National Health Investors (NHI) 10-Q 5 Nov 24 2024 Q3 Quarterly report Financial data

Cover

Cover - shares	9 Months Ended
	Sep. 30, 2024	Nov. 01, 2024
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2024
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		45,422,064
Amendment Flag	false
Document Fiscal Year Focus	2024
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, 2024	Dec. 31, 2023
Real estate properties:
Land		$ 181,173	$ 180,749
Buildings and improvements		2,627,928	2,593,696
Construction in progress		11,329	5,913
Real estate properties, gross		2,820,430	2,780,358
Less accumulated depreciation		(723,606)	(673,276)
Real estate properties, net		2,096,824	2,107,082
Mortgage and other notes receivable, net of reserve of $19,411 and $15,476, respectively		232,550	245,271
Cash and cash equivalents		15,550	22,347
Straight-line rent receivable		86,334	84,713
Assets held for sale, net		5,669	5,004
Other assets, net		23,163	24,063
Total Assets	[1]	2,460,090	2,488,480
Liabilities and Stockholders’ Equity:
Debt		1,136,302	1,135,051
Accounts payable and accrued expenses		32,508	34,304
Dividends payable		39,260	39,069
Deferred income		4,612	6,009
Total Liabilities	[1]	1,212,682	1,214,433
Commitments and contingencies
Redeemable noncontrolling interest		8,925	9,656
National Health Investors, Inc. Stockholders’ Equity:
Common stock		436	434
Capital in excess of par value		1,601,450	1,603,757
Retained earnings		2,561,587	2,466,844
Cumulative dividends		(2,934,523)	(2,817,083)
Total National Health Investors, Inc. Stockholders’ Equity		1,228,950	1,253,952
Noncontrolling interests		9,533	10,439
Total Equity		1,238,483	1,264,391
Total Liabilities and Equity		$ 2,460,090	$ 2,488,480
[1] The Condensed Consolidated Balance Sheets include the following amounts related to our consolidated variable interest entities: $507.1 million and $513.2 million of Real estate properties, net; $6.9 million and $10.9 million of Cash and cash equivalents; $9.9 million and $9.7 million of Straight-line rent receivable; $8.1 million and $9.4 million of Other assets, net; and $4.6 million and $4.7 million of Accounts payable and accrued expenses, in each case as of September 30, 2024 and December 31, 2023, respectively.

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Statement of Financial Position [Abstract]
Mortgage and other notes receivable, net of reserve	$ 19,411	$ 15,476
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)	43,622,064	43,622,064
Common stock, shares outstanding (in shares)	43,409,841	43,409,841
Real estate properties, net	$ 2,096,824	$ 2,107,082
Cash and cash equivalents	15,550	22,347
Straight-line rent receivable	86,334	84,713
Other assets, net	23,163	24,063
Accounts payable and accrued expenses	(32,508)	(34,304)
Variable Interest Entity, Primary Beneficiary
Real estate properties, net	507,100	513,200
Cash and cash equivalents	6,900	10,900
Straight-line rent receivable	9,900	9,700
Other assets, net	8,100	9,400
Accounts payable and accrued expenses	$ (4,600)	$ (4,700)

Condensed Consolidated Statemen

Condensed Consolidated Statements Of Income - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Revenues:
Rental income	$ 63,318	$ 62,255	$ 191,265	$ 188,505
Resident fees and services	13,771	12,367	40,416	35,860
Interest income and other	5,855	5,484	17,745	16,005
Total revenues	82,944	80,106	249,426	240,370
Expenses:
Depreciation	17,768	17,515	52,763	52,862
Interest	14,939	15,086	44,663	43,308
Senior housing operating expenses	10,744	10,045	31,494	29,525
Legal	240	67	641	364
Franchise, excise and other taxes	83	2	(56)	443
General and administrative	4,810	4,430	15,318	14,390
Taxes and insurance on leased properties	2,786	2,908	8,321	8,738
Loan and realty losses	3,434	1,959	4,550	1,727
Total operating expenses	54,804	52,012	157,694	151,357
Gains on sales of real estate, net	102	737	1,718	13,500
Gain on operations transfer, net	0	0	0	20
Loss on early retirement of debt	0	0	0	(73)
Gains from equity method investment	0	0	402	0
Other non-operating income	0	202	0	202
Net income	28,242	29,033	93,852	102,662
Add: net loss attributable to noncontrolling interests	298	313	891	946
Net income attributable to stockholders	28,540	29,346	94,743	103,608
Less: net income attributable to unvested restricted stock awards	(29)	(19)	(90)	(38)
Net income attributable to common stockholders - basic and diluted	$ 28,511	$ 29,327	$ 94,653	$ 103,570
Weighted average common shares outstanding:
Basic (in shares)	43,476,067	43,388,841	43,420,663	43,388,779
Diluted (in shares)	43,987,072	43,388,841	43,658,425	43,389,675
Earnings per common share - basic (in dollars per share)	$ 0.66	$ 0.68	$ 2.18	$ 2.39
Earnings per common share - diluted (in dollars per share)	$ 0.65	$ 0.68	$ 2.17	$ 2.39

