of properties | property						1
Impairment of long-lived assets		$ 1,200
Number of real estate properties, impaired, sold or classified as held for sale | property		1		4
Impairment of real estate				$ 1,600
Asset Held For Sale In 2022
Real Estate [Line Items]
Rental income		$ 600	$ 600	$ 1,900	$ 1,600
Assets Held For Sale in 2023 | Real Estate
Real Estate [Line Items]
Real estate, net						$ 5,000
Assets Held For Use in 2023 | Real Estate
Real Estate [Line Items]
Number of properties | property						2
Real estate, net						$ 12,300

Investment Activity (Schedule o

Investment Activity (Schedule of Tenant Concentrations) (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022
Tenant Concentration [Line Items]
Cost of corporate office	$ 2,600	$ 2,600	$ 2,600	$ 2,600
Credit loss	15,808		15,808		$ 15,338
Real estate	2,776,591		2,776,591		$ 2,729,898
Real estate, at cost	2,429,654		2,429,654
Loans and leases receivable, gross	258,768		258,768
Rental income	62,255	59,394	188,505	163,935
Resident fees and services	12,367	12,013	35,860	24,005
Total revenues	80,106	76,298	$ 240,370	$ 207,524
Percentage of continuing revenue			15%	12%
Independent Living Facility | SHOP
Tenant Concentration [Line Items]
Real estate investment property, portfolio assets	344,400		$ 344,400
Escrow funds received from tenants for property operating expenses
Tenant Concentration [Line Items]
Real estate	0		0
Mortgage and other notes receivable, net	0		0
Rental income	2,908	$ 2,358	$ 8,738	$ 7,553
Percentage of continuing revenue			4%	4%
Senior Living
Tenant Concentration [Line Items]
Real estate	573,631		$ 573,631
Mortgage and other notes receivable, net	48,950		48,950
Rental income			$ 38,466	$ 38,325
Percentage of continuing revenue			16%	18%
Bickford
Tenant Concentration [Line Items]
Real estate	429,043		$ 429,043
Mortgage and other notes receivable, net	16,827		16,827
Rental income			$ 29,280
Percentage of continuing revenue			12%
National HealthCare Corporation (“NHC”)
Tenant Concentration [Line Items]
Real estate	133,770		$ 133,770
Mortgage and other notes receivable, net	0		0
Rental income			$ 28,159	$ 27,875
Percentage of continuing revenue			12%	13%
Less than 10% Operators
Tenant Concentration [Line Items]
Real estate	1,293,210		$ 1,293,210
Mortgage and other notes receivable, net	$ 192,991		192,991
Rental income			$ 99,867	$ 109,766
Percentage of continuing revenue			41%	53%
More than 10% Operators
Tenant Concentration [Line Items]
Rental income			$ 204,510	$ 183,519

Investment Activity (Narrative)

Investment Activity (Narrative) (Details) $ in Thousands	3 Months Ended			9 Months Ended
	Sep. 30, 2023 USD ($) property state lease boardMember	Mar. 31, 2023 USD ($)	Sep. 30, 2022 USD ($)	Sep. 30, 2023 USD ($) property state lease boardMember	Sep. 30, 2022 USD ($)	Dec. 31, 2022 USD ($) operator
Real Estate [Line Items]
Straight-line rent, net of write-offs				$ 6,011	$ (11,360)
Number of board of directors | boardMember	2			2
Lease incentive payments, net	$ 11,392			$ 11,392		$ 3,190
Rental income	62,255		$ 59,394	188,505	163,935
Real estate properties, net	$ 2,120,436			$ 2,120,436		$ 2,118,210
Independent Living Facility
Real Estate [Line Items]
Number of states in which entity operates | state	8			8
Properties | property	3			3
Skilled Nursing Facility
Real Estate [Line Items]
Properties | property	32			32
Lease Option
Real Estate [Line Items]
Properties | property	3			3
Lease Option, Between 2027 and 2028
Real Estate [Line Items]
Rental income	$ 1,800		$ 1,800	$ 5,400	5,300
Real estate properties, net	$ 58,800			58,800
Senior Living
Real Estate [Line Items]
Straight-line rent, net of write-offs				(900)	(300)
Rental income				$ 38,466	38,325
Senior Living | NHC - 1991 Lease
Real Estate [Line Items]
Properties | property	10			10
National HealthCare Corporation (“NHC”)
Real Estate [Line Items]
Straight-line rent, net of write-offs				$ 900	100
Rental income				$ 28,159	$ 27,875
National HealthCare Corporation (“NHC”) | Skilled Nursing Facility | Subleased Facilities
Real Estate [Line Items]
Properties | property	4			4
Bickford
Real Estate [Line Items]
Properties | property	39			39
Number of leases | lease	4			4
Write off of financing receivable				$ 18,100
Rent deferral	$ 19,000			19,000
Rental income				29,280
Bickford | Bickford
Real Estate [Line Items]
Payments for rent	800			1,300
Cash Basis Lessees
Real Estate [Line Items]
Lease incentive payments, net	7,100			7,100
Rental income	3,400			10,000
Lessor, number of operators converted to cash basis accounting | operator						2
Cash Basis Lessees | Bickford
Real Estate [Line Items]
Asset acquisition, rent deferral deduction		$ 2,500
Rental income	$ 8,600			$ 24,500
Revenue as % of Total, Exceeds 10%
Real Estate [Line Items]
Number of states in which entity operates | state	2			2
Geographic Concentration Risk | South Carolina | Investment Consideration Benchmark
Real Estate [Line Items]
Concentration risk percentage				12.10%
Geographic Concentration Risk | Texas | Investment Consideration Benchmark
Real Estate [Line Items]
Concentration risk percentage				10.70%

Investment Activity (Schedule_2

Investment Activity (Schedule of Future Minimum Lease Payments) (Details) $ in Thousands	Sep. 30, 2023 USD ($)
Real Estate [Abstract]
Remainder of 2023	$ 57,301
2024	237,531
2025	241,391
2026	246,792
2027	201,627
2028	195,138
Thereafter	679,952
Future minimum lease payments	$ 1,859,732

Investment Activity (Schedule_3

Investment Activity (Schedule of Fixed and Variable Lease Payments) (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Fixed and Variable Lease Payments [Line Items]
Rental income	$ 62,255	$ 59,394	$ 188,505	$ 163,935
Straight-line rent, net of write-offs			6,011	(11,360)
Lease payments based on fixed escalators
Fixed and Variable Lease Payments [Line Items]
Rental income	57,200	53,394	169,675	172,767
Lease payments based on variable escalators
Fixed and Variable Lease Payments [Line Items]
Rental income	1,830	1,224	5,879	2,452
Straight-line rent, net of write-offs
Fixed and Variable Lease Payments [Line Items]
Straight-line rent, net of write-offs	1,040	2,476	6,011	(11,360)
Escrow funds received from tenants for property operating expenses
Fixed and Variable Lease Payments [Line Items]
Rental income	2,908	2,358	8,738	7,553
Amortization and write-off of lease incentives
Fixed and Variable Lease Payments [Line Items]
Amortization and write-off of lease incentives	$ (723)	$ (58)	$ (1,798)	$ (7,477)