Condensed Consolidated Statem_2

Condensed Consolidated Statements Of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
Cash flows from operating activities:
Net income	$ 93,852	$ 102,662
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation	52,763	52,862
Amortization of debt issuance costs, debt discounts and prepaids	4,522	3,392
Amortization of commitment fees and note receivable discounts	(17)	(323)
Amortization of lease incentives	2,168	1,798
Straight-line rent adjustments	(2,066)	(6,011)
Non-cash rental income	0	(2,500)
Non-cash interest income on mortgage and other notes receivable	(39)	(1,302)
Gains on sales of real estate, net	(1,718)	(13,500)
Gains from equity method investment	(402)	0
Loss on early retirement of debt	0	73
Loan and realty losses	4,550	1,727
Payment of lease incentive	0	(10,000)
Non-cash share-based compensation	3,512	3,740
Changes in operating assets and liabilities:
Other assets, net	(2,494)	(2,426)
Accounts payable and accrued expenses	(3,483)	1,317
Deferred income	(953)	(262)
Net cash provided by operating activities	150,195	131,247
Cash flows from investing activities:
Investments in mortgage and other notes receivable	(27,816)	(33,104)
Collections of mortgage and other notes receivable	14,692	11,231
Fees received on mortgage note	82	0
Acquisitions of real estate	(9,866)	(38,081)
Proceeds from sales of real estate	4,658	51,542
Investments in renovations of existing real estate	(9,717)	(5,475)
Investments in equipment	(3,551)	(2,579)
Distributions from equity method investment	402	2,500
Net cash used in investing activities	(31,116)	(13,966)
Cash flows from financing activities:
Proceeds from revolving credit facility	244,000	283,000
Payments on revolving credit facility	(170,000)	(120,000)
Borrowings on term loan	0	200,000
Payments on term loans	(75,327)	(365,304)
Debt issuance costs	0	(2,747)
Forward equity costs	(782)	0
Distributions to noncontrolling interests	(821)	(1,004)
Dividends paid to stockholders	(117,250)	(117,169)
Taxes related to net settlement of equity awards	(5,819)	0
Proceeds from noncontrolling interest	70	2,922
Net cash used in financing activities	(125,929)	(120,302)
Decrease in cash and cash equivalents and restricted cash	(6,850)	(3,021)
Cash and cash equivalents and restricted cash, beginning of period	24,617	21,516
Cash and cash equivalents and restricted cash, end of period	17,767	18,495
Supplemental disclosure of cash flow information:
Interest paid, net of amounts capitalized	45,250	41,222
Supplemental disclosure of non-cash investing and financing activities:
Real estate acquired in exchange for mortgage note receivable	22,184	14,200
Increase in notes receivable from sales of real estate	0	699
Change in accounts payable related to renovations of existing real estate	(1,430)	80
Change in accounts payable related to distributions to noncontrolling interests	(6)	(61)
Right of use assets in exchange for lease liabilities	344	0
Reclassification of prepaid equity issuance costs to capital in excess of par value	$ 0	$ 275

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 (in shares) at Dec. 31, 2022			43,388,742
Beginning 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 (in shares) at Sep. 30, 2023			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
Beginning balance (in shares) at Dec. 31, 2023	43,409,841		43,409,841
Beginning balance at Dec. 31, 2023	$ 1,264,391	1,253,952	$ 434	1,603,757	2,466,844	(2,817,083)	10,439
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Shares issued on stock options exercised (in shares)	1,065,119
Ending balance (in shares) at Sep. 30, 2024	43,409,841		43,622,064
Ending balance at Sep. 30, 2024	$ 1,238,483	$ 1,228,950	$ 436	$ 1,601,450	$ 2,561,587	$ (2,934,523)	$ 9,533

Condensed Consolidated Statem_4

Condensed Consolidated Statement Of Equity (Parenthetical) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Jun. 30, 2024	Jun. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Statement of Stockholders' Equity [Abstract]
Distributions			$ 9		$ 9
Net loss attributable to redeemable noncontrolling interest	$ 244	$ 250	$ 478	$ 575	$ 722
Dividends to common stockholders (in dollars per share)	$ 0.90	$ 0.90	$ 1.80	$ 1.80	$ 2.70	$ 2.70

Organization and Nature of Busi

Organization and Nature of Business	9 Months Ended
	Sep. 30, 2024
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, and mortgage and other notes receivables in independent living facilities (“ILFs”), assisted living facilities (“ALFs”), entrance-fee communities (“EFCs”), senior living campuses (“SLCs”), skilled nursing facilities (“SNFs”) and hospitals (“HOSPs”). As of September 30, 2024, we had gross real estate investments of approximately $2.5 billion in 161 healthcare real estate properties located in 31 states and leased pursuant primarily to triple-net leases to 25 tenants consisting of 95 senior housing communities, 65 SNFs and one HOSP, excluding two properties classified as assets held for sale. Our portfolio of nine mortgages alon g with other notes receivable totaled $252.0 million, excluding an allowance for expected credit losses of $19.4 million, as of September 30, 2024. Our SHOP segment is comprised of two ventures that own the operations of ILFs. For this segment, as of September 30, 2024, we had gross investments of approximately $354.9 million in 15 ILFs located in eight states with a combined 1,732 units that are operated on behalf of the Company by independent managers pursuant to the terms of separate management agreements. The third-party managers, or related parties of the managers, own equity interests in the respective ventures. Units, beds and property count disclosures in these notes to the condensed consolidated financial statements are outside the scope of our independent registered accounting firm’s review.

Basis of Presentation and Signi

Basis of Presentation and Significant Accounting Policies	9 Months Ended
	Sep. 30, 2024
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 notes 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, 2023, included in our Annual Report on Form 10-K for the year ended December 31, 2023 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. 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. Reference Notes 5 and 16 for further discussion of our SHOP ventures. We also consolidate two real estate partner ships formed with our partners, Discovery Senior Housing Investor XXIV, LLC, a related party of Discovery, and LCS Timber Ridge LLC (“LCS”), 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. Reference Note 16 for further discussion of these consolidated real estate partnerships. We use the equity method of accounting when we own an interest in an entity over which we can exert significant influence 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 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. 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, contributions, 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, 2024 and December 31, 2023, the Merrill SHOP venture noncontrolling interest was classified in the Condensed Consolidated Balance Sheets as 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 the Condensed Consolidated Balance Sheets as equity as of September 30, 2024 and December 31, 2023. Cash and Cash Equivalents and Restricted Cash Cash equivalents consist of all highly liquid investments with original maturities 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, 2024 September 30, 2023 Beginning of period: Cash and cash equivalents $ 22,347 $ 19,291 Restricted cash (included in Other assets, net) 2,270 2,225 Cash, cash equivalents, and restricted cash $ 24,617 $ 21,516 End of period: Cash and cash equivalents $ 15,550 $ 16,579 Restricted cash (included in Other assets, net) 2,217 1,916 Cash, cash equivalents, and restricted cash $ 17,767 $ 18,495 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 mortgage and other notes receivable consist primarily of secured loans on facilities. Our financial instruments, principally our investments in mortgage and other 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 mortgage and other 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. 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 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 collectable 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 of substantially all lease payments 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. Reference Note 3 for further discussion. Resident Fees and Services - Resident fee and services 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 recognizes 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 or other note receivable 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, 2024, we had two mortgage notes receivable and a mezzanine loan totaling an aggregate of $26.4 million due from affiliates of two operators/borrowers 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. 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 taxable REIT subsidiaries (“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: Re al 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. Forward Equity Sales The Company has and may continue to enter into forward sale agreements relating to shares of its common stock, either through its at-the-market (“ATM “) equity program or through underwritten public offerings. These agreements may be physically settled in stock, settled in cash or net share settled at the Company’s election. The forward sale price that we will receive upon physical settlement of the forward sale agreements will be subject to adjustment for (i) a floating interest rate factor equal to a specified daily rate less a spread, and (ii) scheduled dividends during the term of the forward sale agreement. The Company evaluated its forward sale agreements and concluded they meet the conditions to be classified within stockholders’ equity. Shares issuable under a forward equity sales agreement are reflected in the diluted earnings per share calculations for the applicable periods using the treasury stock method. Under this method, the number of our common shares used in calculating diluted earnings per share is deemed to be increased by the excess, if any, of the number of common shares that would be issued upon full physical settlement of the forward equity sales agreement over the number of common shares that could be purchased by us in the market (based on the average market price during the period) using the proceeds receivable upon full physical settlement (based on the average forward price during the reporting period). 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 average number of shares of common stock outstanding during the period. Diluted earnings per common share reflects the effect of dilutive securities. Recent Accounting Pronouncements