Mortgage And Other Notes Rece_3

Mortgage And Other Notes Receivable (Narrative) (Details) $ in Thousands		3 Months Ended		9 Months Ended
	Sep. 21, 2023 USD ($)	Sep. 30, 2023 USD ($)	Sep. 30, 2022 USD ($)	Sep. 30, 2023 USD ($) property	Sep. 30, 2022 USD ($)	Sep. 30, 2023 property	Sep. 30, 2023 mortgage	Sep. 30, 2023 bedOrUnitInTheProperty	Sep. 30, 2023 operator	Sep. 30, 2023	Sep. 30, 2023 realEstateInvestment	Sep. 30, 2023 renewalOption	Sep. 30, 2023 loan	Sep. 20, 2023 USD ($)	Dec. 31, 2022 USD ($)	Sep. 30, 2021 property
Accounts, Notes, Loans and Financing Receivable [Line Items]
Number of health care properties related to mortgage notes receivables						14	14
Credit loss reserve		$ (15,808)		$ (15,808)											$ (15,338)
Financing receivable, excluding accrued interest, after allowance for credit loss		(242,960)		(242,960)											(233,141)
Collections of mortgage and other notes receivable				(11,231)	$ (117,973)
Loans and leases agreement				145,400
Interest income and other		5,484	$ 4,891	16,005	19,584
Increase rate in the amount of loss from a default										20%
Effective adjustment rate										44%
Montecito Medical Real Estate
Accounts, Notes, Loans and Financing Receivable [Line Items]
Mortgage and other notes receivable, net		20,300		20,300
Interest income and other		500		1,400
Loans and leases agreement				$ 50,000
Number of real estate investments | realEstateInvestment											2
Investment accrue interest rate										7.50%
Deferred interest rate to be paid upon certain future events										4.50%
Annual interest rate from master credit agreement										9.50%
Deferred interest										2.50%
Loan agreement term				5 years
Number of extensions | renewalOption												2
Note receivable renewal term				1 year
Bickford
Accounts, Notes, Loans and Financing Receivable [Line Items]
Mortgage and other notes receivable, net		16,827		$ 16,827
Properties | property						39
Interest income and other		300	300	1,000	1,000
Repayments of term loan		100		300
Bickford Note Investment
Accounts, Notes, Loans and Financing Receivable [Line Items]
Contingent incentive payments		2,000		2,000
Senior Living
Accounts, Notes, Loans and Financing Receivable [Line Items]
Mortgage and other notes receivable, net		48,950		48,950
Number of extensions | property						2
Revolving amount line of credit		20,000		20,000
Revolving note receivable amount outstanding		(16,300)		$ (16,300)
Loans receivable facility bears interest rate				8%
Purchase option at a stated minimum price		38,300		$ 38,300
Senior Living Communities
Accounts, Notes, Loans and Financing Receivable [Line Items]
Financing receivable, renewal term				1 year
Non-performing
Accounts, Notes, Loans and Financing Receivable [Line Items]
Number of operators/borrowers | operator									1
Interest income and other		500	$ 500	$ 1,400	$ 1,400
Mortgage notes receivable, designated as nonperforming		(2,100)
Mezzanine
Accounts, Notes, Loans and Financing Receivable [Line Items]
Credit loss reserve		(10,000)		(10,000)											(10,000)
Mezzanine | Non-performing
Accounts, Notes, Loans and Financing Receivable [Line Items]
Financing receivable, excluding accrued interest, after allowance for credit loss		(14,500)		(14,500)											$ (14,500)
Secured By Real Estate
Accounts, Notes, Loans and Financing Receivable [Line Items]
Mortgage and other notes receivable, net		159,400		159,400
Not Secured By Real Estate
Accounts, Notes, Loans and Financing Receivable [Line Items]
Mortgage and other notes receivable, net		99,400		$ 99,400
Capital Funding Group, Inc.
Accounts, Notes, Loans and Financing Receivable [Line Items]
Financing receivable, excluding accrued interest, after allowance for credit loss	$ (25,000)													$ (8,100)
Financing receivable, stated interest rate	10%
Property Held by Fund | Montecito Medical Real Estate
Accounts, Notes, Loans and Financing Receivable [Line Items]
Number of medical office buildings | property				9
Combined purchase price of medical office buildings				$ 86,700
Fully Funded | Bickford
Accounts, Notes, Loans and Financing Receivable [Line Items]
Loans and leases agreement				14,700
Number of construction loans | loan													1
Disposal Group, Disposed of by Sale, Not Discontinued Operations | Bickford
Accounts, Notes, Loans and Financing Receivable [Line Items]
Properties | property																6
Note receivable interest rate																10%
Disposal Group, Disposed of by Sale, Not Discontinued Operations | Bickford Note Investment | Unlikely to be Collected Financing Receivable
Accounts, Notes, Loans and Financing Receivable [Line Items]
Increase in notes receivable from sales of real estate				(12,700)
After 2021 | Senior Living
Accounts, Notes, Loans and Financing Receivable [Line Items]
Revolving amount line of credit		$ 15,000		15,000
July 2019 Transaction | Senior Living
Accounts, Notes, Loans and Financing Receivable [Line Items]
Loans and leases agreement				$ 32,700
Annual interest rate from master credit agreement										7.25%
Loan agreement term				5 years
Number of units acquired in a assisted living facility | bedOrUnitInTheProperty								248

Mortgage And Other Notes Rece_4

Mortgage And Other Notes Receivable (Schedule of Financing Receivables By Credit Quality Indicator) (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Financing Receivable, Credit Quality Indicator [Line Items]
Credit loss reserve	$ (15,808)	$ (15,338)
Financing receivable, after allowance for credit loss	242,960	$ 233,141
Mortgages
Financing Receivable, Credit Quality Indicator [Line Items]
2023	0
2022	68,463
2021	0
2020	22,307
2019	39,123
Prior	17,341
Total	147,234
Mezzanine
Financing Receivable, Credit Quality Indicator [Line Items]
2023	712
2022	0
2021	40,469
2020	0
2019	0
Prior	25,000
Total	66,181
Non-performing
Financing Receivable, Credit Quality Indicator [Line Items]
2023	0
2022	0
2021	0
2020	2,127
2019	0
Prior	24,500
Total	26,627
Revolver
Financing Receivable, Credit Quality Indicator [Line Items]
Total	18,726
more than 1.5x | Mortgages
Financing Receivable, Credit Quality Indicator [Line Items]
2023	0
2022	68,463
2021	0
2020	22,307
2019	0
Prior	2,641
Total	93,411
more than 1.5x | Mezzanine
Financing Receivable, Credit Quality Indicator [Line Items]
2023	496
2022	0
2021	16,526
2020	0
2019	0
Prior	0
Total	17,022
between 1.0x and 1.5x | Mortgages
Financing Receivable, Credit Quality Indicator [Line Items]
2023	0
2022	0
2021	0
2020	0
2019	32,700
Prior	14,700
Total	47,400
between 1.0x and 1.5x | Mezzanine
Financing Receivable, Credit Quality Indicator [Line Items]
2023	216
2022	0
2021	23,943
2020	0
2019	0
Prior	0
Total	24,159
between 1.0x and 1.5x | Revolver
Financing Receivable, Credit Quality Indicator [Line Items]
Total	18,726
less than 1.0x | Mortgages
Financing Receivable, Credit Quality Indicator [Line Items]
2023	0
2022	0
2021	0
2020	0
2019	6,423
Prior	0
Total	6,423
less than 1.0x | Mezzanine
Financing Receivable, Credit Quality Indicator [Line Items]
2023	0
2022	0
2021	0
2020	0
2019	0
Prior	25,000
Total	25,000
EBITDARM Coverage less than 1.0x | Non-performing
Financing Receivable, Credit Quality Indicator [Line Items]
2023	0
2022	0
2021	0
2020	2,127
2019	0
Prior	24,500
Total	$ 26,627