Investment Activity

Investment Activity	9 Months Ended
	Sep. 30, 2024
Real Estate [Abstract]
Investment Activity	Investment Activity Asset Acquisitions In June 2024, we acquired a 110-unit ALF located in Sussex, Wisconsin, from Encore Senior Living (“Encore”). The acquisition price was $32.1 million, including $0.1 million in closing costs, and the cancellation of an outstanding construction note receivable held by us of $22.2 million including interest. We added the facility to an existing master lease with Encore for a term of 15 years at an initial lease rate of 8.25% and annual escalators of 2.21%. Of the total purchase price, $1.3 million was allocated to land and $30.8 million was allocated to buildings and improvements. Asset Dispositions During the nine months ended September 30, 2024, we completed the sale of two ALFs located in Louisiana, previously leased to one of our tenants on cash basis of accounting for revenue recognition, for net cash proceeds of $4.7 million, resulting in a gain of approximately $1.4 million. Assets Held for Sale and Impairments of Long-Lived Assets The following is a summary of our assets held for sale in our Real Estate Investments portfolio ( $ in thousands ): As of As of September 30, 2024 December 31, 2023 Number of facilities 2 1 Real estate, net $5,669 $5,004 Rental income associated with assets he ld for sale as of September 30, 2024 totaled $0.2 million and $1.1 million for the three and nine months ended September 30, 2024, respectively, and $0.6 million and $1.5 million for the three and nine months ended September 30, 2023, respectively. During the nine months ended September 30, 2024, we recorded impairment charges of approximately $0.7 million on one property reclassified to assets held for sale in the second quarter of 2024 in our Real Estate Investments segment. During the three months ended September 30, 2023, we recorded impairment charges of approximately $1.2 million on 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 on four properties in our Real Estate Investments segment. The impairment charges were determined in connection with the preparation of the financial statements for the applicable quarterly period and are included in “ Loan and realty losses ” in the Condensed Consolidated Statements of Income for the three and nine months ended September 30, 2024 and 2023. We reduce the carrying value of impaired properties to their estimated fair value or, with respect to the properties classified as assets held for sale, to the 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, broker quotes of estimated values (Level 3 inputs), and/or independent third-party valuations (Level 1 and 3 inputs). We lease a SLC that is subject to an outstanding purchase and sale agreement for the tenant to acquire the property for approximately $38.5 million. The purchase and sale agreement, as amended, expires in June 2025. The property continues to be classified as held and used and is leased pursuant to the existing triple-net lease that generates approximately $2.8 million in annual rent and expires in July 2027. The property will be reclassified to assets held for sale when the sale becomes probable, including when the tenant demonstrates its ability to obtain sufficient financing to close on the sale of the property within the terms of the purchase and sale agreement. The property had a net investment of $19.3 million as of September 30, 2024. Fourth Quarter 2024 Acquisitions In October 2024, we acquired a portfolio of ten assisted living and memory care communities located in North Carolina for a total purchase price of $121.0 million, excluding $0.3 million in closing costs. The 15-year master lease, which includes two five-year extension options, has an initial lease rate of 8.25% with fixed annual escalators of 2%. The master lease includes a $10.0 million earnout incentive which will be added to the respective lease base if funded. 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 as of and for the nine months ended September 30, 2024 and 2023, excluding $2.6 million for our corporate office, a credit loss reserve of $19.4 million and $354.9 million in real estate assets in the SHOP segment ( $ in thousands ): As of September 30, 2024 Revenues 1 Asset Class Gross Real Estate 2 Notes Receivable Nine Months Ended September 30, 2024 2023 Senior Living Communities, LLC (“Senior Living”) EFC $ 576,829 $ 42,896 $ 39,980 16% $ 38,466 16% Bickford Senior Living (“Bickford”) ALF 431,085 16,647 31,233 13% 29,280 12% National HealthCare Corporation (“NHC”) SNF 133,770 — 30,426 12% 28,159 12% All others, net Various 1,336,671 192,418 99,050 40% 99,867 41% Escrow funds received from tenants for property operating expenses Various — — 8,321 3% 8,738 4% $ 2,478,355 $ 251,961 209,010 204,510 Resident fees and services 3 40,416 16% 35,860 15% $ 249,426 $ 240,370 1 Includes interest income on notes receivable and rental income from properties classified as assets held for sale. 2 Amounts include any properties classified as held for sale. 3 There is no tenant concentration in “Resident fees and services” because these agreements are with individual residents. At September 30, 2024, the two states in which we had an investment concentration of 10% or more were South Carolina (12.1%) and Texas (10.6%). Senior Living As of September 30, 2024, we leased ten retirement communities to Senior Living. In the second quarter of 2024, two of the leases were amended to extend the maturity dates by two years and to provide up to $10.0 million of capital improvements on various properties. Rental revenue will increase at a lease rate of 8.5% applied to the amount expended. We recognized straight-line rent revenue of $(0.4) million and $(0.9) million from Senior Living for the nine months ended September 30, 2024 and 2023, respectively. Bickford As of September 30, 2024, we leased 39 facilities, including one property reclassified to assets held for sale in the second quarter of 2024, to Bickford under four leases. Bickford has been on the cash basis of revenue recognition since the second quarter of 2022 based upon information obtained from Bickford regarding its financial condition that has raised substantial doubt as to its ability to continue. Effective April 1, 2024, the combined rent for the Bickford leased portfolio was reset to $34.5 million per year with nominal increases through April 1, 2026, at which time the rent will be reset to a fair market value based on the Consumer Price Index (“CPI”). Base rent will escalate annually thereafter based on either a fixed percentage or CPI subject to a floor of 2% and a ceiling of 3%. As part of the lease amendments, we agreed to fund up to $8.0 million of capital improvements on various properties. Rental revenue will increase at a lease rate of 8.0% applied to the amount expended. During the three and nine months ended September 30, 2024, Bickford repaid $1.1 million and $4.0 million, respectively, of its outstanding pandemic-related rent deferrals. 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 rent deferrals, in addition to the reduction in rent deferrals of $2.5 million recognized in connection with the acquisition of an ALF located in Chesapeake, Virginia from Bickford through a note receivable conversion. As of September 30, 2024, Bickford’s outstanding pandemic-related rent deferrals were $14.0 million. NHC As of September 30, 2024, we leased three ILFs and 32 SNFs to NHC, a publicly held company, under a master lease (four of which were subleased to other parties for whom the lease payments were guaranteed to us by NHC). Straight-line rent revenue of $0.2 million and $(0.9) million was recognized from NHC for the nine months ended September 30, 2024 and 2023, respectively. NHC Percentage Rent - Under the terms of our master lease agreement with NHC, rent escalates by 4% of the increase, if any, in each of the facility’s revenue over a base year and is referred to as “percentage rent.” The following table summarizes the percentage rent income from NHC ( $ in thousands ): Nine Months Ended September 30, 2024 2023 Current year $ 4,138 $ 2,896 Prior year final certification 1 1,656 630 Total percentage rent income $ 5,794 $ 3,526 1 For purposes of the percentage rent calculation described in the master lease agreement, NHC’s annual revenue by facility for a given year is certified to NHI by March 31 st of the following year. Two of the members of our Board of Directors, including our chairman, are also members of NHC’s board of directors. Cash Basis Operators We had three tenants on the cash basis of accounting for revenue recognition for their leasing arrangements based on our assessment of each tenant’s ability to satisfy its contractual obligations as of September 30, 2024. Cash rents received from these tenants for the three and nine months ended September 30, 2024 and 2023 were as follows ( $ in thousands ): Three Months Ended September 30, Nine Months Ended September 30, 2024 2023 2024 2023 Bickford 1 $ 9,850 $ 8,607 $ 29,161 $ 24,534 All others 2 1,855 3,446 9,398 9,963 Total rental income from cash basis operators $ 11,705 $ 12,053 $ 38,559 $ 34,497 1 Excludes $2.5 million of rental income related to the reduction of pandemic-related rent deferrals recognized in connection with the acquisition of an ALF from Bickford in the first quarter of 2023. 2 In the second quarter of 2024, we received a $2.5 million lump sum payment from an operator for partial repayment of pandemic-related rent deferrals. Senior Living Management Senior Living Management (“SLM”) has been on the cash basis of accounting for its four leased properties since the fourth quarter of 2022. In late September 2024, SLM notified us that ongoing liquidity constraints raised doubts about SLM’s ability to sustain its operations and pay its contractual rent and interest obligations prospectively. Effective October 1, 2024, one property was transitioned to a new operator under a new lease agreement, as previously planned, and the remaining three leased properties were transitioned pursuant to interim management agreements. The net book value of the leased properties was $16.3 million as of September 30, 2024, including $5.0 million associated with one property classified as assets held for sale. SLM was current on its lease obligations through the six months ended June 30, 2024. Rental income from SLM recognized for the three and nine months ended September 30, 2024 was $0.4 million and $2.5 million, respectively. SLM repaid approximately $0.3 million in prior rent deferrals during the quarter ended June 30, 2024. Rental income from SLM for the property was $1.5 million and $4.3 million for the three and nine months ended September 30, 2023, respectively. Reference Note 4 for further discussion on the two non-performing notes receivable from SLM. Other Tenant Transitions In June 2024, we transitioned a leased SNF located in Wisconsin to a new operator. The new lease contains a purchase option to acquire the property at the end of the initial lease term in 2031 or during the renewal period at a fixed minimum internal rate of return on our investment. In the first quarter of 2024, we wrote off to “ Rental income ” the straight-line rent receivable of approximately $0.8 million associated with the terminated lease. In November 2024, we transitioned a leased ALF located in Alabama to a new operator and wrote off to “ Rental income ” the straight-line rent receivable of approximately $0.8 million associated with the terminated lease. Tenant Purchase Options Certain of our leases contain purchase options allowing tenants to acquire the leased properties at a fixed base price plus a specified share in any appreciation, fixed base price, or a fixed minimum internal rate of return on our investment. At September 30, 2024, tenants had purchase options on four properties with an aggregate net investment of $77.8 million that will become exercisable between 2027 and 2031. Rental income from these properties with tenant purchase options was $2.5 million and $6.3 million for the three and nine months ended September 30, 2024, respectively. Rental income from these properties with tenant purchase options was $1.8 million and $5.4 million for three and nine months ended September 30, 2023, 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, 2024, were as follows ( $ in thousands ): Remainder of 2024 $ 59,197 2025 239,285 2026 246,076 2027 199,386 2028 193,720 2029 182,170 Thereafter 712,948 $ 1,832,782 Variable Lease Payments Most of our 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, 2024 2023 2024 2023 Lease payments based on fixed escalators $ 57,682 $ 57,200 $ 174,383 $ 169,675 Lease payments based on variable escalators 2,412 1,830 8,663 5,879 Straight-line rent, net of write-offs 1,161 1,040 2,066 6,011 Escrow funds received from tenants for property operating expenses 2,786 2,908 8,321 8,738 Amortization of lease incentives (723) (723) (2,168) (1,798) Rental income $ 63,318 $ 62,255 $ 191,265 $ 188,505