Mortgage And Other Notes Rece_5

Mortgage And Other Notes Receivable (Schedule of Financing Receivables By Allowance for Credit Loss) (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2023 USD ($)
Financing Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance at January 1, 2023	$ 15,338
Provision for expected credit losses	470
Balance at September 30, 2023	$ 15,808

Senior Housing Operating Port_2

Senior Housing Operating Portfolio Formation Activities (Details)	1 Months Ended	3 Months Ended	9 Months Ended
	Oct. 31, 2023 USD ($)	Jun. 30, 2023 USD ($)	Sep. 30, 2023 USD ($) property bedOrUnitInTheProperty jointVenture	Apr. 01, 2022 property
Senior Housing Operating Portfolio Formation Activities [Line Items]
Number of joint ventures | jointVenture			2
Annual fixed preferred return			$ 10,200,000
Cash contributed for its common equity interest in the venture		$ 4,600,000
Subsequent Event
Senior Housing Operating Portfolio Formation Activities [Line Items]
Cash contributed for its common equity interest in the venture	$ 2,600,000
Minimum
Senior Housing Operating Portfolio Formation Activities [Line Items]
Management fee multiplier			$ 1,000
SHOP | New Venture
Senior Housing Operating Portfolio Formation Activities [Line Items]
Ownership percentage			100%
Merrill Gardens Managed Portfolio
Senior Housing Operating Portfolio Formation Activities [Line Items]
Cash contributed for its common equity interest in the venture			$ 10,600,000
Interest in joint venture percentage			20%
Management fee			5%
Real estate services fee			5%
Merrill Gardens Managed Portfolio | Subsequent Event
Senior Housing Operating Portfolio Formation Activities [Line Items]
Cash contributed for its common equity interest in the venture	$ 900,000
Discovery Managed Portfolio
Senior Housing Operating Portfolio Formation Activities [Line Items]
Cash contributed for its common equity interest in the venture			$ 1,100,000
Management fee			5%
Common equity interest in venture			2%
Independent Living Facility
Senior Housing Operating Portfolio Formation Activities [Line Items]
Properties | property			3
Number of joint ventures | jointVenture			2
Independent Living Facility | SHOP
Senior Housing Operating Portfolio Formation Activities [Line Items]
Properties | property			15	15
Independent Living Facility | Merrill Gardens Managed Portfolio
Senior Housing Operating Portfolio Formation Activities [Line Items]
Properties | bedOrUnitInTheProperty			6
Independent Living Facility | Discovery Managed Portfolio
Senior Housing Operating Portfolio Formation Activities [Line Items]
Properties | bedOrUnitInTheProperty			9

Equity Method Investment (Detai

Equity Method Investment (Details) $ in Thousands	1 Months Ended	3 Months Ended		9 Months Ended
	Feb. 28, 2023 USD ($)	Sep. 30, 2023 USD ($)	Sep. 30, 2022 USD ($)	Sep. 30, 2023 USD ($) extensionOption	Sep. 30, 2022 USD ($)	Dec. 31, 2022 USD ($)
Schedule of Equity Method Investments [Line Items]
Cumulative unrecognized equity method losses		$ (5,000)		$ (5,000)		$ (5,000)
Unrecognized equity method gain (loss)		600	$ 900	1,900	$ 2,600
Gains from equity method investment		$ 0	$ 0	$ 0	569
Operating lease term		7 years		7 years
Number of renewal options | extensionOption				2
Balance secured by the deed and indenture		$ 12,500		$ 12,500
Timber Ridge OpCo
Schedule of Equity Method Investments [Line Items]
Amortization and write-off of lease incentives	$ 2,500	2,500
Maximum exposure to loss		5,000		5,000
Timber Ridge OpCo
Schedule of Equity Method Investments [Line Items]
Financing receivable of revolving credit facility		5,000
Mortgage and other notes receivable, net		0		$ 0
Gains from equity method investment					$ 600
Real Estate Operating Company | LCS Timber Ridge
Schedule of Equity Method Investments [Line Items]
Equity interest in affiliates				25%
Cumulative Amount | Timber Ridge OpCo
Schedule of Equity Method Investments [Line Items]
Cumulative unrecognized equity method losses		(7,800)		$ (7,800)
Noncontrolling Interests | Real Estate Operating Company | Timber Ridge OpCo
Schedule of Equity Method Investments [Line Items]
Investments in affiliates		$ 900		$ 900

Other Assets (Details)

Other Assets (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022	Dec. 31, 2021
Segment Reporting Information [Line Items]
Lease incentive payments, net	$ 11,392		$ 3,190
Regulatory escrows	6,208		6,208
Restricted cash	1,916	$ 2,903	2,225	$ 2,073
Other assets	24,691		16,585
Payment of lease incentive	10,000	$ 0
Timber Ridge OpCo
Segment Reporting Information [Line Items]
Payment of lease incentive	10,000
SHOP
Segment Reporting Information [Line Items]
Accounts receivable and prepaid expenses	792		1,341
Allowance	352		375
Real Estate
Segment Reporting Information [Line Items]
Accounts receivable and prepaid expenses	$ 4,383		$ 3,621

Debt (Schedule of Debt) (Detail

Debt (Schedule of Debt) (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Debt Instrument [Line Items]
Revolving credit facility - unsecured	$ 205,000	$ 42,000
Unamortized loan costs	(9,549)	(8,538)
Debt	1,144,438	1,147,511
Discount	2,358
Bank term loans - unsecured
Debt Instrument [Line Items]
Bank term loans - unsecured	200,000	240,000
Senior Notes Due 2031
Debt Instrument [Line Items]
Bank term loans - unsecured	397,642	397,400
Discount	2,358	2,600
Private placement notes - unsecured
Debt Instrument [Line Items]
Bank term loans - unsecured	275,000	400,000
Fannie Mae term loans - secured, non-recourse
Debt Instrument [Line Items]
Fannie Mae term loans - secured, non-recourse	$ 76,345	$ 76,649

Debt (Schedule of Maturities of

Debt (Schedule of Maturities of Long-term Debt) (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Debt Instruments [Abstract]
Remainder of 2023	$ 50,104
2024	75,425
2025	325,816
2026	205,000
2027	100,000
2028	0
Thereafter	400,000
Long-term debt, gross	1,156,345
Less: discount	(2,358)
Less: unamortized loan costs	(9,549)	$ (8,538)
Debt	$ 1,144,438	$ 1,147,511

Debt (Narrative) (Details)