Mortgage and Other Notes Receiv

Mortgage and Other Notes Receivable	9 Months Ended
	Sep. 30, 2024
Accounts, Notes, Loans and Financing Receivable, Gross, Allowance, and Net [Abstract]
Mortgage and Other Notes Receivable	Mortgage and Other Notes Receivable At September 30, 2024, our investments in mortgage notes receivable totaled $163.2 million secured by real estate and other assets of the borrowers ( e.g ., Uniform Commercial Code liens on personal property) related to 17 facilities, and our investments in other notes receivable totaled $88.8 million, substantially all of which were 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 $19.4 million at September 30, 2024. Our loans designated as non-performing as of September 30, 2024 and December 31, 2023 include a mortgage note receivable of $1.9 million and $2.1 million, respectively, due from Bickford, and a mortgage note receivable of $10.0 million and a mezzanine loan of $14.5 million due from affiliates of SLM. Interest income recognized, representing cash received, from these non-performing loans was $0.3 million and $1.3 million, respectively, for the three and nine months ended September 30, 2024. Interest income recognized for the three and nine months ended September 30, 2023 was $0.5 million and $1.4 million, respectively. All other loans were on full accrual basis as of September 30, 2024. The credit loss reserve related to non-performing loans totaled $16.0 million and $11.9 million at September 30, 2024 and December 31, 2023, respectively. The credit loss reserve was increased $3.6 million during the three months ended September 30, 2024 related to the $14.5 million mezzanine loan due from SLM based upon further deterioration in SLM’s liquidity. Reference Note 3 for further discussion. The Sanders Trust, LLC In August 2024, we entered into an agreement to fund up to $27.7 million on a construction loan with TST Lake City IRF, LLC for the development of an in-patient rehabilitation facility to be located in Lake City, Florida. The four-year loan agreement provides for an annual interest rate of 9.0% and two one-year extensions. As of September 30, 2024, $1.1 million was outstanding on the loan. Compass Senior Living, LLC In June 2024, we funded $9.5 million on a mortgage note receivable secured by two facilities with Compass Senior Living, LLC. The five-year loan agreement provides for an annual interest rate of 8.5% with an option for the Company to purchase one or both facilities after July 2026. Carriage Crossing Senior Living Bloomington In February 2024, we funded $15.0 million on a mortgage note receivable with Carriage Crossing Senior Living Bloomington, with an additional $2.0 million available to be funded contingent upon the performance of facility operations through March 31, 2027. The five-year loan agreement provides for an annual interest rate of 8.75% and two one-year extensions. 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. In the second quarter of 2024, approximately $2.1 million of principal was repaid upon the sale by the fund of two of the underlying properties. As of September 30, 2024, $18.0 million was outstanding on the loan associated with seven medical office buildings with a combined purchase price of approximately $76.4 million. For the three and nine months ended September 30, 2024, we recognized interest income of $0.4 million and $1.4 million, respectively. Interest income recognized for the three and nine months ended September 30, 2023 was $0.5 million and $1.4 million, respectively. Bickford Construction and Mortgage Loans As of September 30, 2024, 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 . At September 30, 2024, we held a $12.4 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 both the three and nine months ended September 30, 2024 and 2023, 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, 2024 and December 31, 2023. During the three and nine months ended September 30, 2024 and 2023, Bickford repaid $0.1 million and $0.3 million, respectively, of principal on this note receivable which is reflected in “ Gains on sale of real estate, net ” in the Condensed Consolidated Statements of Income. 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 2031 at the time of the Senior Living lease maturity. At September 30, 2024, the $10.3 million outstanding under the revolver bore 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 matures in July 2025, which may be extended for one-year, and 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, 2024, 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, 2024 is presented below for the amortized cost, net by year of origination ( $ in thousands ): 2024 2023 2022 2021 2020 Prior Total Mortgages more than 1.5x $ 10,227 $ — $ 42,443 $ — $ — $ 39,068 $ 91,738 between 1.0x and 1.5x 14,870 930 28,368 — — — 44,168 less than 1.0x — 620 — — — 14,700 15,320 25,097 1,550 70,811 — — 53,768 151,226 Mezzanine more than 1.5x — 518 — 13,547 — — 14,065 between 1.0x and 1.5x — 226 — 21,521 — — 21,747 less than 1.0x — — — — — 25,000 25,000 — 744 — 35,068 — 25,000 60,812 Non-performing more than 1.5x — — — — — 10,000 10,000 between 1.0x and 1.5x — — — — — 14,500 14,500 less than 1.0x — — — — 1,947 — 1,947 — — — — 1,947 24,500 26,447 Revolver more than 1.5x 13,476 13,476 Credit loss reserve (19,411) $ 232,550 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 periods. The allowance for expected credit losses is presented in the following table for the nine months ended September 30, 2024 ( $ in thousands ): Balance at January 1, 2024 $ 15,476 Provision for expected credit losses 3,935 Balance at September 30, 2024 $ 19,411