Debt (Narrative) (Details) $ in Millions			1 Months Ended			3 Months Ended	9 Months Ended
	Nov. 07, 2023 USD ($)	Mar. 31, 2022 USD ($) extensionOption	Jun. 30, 2023 USD ($)	Jan. 31, 2023 USD ($)	Jan. 31, 2021 USD ($)	Mar. 31, 2023 USD ($)	Sep. 30, 2023 USD ($) property	Mar. 30, 2022 USD ($)
Debt Instrument [Line Items]
Discount						$ 2.7
Fannie Mae term-debt financing amount			$ 220
Gain on note receivable payoff						$ 0.1
Debt leverage limit							50%
January 2023
Debt Instrument [Line Items]
Repayments of term loan				$ 125
November 2023
Debt Instrument [Line Items]
Fixed Rate							3.99%
November 2023 | Subsequent Event
Debt Instrument [Line Items]
Repayments of term loan	$ 50
Secured Overnight Financing Rate (SOFR)
Debt Instrument [Line Items]
Basis spread on variable rate		1%
Fed Funds Effective Rate Overnight Index Swap Rate
Debt Instrument [Line Items]
Basis spread on variable rate		0.50%
Minimum
Debt Instrument [Line Items]
Facility fee percentage		0.125%
Maximum
Debt Instrument [Line Items]
Facility fee percentage		0.30%
Revolving Credit Facility | Minimum | Base Rate
Debt Instrument [Line Items]
Basis spread on variable rate		0%
Revolving Credit Facility | Minimum | Secured Overnight Financing Rate (SOFR)
Debt Instrument [Line Items]
Basis spread on variable rate		0.725%
Revolving Credit Facility | Maximum | Base Rate
Debt Instrument [Line Items]
Basis spread on variable rate		0.40%
Revolving Credit Facility | Maximum | Secured Overnight Financing Rate (SOFR)
Debt Instrument [Line Items]
Basis spread on variable rate		1.40%
Unsecured Debt | Revolving Credit Facility
Debt Instrument [Line Items]
Unsecured revolving credit facility		$ 700	$ 200					$ 550
Debt instrument, number of extension options | extensionOption		2
Debt instrument, extension period		6 months
Term of debt			2 years
Unused balance of the unsecured revolving credit facility							$ 495
Unsecured Debt | Revolving Credit Facility | Secured Overnight Financing Rate (SOFR)
Debt Instrument [Line Items]
Basis spread on variable rate						0.10%
$75M Term Loan
Debt Instrument [Line Items]
Repayments of term loan						$ 20
Senior Notes Due 2031 | Senior Notes
Debt Instrument [Line Items]
Aggregate principle amount issued					$ 400
Fixed Rate					3%
Percentage of issue price on face value					0.99196%
Proceeds from issuance of senior notes					$ 392.3
Fannie Mae term loans - secured, non-recourse
Debt Instrument [Line Items]
Term of debt							10 years
Fixed Rate							3.79%
Long-term debt							$ 60.1
Number of real estate properties | property							11
Net book value							$ 101.7
FNMA Berkadia Note
Debt Instrument [Line Items]
Fixed Rate							4.60%
Long-term debt							$ 16.2

Debt (Schedule of Unsecured Ter

Debt (Schedule of Unsecured Term Loans) (Details) $ in Thousands	Sep. 30, 2023 USD ($)
November 2023
Unsecured Term Loans [Line Items]
Amount	$ 50,000
Fixed Rate	3.99%
September 2024
Unsecured Term Loans [Line Items]
Amount	$ 75,000
Fixed Rate	3.93%
November 2025
Unsecured Term Loans [Line Items]
Amount	$ 50,000
Fixed Rate	4.33%
January 2027
Unsecured Term Loans [Line Items]
Amount	$ 100,000
Fixed Rate	4.51%

Debt (Schedule of Interest Expe

Debt (Schedule of Interest Expense) (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Debt Instruments [Abstract]
Interest expense on debt at contractual rates	$ 14,387	$ 10,821	$ 41,439	$ 30,640
Capitalized interest	(21)	(18)	(61)	(28)
Amortization of debt issuance costs, debt discount and other	720	609	1,930	1,860
Total interest expense	$ 15,086	$ 11,412	$ 43,308	$ 32,472

Commitments. Contingencies an_3

Commitments. Contingencies and Uncertainties (Narrative) (Details) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023 USD ($) leaseAgreement property operator	Jun. 30, 2022 USD ($) property	Sep. 30, 2023 USD ($) leaseAgreement property operator	Sep. 30, 2022 USD ($)	Dec. 31, 2022 USD ($)
Commitment and Contingencies [Line Items]
Loans and leases agreement			$ 145,400
Development commitments for construction and renovation	$ 23,200		23,200
Amount funded toward the development commitments	18,800		18,800
Amount funded on real estate investments	1,000		1,000
Contingent lease inducement commitments and contingent consideration of acquisitions	13,900		13,900
Payment of lease incentive			10,000	$ 0
Properties | property		3
Regulatory escrows	6,208		6,208		$ 6,208
Bickford Senior Living Acquisition
Commitment and Contingencies [Line Items]
Asset acquisition, rent deferral deduction			2,500
Lease Payment Deferral | COVID-19
Commitment and Contingencies [Line Items]
Repayments of deferred rent	2,100		5,500
Aggregate lease concessions granted to tenants
Commitment and Contingencies [Line Items]
Operating lease income	26,900
Discovery PropCo
Commitment and Contingencies [Line Items]
Development commitments for construction and renovation	2,000		2,000
Timber Ridge OpCo
Commitment and Contingencies [Line Items]
Payment of lease incentive			10,000
Bickford
Commitment and Contingencies [Line Items]
Mortgage and other notes receivable, net	$ 16,827		$ 16,827
Regulatory escrows		$ 2,400
Bickford | Lease Payment Deferral and Abatement
Commitment and Contingencies [Line Items]
Operating lease income				10,700
Reduction to revenue, rent concessions				$ (5,500)
Loans Receivable
Commitment and Contingencies [Line Items]
Number of operators/tenants | operator	6		6
Notes Receivable Remain Unfunded
Commitment and Contingencies [Line Items]
Mortgage and other notes receivable, net	$ 102,000		$ 102,000
Development Commitment
Commitment and Contingencies [Line Items]
Number of operators/tenants | property	7		7
Lease Inducement
Commitment and Contingencies [Line Items]
Number of leases | leaseAgreement	5		5
Collection of Rent Deferred | Lease Payment Deferral
Commitment and Contingencies [Line Items]
Reduction to revenue, rent concessions	$ (9,200)

Commitments. Contingencies an_4

Commitments. Contingencies and Uncertainties (Off Balance Sheet Credit Loss Liability Roll Forward Schedule) (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2023 USD ($)
Off Balance Sheet, Credit Loss [Roll Forward]
Provision for expected credit losses	$ (385)
Ending balance	298
Accounting Standards Update 2016-13
Off Balance Sheet, Credit Loss [Roll Forward]
Beginning balance	$ 683

Redeemable Noncontrolling Int_3

Redeemable Noncontrolling Interest (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Jun. 30, 2023	Jun. 30, 2022	Sep. 30, 2023
Redeemable Noncontrolling Interests [Roll Forward]
Beginning balance			$ 9,825		$ 9,825
Contributions					922
Net loss	$ (250)	$ (278)	$ (575)	$ 227	(825)
Ending balance	$ 9,922				$ 9,922

Equity and Dividends (Narrative

Equity and Dividends (Narrative) (Details) - USD ($) $ / shares in Units, $ in Thousands			3 Months Ended			6 Months Ended		9 Months Ended		12 Months Ended
	Nov. 03, 2023	Feb. 17, 2023	Sep. 30, 2023	Mar. 31, 2023	Sep. 30, 2022	Jun. 30, 2023	Jun. 30, 2022	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022
Equity, Class of Treasury Stock [Line Items]
Authorized repurchase amount		$ 160,000
Common stock, par value (in dollars per share)		$ 0.01	$ 0.01					$ 0.01		$ 0.01
Effective period of stock repurchase plan		1 year
Shares of common stock repurchased through the open market transactions (in shares)										2,468,354
Repurchase of common stock					$ 81,974		$ 69,977			$ 151,600
At-the market shelf registration, equity offering sales agreement, aggregate sales price				$ 500,000
Payment of stock issuance costs				$ 500
Dividends to common stockholders (in dollars per share)			$ 0.90		$ 0.90	$ 1.80	$ 1.80	$ 2.70	$ 2.70
Subsequent Event
Equity, Class of Treasury Stock [Line Items]
Dividends to common stockholders (in dollars per share)	$ 0.9

Equity and Dividends (Schedule

Equity and Dividends (Schedule of Dividends Declared) (Details) - $ / shares	Nov. 03, 2023	May 05, 2023	Feb. 17, 2023	Nov. 06, 2022	Nov. 04, 2022	May 06, 2022	Feb. 16, 2022	Nov. 05, 2021
Equity, Class of Treasury Stock [Line Items]
Quarterly dividend (in dollars per share)		$ 0.90	$ 0.90	$ 0.90	$ 0.90	$ 0.90	$ 0.90	$ 0.90
Subsequent Event
Equity, Class of Treasury Stock [Line Items]
Quarterly dividend (in dollars per share)	$ 0.90

Share-Based Compensation (Narra

Share-Based Compensation (Narrative) (Details)	1 Months Ended	9 Months Ended
	May 31, 2023 $ / shares shares	Sep. 30, 2023 USD ($) plan $ / shares shares	Sep. 30, 2022 USD ($) $ / shares shares	Apr. 30, 2023 shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of incentive plans | plan		2
Options granted (in shares) | shares			718,000
Weighted average fair value of options granted (in US dollars per share) | $ / shares		$ 10.56	$ 11.92
Aggregate intrinsic value of stock options outstanding		$ 0
Aggregate intrinsic value of stock options exercisable		$ 0
Weighted average aggregate intrinsic value options exercised (in US dollars per share) | $ / shares		$ 1.23	$ 4.94
Aggregate intrinsic value of stock options exercised		$ 100,000	$ 100,000
Unrecognized compensation cost		$ 2,700,000
2019 Stock Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options granted (in shares) | shares		385,500
Common Stock | 2019 Stock Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares authorized (in shares) | shares	6,000,000			3,000,000
Restricted Stock | Executive Officer | 2019 Stock Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares issued in period (in shares) | shares	21,000
Shares issued in period (in dollars per shares) | $ / shares	$ 49.30
Stock option plan, award vesting period	5 years
Restricted Stock | Executive Officer | 2019 Stock Incentive Plan | Share-Based Payment Arrangement, Tranche Five
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting rights, percentage	20%
Expected To Be Recognized Remainder Of 2023
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation cost		$ 900,000
Expected To Be Recognized During 2024
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation cost		1,300,000
Expected To Be Recognized During 2025
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation cost		300,000
Expected To Be Recognized During 2026
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation cost		100,000
Expected To Be Recognized During Thereafter
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation cost		$ 100,000

Share-Based Compensation (Sched

Share-Based Compensation (Schedule of Stock Option Valuation Assumptions) (Details)	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Share-Based Payment Arrangement [Abstract]
Dividend yield	6.90%	7%
Expected volatility	39%	49.30%
Expected lives	2 years 10 months 24 days	2 years 10 months 24 days
Risk-free interest rate	4.56%	1.75%

Share-Based Compensation (Sch_2

Share-Based Compensation (Schedule Of Stock Option Activity) (Details) - $ / shares	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding [Roll Forward]
Options outstanding beginning balance (in shares)	2,216,175	1,652,505
Options granted (in shares)		718,000
Options exercised (in shares)	(5,166)	(56,832)
Options forfeited (in shares)	(61,168)	(23,000)
Options expired (in shares)	(88,170)
Options outstanding, ending balance (in shares)	2,447,171	2,216,175
Stock Options Weighted Average Exercise Price
Options outstanding (in US dollars per share)	$ 70.97	$ 78.10
Options granted (in US dollars per share)		53.62
Options exercised (in US dollars per share)	53.41	53.41
Options forfeited (in US dollars per share)	66.44	62.33
Options expired (in US dollars per share)	64.33
Options outstanding (in US dollars per share)	$ 68.80	$ 70.97
Stock Options Additional Disclosures
Options exercisable (in shares)	2,078,827	1,695,155
Options exercisable (in US dollars per share)	$ 71.40	$ 74.73
Options outstanding (in years)	2 years 6 months 3 days
Options exercisable (in years)	2 years 3 months
2019 Stock Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding [Roll Forward]
Options granted (in shares)	385,500
Options expired (in shares)		(74,498)
Stock Options Weighted Average Exercise Price
Options granted (in US dollars per share)	$ 54.73
Options expired (in US dollars per share)		$ 77.93

Share-Based Compensation (Sch_3

Share-Based Compensation (Schedule of Share-Based Payments) (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Non-cash share-based compensation	$ 866	$ 1,065	$ 3,740	$ 7,576
Restricted Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Non-cash share-based compensation	119	0	191	0
Employee Stock Option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Non-cash share-based compensation	$ 747	$ 1,065	$ 3,549	$ 7,576

Earnings Per Common Share (Summ

Earnings Per Common Share (Summary Of Calculation Of Basic And Diluted Earnings Per Share) (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		6 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Jun. 30, 2023	Jun. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Earnings Per Share [Abstract]
Net income	$ 29,033	$ 34,229			$ 102,662	$ 63,941
Add: net loss attributable to noncontrolling interests	313	239			946	599
Net income attributable to stockholders	29,346	34,468			103,608	64,540
Less: net income attributable to unvested restricted stock awards	(19)	0			(38)	0
Net income attributable to common stockholders - basic	$ 29,327	$ 34,468			$ 103,570	$ 64,540
BASIC:
Weighted average common shares outstanding (in shares)	43,388,841	44,339,975			43,388,779	45,236,696
DILUTED:
Weighted average common shares outstanding (in shares)	43,388,841	44,339,975			43,388,779	45,236,696
Stock options (in shares)	0	62,607			896	24,427
Weighed average dilutive common shares outstanding (in shares)	43,388,841	44,402,582			43,389,675	45,261,123
Earnings per common share - basic (in US dollars per share)	$ 0.68	$ 0.78			$ 2.39	$ 1.43
Earnings per common share - diluted (in US dollars per share)	$ 0.68	$ 0.78			$ 2.39	$ 1.43
Incremental anti-dilutive shares excluded:
Net share effect of stock options with an exercise price in excess of the average market price for our common shares (in shares)	816,353	390,159			781,727	501,183
Regular dividends declared per common share (in US dollars per share)	$ 0.90	$ 0.90	$ 1.80	$ 1.80	$ 2.70	$ 2.70

Fair Value of Financial Instr_3

Fair Value of Financial Instruments (Fair Value Measurements, Nonrecurring) (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Level 3 | Carrying Amount
Fair Value of Financial Instruments [Line Items]
Mortgage and other notes receivable, net	$ 242,960	$ 233,141
Level 3 | Fair Value Measurement
Fair Value of Financial Instruments [Line Items]
Mortgage and other notes receivable, net	228,282	227,611
Variable rate debt | Level 2 | Carrying Amount
Fair Value of Financial Instruments [Line Items]
Debt instrument, fair value disclosure	399,233	277,699
Variable rate debt | Level 2 | Fair Value Measurement
Fair Value of Financial Instruments [Line Items]
Debt instrument, fair value disclosure	405,000	282,000
Fixed rate debt | Level 2 | Carrying Amount
Fair Value of Financial Instruments [Line Items]
Debt instrument, fair value disclosure	745,205	869,812
Fixed rate debt | Level 2 | Fair Value Measurement
Fair Value of Financial Instruments [Line Items]
Debt instrument, fair value disclosure	$ 642,539	$ 773,994