Senior Housing Operating Portfo

Senior Housing Operating Portfolio Structure	9 Months Ended
	Sep. 30, 2024
Senior Housing Operating Portfolio Structure [Abstract]
Senior Housing Operating Portfolio Structure	Senior Housing Operating Portfolio Structure Our SHOP segment is comprised of two ventures that own the operations of 15 ILFs. These ventures 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 ventures were capitalized with preferred and common equity interests, with the Company owning 100% of the preferred equity and a controlling common equity interest in each venture. The managers, or related parties of the managers, own a non-controlling common equity interest in their respective ventures. Each venture is discussed in more detail below. Merrill Managed Portfolio We have six ILFs located in California and Washington in a consolidated venture with Merrill, which owns a 20% common equity interest in the venture . In the fourth quarter of 2024, the members contributed an additional $5.5 million, of which Merrill contributed approximately $1.1 million in cash in accordance with its common equity interest percentage in the venture. T he operating agreement for the venture provides for contingent distributions to the members based on the attainment of certain yiel ds 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. The noncontrolling interest associated with the venture was determined to be contingently redeemable and is classified in mezzanine equity on the Condensed Consolidated Balance Sheets as of September 30, 2024 and December 31, 2023, as discussed further in Note 10. Discovery Managed Portfolio We have nine ILFs located in Arkansas, Georgia, Ohio, Oklahoma, New Jersey, and South Carolina in a consolidated venture with the Discovery member, which owns a 2% common equity interest in the venture. In the second quarter of 2024, the members contributed an additional $3.5 million to fund additional capital expenditures, of which the Discovery member contributed approximately $0.1 million in cash in accordance with its common equity interest percentage in the venture. Th e 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 associated with the venture is included in “ Equity ” on the Condensed Consolidated Balance Sheets as of September 30, 2024 and December 31, 2023. 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, 2024
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, LLC (“Timber Ridge OpCo”), representing a 25.0% 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, 2024, 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, 2024. Excess unrecognized equity method losses for this investment for the three and nine months ended September 30, 2024 were $0.9 million and $2.1 million, respectively, and $0.6 million and $1.9 million for the three and nine months ended September 30, 2023, respectively. Cumulative unrecognized losses for this investment were $11.6 million through September 30, 2024. We recognized gains of approximately $0.4 million, representing cash distributions received related to our investment in Timber Ridge OpCo for the nine months ended September 30, 2024. The Timber Ridge OpCo 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 agreements, during the term of the lease (seven years with two five-year renewal options), Timber Ridge OpCo is to indemnify Timber Ridge PropCo for any repayment by Timber Ridge PropCo of these early resident mortgage 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, 2024. The balance secured by the Deed and Indenture was $11.1 million at September 30, 2024.

Other Assets

Other Assets	9 Months Ended
	Sep. 30, 2024
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]
Other Assets	Other Assets Other assets, net consist of the following ( $ in thousands ): September 30, 2024 December 31, 2023 SHOP accounts receivable, net of allowance of $598 and $343, and other assets $ 2,160 $ 1,620 Real estate investments accounts receivable and prepaid expenses 4,077 3,296 Lease incentive payments, net 8,501 10,669 Regulatory escrows 6,208 6,208 Restricted cash 2,217 2,270 $ 23,163 $ 24,063 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, 2024
Debt Instruments [Abstract]
Debt	Debt Debt consisted of the following ( $ in thousands ): September 30, 2024 December 31, 2023 Revolving credit facility - unsecured $ 319,000 $ 245,000 Bank term loans - unsecured 200,000 200,000 2031 Senior Notes - unsecured, net of discount of $2,037 and $2,278 397,963 397,722 Private placement notes - unsecured 150,000 225,000 Fannie Mae term loans - secured, non-recourse 75,925 76,241 Unamortized loan costs (6,586) (8,912) $ 1,136,302 $ 1,135,051 Aggregate principal maturities of debt as of September 30, 2024 were as follows ( $ in thousands ): Remainder of 2024 $ 425 2025 325,500 2026 319,000 2027 100,000 2028 — 2029 — Thereafter 400,000 1,144,925 Less: discount (2,037) Less: unamortized loan costs (6,586) $ 1,136,302 Unsecured revolving credit facility and bank term loan We have a $700.0 million unsecured revolving credit facility (the “2022 Credit Facility”), which as amended and restated on October 24, 2024 to extend the maturity date from March 2026 to October 2028, which may be further extended by us pursuant to (i) one or both of the two six-month extension extension options or (ii) one twelve-month extension option. Borrowings under the 2022 Credit Facility 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 (x) the agent’s prime rate, (y) the federal funds rate on such day plus 0.50% or (z) the adjusted Term SOFR for a one-month tenor in effect on such day plus 1.0%. In addition, the 2022 Credit Facility requires a facility fee equal to 0.125% to 0.30%, based on our credit rating on the $700.0 million committed capacity, without regard to usage. At September 30, 2024, we had $381.0 million available to draw on the 2022 Credit Facility, subject to usual and customary covenants. Among other stipulations, the credit agreement for the 2022 Credit Facility requires that we maintain certain financial ratios within limits set by our creditors. At September 30, 2024, we were in compliance with these ratios. We have a $200.0 million term loan (the “2025 Term Loan”) that matures June 2025 and bears 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. Concurrently with the amendment and restatement of our unsecured revolving credit agreement, we amended the terms of the term loan agreement for the 2025 Term Loans to, among other things, modify the representations, covenants, financial covenants, and events of default to align with the same provisions in amended and restated unsecured revolving credit agreement. 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 in 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, 2024. Private Placement Notes In September 2024, we repaid the $75.0 million of the private placement notes due September 2024 primarily with proceeds from the 2022 Credit Facility. Our unsecured private placement notes outstanding as of September 30, 2024, payable interest only, are summarized below ( $ in thousands ): Amount Inception Maturity Fixed Rate $ 50,000 November 2015 November 2025 4.33% 100,000 January 2015 January 2027 4.51% $ 150,000 Covenants pertaining to the unsecured private placement notes are generally conformed with those governing our 2022 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, 2024, we had $60.1 million in Fannie Mae term-debt mortgage 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, bears interest at a rate of 4.60%, and has a remaining balance of $15.8 million at September 30, 2024. Collectively, the Fannie Mae debt is secured by properties having a net book value of $98.8 million at September 30, 2024. Interest Expense The following table summarizes interest expense ($ in thousands ): Three Months Ended Nine Months Ended September 30, September 30, 2024 2023 2024 2023 Interest expense on debt at contractual rates $ 14,131 $ 14,387 $ 42,247 $ 41,439 Capitalized interest (65) (21) (152) (61) Amortization of debt issuance costs, debt discount and other 873 720 2,568 1,930 Total interest expense $ 14,939 $ 15,086 $ 44,663 $ 43,308