Segment Reporting (Narrative) (

Segment Reporting (Narrative) (Details) $ in Millions	9 Months Ended
	Sep. 30, 2023 USD ($) property jointVenture operatingSegment	Sep. 30, 2022 USD ($)	Apr. 01, 2022 jointVenture property
Segment Reporting Information [Line Items]
Number of operating segments | operatingSegment	2
Number of joint ventures | jointVenture	2
SHOP
Segment Reporting Information [Line Items]
Capital expenditures | $	$ 6.3	$ 1.8
Real Estate
Segment Reporting Information [Line Items]
Properties | property	163
Capital expenditures | $	$ 56.5	$ 7.6
Holiday Acquisition Holdings
Segment Reporting Information [Line Items]
Number of joint ventures | jointVenture			2
Independent Living Facility
Segment Reporting Information [Line Items]
Properties | property	3
Number of joint ventures | jointVenture	2
Independent Living Facility | SHOP
Segment Reporting Information [Line Items]
Properties | property	15		15

Segment Reporting (Schedule of

Segment Reporting (Schedule of Segment Reporting Information, by Segment) (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022
Segment Reporting Information [Line Items]
Rental income	$ 62,255	$ 59,394	$ 188,505	$ 163,935
Resident fees and services	12,367	12,013	35,860	24,005
Interest income and other	5,484	4,891	16,005	19,584
Total revenues	80,106	76,298	240,370	207,524
Senior housing operating expenses	10,045	9,239	29,525	18,352
Taxes and insurance on leased properties	2,908	2,358	8,738	7,553
NOI	67,153	64,701	202,107	181,619
Depreciation	17,515	17,533	52,862	53,577
Interest	15,086	11,412	43,308	32,472
Legal	67	88	364	2,254
Franchise, excise and other taxes	2	225	443	694
General and administrative	4,430	4,744	14,390	17,893
Loan and realty losses	1,959	11,329	1,727	39,951
Gains on sales of real estate, net	(737)	(14,840)	(13,500)	(28,342)
Gain on operations transfer, net	0	(19)	(20)	710
Gain on note receivable payoff	0	0	0	(1,113)
Other non-operating income	(202)	0	(202)	0
Loss on early retirement of debt	0	0	73	151
Gains from equity method investment	0	0	0	(569)
Net income	29,033	34,229	102,662	63,941
Total assets	2,499,090	2,508,785	2,499,090	2,508,785	$ 2,507,424
Operating Segments | Real Estate
Segment Reporting Information [Line Items]
Rental income	62,255	59,394	188,505	163,935
Resident fees and services	0	0	0	0
Interest income and other	5,337	4,820	15,727	19,362
Total revenues	67,592	64,214	204,232	183,297
Senior housing operating expenses	0	0	0	0
Taxes and insurance on leased properties	2,908	2,358	8,738	7,553
NOI	64,684	61,856	195,494	175,744
Depreciation	15,211	15,390	46,064	49,282
Interest	773	837	2,298	2,371
Legal	0	0	0	0
Franchise, excise and other taxes	0	0	0	0
General and administrative	0	0	0	0
Loan and realty losses	1,959	11,329	1,727	39,951
Gains on sales of real estate, net	(737)	(14,840)	(13,500)	(28,342)
Gain on operations transfer, net		(19)	(20)	710
Gain on note receivable payoff				(1,113)
Other non-operating income	(202)		(202)
Loss on early retirement of debt			0	0
Gains from equity method investment				(569)
Net income	47,680	49,159	159,127	113,454
Total assets	2,218,699	2,214,475	2,218,699	2,214,475
Operating Segments | SHOP
Segment Reporting Information [Line Items]
Rental income	0	0	0	0
Resident fees and services	12,367	12,013	35,860	24,005
Interest income and other	0	0	0	0
Total revenues	12,367	12,013	35,860	24,005
Senior housing operating expenses	10,045	9,239	29,525	18,352
Taxes and insurance on leased properties	0	0	0	0
NOI	2,322	2,774	6,335	5,653
Depreciation	2,292	2,129	6,757	4,245
Interest	0	0	0	0
Legal	0	0	0	0
Franchise, excise and other taxes	0	0	0	0
General and administrative	0	0	0	0
Loan and realty losses	0	0	0	0
Gains on sales of real estate, net	0	0	0	0
Gain on operations transfer, net		0	0	0
Gain on note receivable payoff				0
Other non-operating income	0		0
Loss on early retirement of debt			0	0
Gains from equity method investment				0
Net income	30	645	(422)	1,408
Total assets	277,014	290,708	277,014	290,708
Non-segment/Corporate
Segment Reporting Information [Line Items]
Rental income	0	0	0	0
Resident fees and services	0	0	0	0
Interest income and other	147	71	278	222
Total revenues	147	71	278	222
Senior housing operating expenses	0	0	0	0
Taxes and insurance on leased properties	0	0	0	0
NOI	147	71	278	222
Depreciation	12	14	41	50
Interest	14,313	10,575	41,010	30,101
Legal	67	88	364	2,254
Franchise, excise and other taxes	2	225	443	694
General and administrative	4,430	4,744	14,390	17,893
Loan and realty losses	0	0	0	0
Gains on sales of real estate, net	0	0	0	0
Gain on operations transfer, net		0	0	0
Gain on note receivable payoff				0
Other non-operating income	0		0
Loss on early retirement of debt			73	151
Gains from equity method investment				0
Net income	(18,677)	(15,575)	(56,043)	(50,921)
Total assets	$ 3,377	$ 3,602	$ 3,377	$ 3,602

Unconsolidated Variable Inter_3

Unconsolidated Variable Interest Entities (Details) $ in Thousands	Sep. 30, 2023 USD ($)
Senior Living | Straight-Line Rent Receivable
Variable Interest Entity [Line Items]
Carrying Amount	$ 89,728
Maximum Exposure to Loss	93,478
Senior Living Management | Straight-Line Rent Receivable
Variable Interest Entity [Line Items]
Carrying Amount	24,500
Maximum Exposure to Loss	24,500
Bickford | Straight-Line Rent Receivable
Variable Interest Entity [Line Items]
Carrying Amount	17,108
Maximum Exposure to Loss	29,816
Encore Senior Living | Notes Receivable
Variable Interest Entity [Line Items]
Carrying Amount	54,161
Maximum Exposure to Loss	56,536
Timber Ridge OpCo
Variable Interest Entity [Line Items]
Maximum Exposure to Loss	5,000
Timber Ridge OpCo | Notes Receivable
Variable Interest Entity [Line Items]
Carrying Amount	1,977
Maximum Exposure to Loss	6,977
Watermark Retirement | Notes Receivable
Variable Interest Entity [Line Items]
Carrying Amount	8,921
Maximum Exposure to Loss	11,445
Montecito Medical Real Estate | Notes Receivable
Variable Interest Entity [Line Items]
Carrying Amount	20,514
Maximum Exposure to Loss	50,260
Vizion Health | Notes Receivable
Variable Interest Entity [Line Items]
Carrying Amount	17,948
Maximum Exposure to Loss	17,948
Navion Senior Solutions | Notes Receivable
Variable Interest Entity [Line Items]
Carrying Amount	8,025
Maximum Exposure to Loss	8,025
Kindcare Senior Living | Notes Receivable
Variable Interest Entity [Line Items]
Carrying Amount	733
Maximum Exposure to Loss	$ 733

Uncategorized Items - nhi-20230

Label	Element	Value
Share-Based Payment Arrangement, Decrease for Tax Withholding Obligation	us-gaap_AdjustmentsRelatedToTaxWithholdingForShareBasedCompensation	$ 14,000
Share-Based Payment Arrangement, Decrease for Tax Withholding Obligation	us-gaap_AdjustmentsRelatedToTaxWithholdingForShareBasedCompensation	274,000
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(115,482,000)
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(9,300,000)
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(86,053,000)
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	122,000
Stock Issued During Period, Value, New Issues	us-gaap_StockIssuedDuringPeriodValueNewIssues	(275,000)
Noncontrolling Interest, Decrease from Distributions to Noncontrolling Interest Holders	us-gaap_MinorityInterestDecreaseFromDistributionsToNoncontrollingInterestHolders	486,000
Noncontrolling Interest, Decrease from Distributions to Noncontrolling Interest Holders	us-gaap_MinorityInterestDecreaseFromDistributionsToNoncontrollingInterestHolders	380,000
Noncontrolling Interest, Decrease from Distributions to Noncontrolling Interest Holders	us-gaap_MinorityInterestDecreaseFromDistributionsToNoncontrollingInterestHolders	241,000
Noncontrolling Interest, Decrease from Distributions to Noncontrolling Interest Holders	us-gaap_MinorityInterestDecreaseFromDistributionsToNoncontrollingInterestHolders	563,000
APIC, Share-Based Payment Arrangement, Increase for Cost Recognition	us-gaap_AdjustmentsToAdditionalPaidInCapitalSharebasedCompensationRequisiteServicePeriodRecognitionValue	6,511,000
APIC, Share-Based Payment Arrangement, Increase for Cost Recognition	us-gaap_AdjustmentsToAdditionalPaidInCapitalSharebasedCompensationRequisiteServicePeriodRecognitionValue	866,000
APIC, Share-Based Payment Arrangement, Increase for Cost Recognition	us-gaap_AdjustmentsToAdditionalPaidInCapitalSharebasedCompensationRequisiteServicePeriodRecognitionValue	2,874,000
APIC, Share-Based Payment Arrangement, Increase for Cost Recognition	us-gaap_AdjustmentsToAdditionalPaidInCapitalSharebasedCompensationRequisiteServicePeriodRecognitionValue	1,065,000
Dividends, Common Stock, Cash	us-gaap_DividendsCommonStockCash	81,455,000
Dividends, Common Stock, Cash	us-gaap_DividendsCommonStockCash	39,050,000
Dividends, Common Stock, Cash	us-gaap_DividendsCommonStockCash	39,069,000
Dividends, Common Stock, Cash	us-gaap_DividendsCommonStockCash	78,119,000
Comprehensive Income (Loss), Net of Tax, Excluding Loss, Attributable to Noncontrolling Interest	nhi_ComprehensiveIncomeLossNetOfTaxExcludingLossAttributableToNoncontrollingInterest	29,283,000
Comprehensive Income (Loss), Net of Tax, Excluding Loss, Attributable to Noncontrolling Interest	nhi_ComprehensiveIncomeLossNetOfTaxExcludingLossAttributableToNoncontrollingInterest	74,205,000
Comprehensive Income (Loss), Net of Tax, Including Portion Attributable to Noncontrolling Interest	us-gaap_ComprehensiveIncomeNetOfTaxIncludingPortionAttributableToNoncontrollingInterest	29,939,000
Comprehensive Income (Loss), Net of Tax, Including Portion Attributable to Noncontrolling Interest	us-gaap_ComprehensiveIncomeNetOfTaxIncludingPortionAttributableToNoncontrollingInterest	34,506,000
Noncontrolling Interest, Increase from Subsidiary Equity Issuance	us-gaap_NoncontrollingInterestIncreaseFromSubsidiaryEquityIssuance	2,000,000
Adjustments to Additional Paid in Capital, Stock Issued, Issuance Costs	us-gaap_AdjustmentsToAdditionalPaidInCapitalStockIssuedIssuanceCosts	85,000
Common Stock [Member]
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(12,000)
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(13,000)
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	0
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	$ 0
Share-Based Compensation Arrangement by Share-Based Payment Award, Options, Exercises in Period	us-gaap_StockIssuedDuringPeriodSharesStockOptionsExercised	732
Share-Based Compensation Arrangement by Share-Based Payment Award, Options, Exercises in Period	us-gaap_StockIssuedDuringPeriodSharesStockOptionsExercised	99
Shares Issued, Shares, Share-Based Payment Arrangement, after Forfeiture	us-gaap_StockIssuedDuringPeriodSharesShareBasedCompensation	5,765
Stock Issued During Period, Shares, Period Increase (Decrease)	us-gaap_StockIssuedDuringPeriodSharesPeriodIncreaseDecrease	(1,195,443)
Stock Issued During Period, Shares, Period Increase (Decrease)	us-gaap_StockIssuedDuringPeriodSharesPeriodIncreaseDecrease	(1,266,414)
Stock Issued During Period, Shares, Period Increase (Decrease)	us-gaap_StockIssuedDuringPeriodSharesPeriodIncreaseDecrease	0
Stock Issued During Period, Shares, Period Increase (Decrease)	us-gaap_StockIssuedDuringPeriodSharesPeriodIncreaseDecrease	21,099
Stock Repurchased During Period, Shares	us-gaap_StockRepurchasedDuringPeriodShares	1,272,179
Stock Repurchased During Period, Shares	us-gaap_StockRepurchasedDuringPeriodShares	1,196,175
Stock Repurchased During Period, Value	us-gaap_StockRepurchasedDuringPeriodValue	$ 12,000
Stock Repurchased During Period, Value	us-gaap_StockRepurchasedDuringPeriodValue	$ 13,000
Stock Issued During Period, Shares, Restricted Stock Award, Gross	us-gaap_StockIssuedDuringPeriodSharesRestrictedStockAwardGross	21,000
Parent [Member]
Share-Based Payment Arrangement, Decrease for Tax Withholding Obligation	us-gaap_AdjustmentsRelatedToTaxWithholdingForShareBasedCompensation	$ 14,000
Share-Based Payment Arrangement, Decrease for Tax Withholding Obligation	us-gaap_AdjustmentsRelatedToTaxWithholdingForShareBasedCompensation	274,000
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(114,863,000)
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(8,857,000)
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(85,850,000)
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(1,257,000)
Stock Issued During Period, Value, New Issues	us-gaap_StockIssuedDuringPeriodValueNewIssues	(275,000)
APIC, Share-Based Payment Arrangement, Increase for Cost Recognition	us-gaap_AdjustmentsToAdditionalPaidInCapitalSharebasedCompensationRequisiteServicePeriodRecognitionValue	6,511,000
APIC, Share-Based Payment Arrangement, Increase for Cost Recognition	us-gaap_AdjustmentsToAdditionalPaidInCapitalSharebasedCompensationRequisiteServicePeriodRecognitionValue	866,000
APIC, Share-Based Payment Arrangement, Increase for Cost Recognition	us-gaap_AdjustmentsToAdditionalPaidInCapitalSharebasedCompensationRequisiteServicePeriodRecognitionValue	2,874,000
APIC, Share-Based Payment Arrangement, Increase for Cost Recognition	us-gaap_AdjustmentsToAdditionalPaidInCapitalSharebasedCompensationRequisiteServicePeriodRecognitionValue	1,065,000
Dividends, Common Stock, Cash	us-gaap_DividendsCommonStockCash	39,069,000
Dividends, Common Stock, Cash	us-gaap_DividendsCommonStockCash	39,050,000
Dividends, Common Stock, Cash	us-gaap_DividendsCommonStockCash	78,119,000
Dividends, Common Stock, Cash	us-gaap_DividendsCommonStockCash	81,455,000
Comprehensive Income (Loss), Net of Tax, Excluding Loss, Attributable to Noncontrolling Interest	nhi_ComprehensiveIncomeLossNetOfTaxExcludingLossAttributableToNoncontrollingInterest	29,346,000
Comprehensive Income (Loss), Net of Tax, Excluding Loss, Attributable to Noncontrolling Interest	nhi_ComprehensiveIncomeLossNetOfTaxExcludingLossAttributableToNoncontrollingInterest	74,263,000
Comprehensive Income (Loss), Net of Tax, Including Portion Attributable to Noncontrolling Interest	us-gaap_ComprehensiveIncomeNetOfTaxIncludingPortionAttributableToNoncontrollingInterest	34,468,000
Comprehensive Income (Loss), Net of Tax, Including Portion Attributable to Noncontrolling Interest	us-gaap_ComprehensiveIncomeNetOfTaxIncludingPortionAttributableToNoncontrollingInterest	30,072,000
Stock Repurchased During Period, Value	us-gaap_StockRepurchasedDuringPeriodValue	69,977,000
Stock Repurchased During Period, Value	us-gaap_StockRepurchasedDuringPeriodValue	81,974,000
Adjustments to Additional Paid in Capital, Stock Issued, Issuance Costs	us-gaap_AdjustmentsToAdditionalPaidInCapitalStockIssuedIssuanceCosts	85,000
Retained Earnings, Appropriated [Member]
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(39,069,000)
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(81,455,000)
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(39,050,000)
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(78,119,000)
Dividends, Common Stock, Cash	us-gaap_DividendsCommonStockCash	78,119,000
Dividends, Common Stock, Cash	us-gaap_DividendsCommonStockCash	81,455,000
Dividends, Common Stock, Cash	us-gaap_DividendsCommonStockCash	39,069,000
Dividends, Common Stock, Cash	us-gaap_DividendsCommonStockCash	39,050,000
Stock Repurchased During Period, Value	us-gaap_StockRepurchasedDuringPeriodValue	69,965,000
Additional Paid-in Capital [Member]
Share-Based Payment Arrangement, Decrease for Tax Withholding Obligation	us-gaap_AdjustmentsRelatedToTaxWithholdingForShareBasedCompensation	14,000
Share-Based Payment Arrangement, Decrease for Tax Withholding Obligation	us-gaap_AdjustmentsRelatedToTaxWithholdingForShareBasedCompensation	274,000
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	6,497,000
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	706,000
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	866,000
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	2,599,000
Stock Issued During Period, Value, New Issues	us-gaap_StockIssuedDuringPeriodValueNewIssues	(275,000)
APIC, Share-Based Payment Arrangement, Increase for Cost Recognition	us-gaap_AdjustmentsToAdditionalPaidInCapitalSharebasedCompensationRequisiteServicePeriodRecognitionValue	2,874,000
APIC, Share-Based Payment Arrangement, Increase for Cost Recognition	us-gaap_AdjustmentsToAdditionalPaidInCapitalSharebasedCompensationRequisiteServicePeriodRecognitionValue	866,000
APIC, Share-Based Payment Arrangement, Increase for Cost Recognition	us-gaap_AdjustmentsToAdditionalPaidInCapitalSharebasedCompensationRequisiteServicePeriodRecognitionValue	6,511,000
APIC, Share-Based Payment Arrangement, Increase for Cost Recognition	us-gaap_AdjustmentsToAdditionalPaidInCapitalSharebasedCompensationRequisiteServicePeriodRecognitionValue	1,065,000
Adjustments to Additional Paid in Capital, Stock Issued, Issuance Costs	us-gaap_AdjustmentsToAdditionalPaidInCapitalStockIssuedIssuanceCosts	85,000
Retained Earnings [Member]
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	29,346,000
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(39,893,000)
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(47,493,000)
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	74,263,000
Dividends, Common Stock, Cash	us-gaap_DividendsCommonStockCash	0
Comprehensive Income (Loss), Net of Tax, Excluding Loss, Attributable to Noncontrolling Interest	nhi_ComprehensiveIncomeLossNetOfTaxExcludingLossAttributableToNoncontrollingInterest	29,346,000
Comprehensive Income (Loss), Net of Tax, Excluding Loss, Attributable to Noncontrolling Interest	nhi_ComprehensiveIncomeLossNetOfTaxExcludingLossAttributableToNoncontrollingInterest	74,263,000
Comprehensive Income (Loss), Net of Tax, Including Portion Attributable to Noncontrolling Interest	us-gaap_ComprehensiveIncomeNetOfTaxIncludingPortionAttributableToNoncontrollingInterest	34,468,000
Comprehensive Income (Loss), Net of Tax, Including Portion Attributable to Noncontrolling Interest	us-gaap_ComprehensiveIncomeNetOfTaxIncludingPortionAttributableToNoncontrollingInterest	30,072,000
Stock Repurchased During Period, Value	us-gaap_StockRepurchasedDuringPeriodValue	81,961,000
Noncontrolling Interest [Member]
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(619,000)
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(443,000)
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(203,000)
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	1,379,000
Noncontrolling Interest, Decrease from Distributions to Noncontrolling Interest Holders	us-gaap_MinorityInterestDecreaseFromDistributionsToNoncontrollingInterestHolders	380,000
Noncontrolling Interest, Decrease from Distributions to Noncontrolling Interest Holders	us-gaap_MinorityInterestDecreaseFromDistributionsToNoncontrollingInterestHolders	486,000
Noncontrolling Interest, Decrease from Distributions to Noncontrolling Interest Holders	us-gaap_MinorityInterestDecreaseFromDistributionsToNoncontrollingInterestHolders	241,000
Noncontrolling Interest, Decrease from Distributions to Noncontrolling Interest Holders	us-gaap_MinorityInterestDecreaseFromDistributionsToNoncontrollingInterestHolders	563,000
Comprehensive Income (Loss), Net of Tax, Excluding Loss, Attributable to Noncontrolling Interest	nhi_ComprehensiveIncomeLossNetOfTaxExcludingLossAttributableToNoncontrollingInterest	(63,000)
Comprehensive Income (Loss), Net of Tax, Excluding Loss, Attributable to Noncontrolling Interest	nhi_ComprehensiveIncomeLossNetOfTaxExcludingLossAttributableToNoncontrollingInterest	(58,000)
Comprehensive Income (Loss), Net of Tax, Including Portion Attributable to Noncontrolling Interest	us-gaap_ComprehensiveIncomeNetOfTaxIncludingPortionAttributableToNoncontrollingInterest	(133,000)
Comprehensive Income (Loss), Net of Tax, Including Portion Attributable to Noncontrolling Interest	us-gaap_ComprehensiveIncomeNetOfTaxIncludingPortionAttributableToNoncontrollingInterest	38,000
Noncontrolling Interest, Increase from Subsidiary Equity Issuance	us-gaap_NoncontrollingInterestIncreaseFromSubsidiaryEquityIssuance	$ 2,000,000