Commitments. Contingencies and

Commitments. Contingencies and Uncertainties	9 Months Ended
	Sep. 30, 2024
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 are included in the respective lease bases when funded. As of September 30, 2024, we had working capital, mortgage, construction, revolving credit and mezzanine loan commitments to seven operators or borrowers for an aggregate of $138.2 million, of which we had funded $63.4 million toward these commitments. Loan funded amounts do not reflect the effects of discounts or commitment fees. As of September 30, 2024, we had $33.5 million of development commitments for renovation of six properties, of which we had funded $18.4 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, 2024. As of September 30, 2024, we had an aggregate of $6.9 million in remaining contingent lease inducement commitments in three lease agreements which are generally based on the performance of facility operations and may or may not be met by the tenant. 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 loan commitments reflected in “ Accounts payable and accrued expenses ” on the Condensed Consolidated Balance Sheets as of September 30, 2024 and December 31, 2023 is presented in the following table for the nine months ended September 30, 2024 ( $ in thousands ): Balance at January 1, 2024 $ 279 Provision for expected credit losses (39) Balance at September 30, 2024 $ 240 Litigation Our facilities are subject to claims and suits in the ordinary course of business. Such claims may include, among other things, professional liability and general liability claims, as well as regulatory proceedings related to our SHOP segment. Our managers, tenants and borrowers have indemnified, and are obligated to continue to indemnify, us against all liabilities arising from the operation of the facilities, and are further obligated to indemnify us against environmental or title problems affecting the real estate underlying such facilities. While there may be lawsuits pending against us and certain of the owners and/or lessees of the facilities, management believes that the ultimate resolution of all such pending proceedings will have no material adverse effect on our financial condition, results of operations or cash flows.

Redeemable Noncontrolling Inter

Redeemable Noncontrolling Interests	9 Months Ended
	Sep. 30, 2024
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, 2024 and December 31, 2023. 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, 2024. 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 in each period. The following table presents the change in “ Redeemable noncontrolling interest” for the nine months ended September 30, 2024 ( $ in thousands ): Nine Months Ended September 30, 2024 Balance at January 1, $ 9,656 Net loss (722) Distributions (9) Balance at September 30, $ 8,925

Equity and Dividends

Equity and Dividends	9 Months Ended
	Sep. 30, 2024
Equity [Abstract]
Equity and Dividends	Equity and Dividends Share Repurchase Plan On February 16, 2024, our Board of Directors renewed our stock repurchase program (the “Repurchase Plan”) pursuant to which we may repurchase up to $160.0 million in shares of our issued and outstanding common stock, par value $0.01 per share. The Repurchase Plan is effective for a period of one year and does not require us to repurchase any specific number of shares. The 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 (the “Exchange Act”), 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 under the Repurchase Plan during the nine months ended September 30, 2024. Forward Sale Agreements In August 2024, we entered into forward equity sale agreements with financial institutions to sell up to an aggregate of 2.76 million shares of common stock, at an initial forward sale price of $68.40 per share, pursuant to which the financial institutions borrowed and sold these shares of common stock in a public offering. We did not receive any proceeds from the sale of common shares by the forward purchasers at the time of the offering. As of September 30, 2024, all 2.76 million shares of common stock were available for settlement for proceeds of approximately $187.3 million at a forward price of $67.88. In the fourth quarter of 2024, we partially settled the forward equity sale agreements by issuing 1.8 million shares of common stock for net proceeds of $122.4 million. ATM Equity Program We maintain an ATM equity program which allows us to sell our common stock directly into the market and have entered into an ATM equity offering sales agreement pursuant to which the Company may sell, from time to time, up to an aggregate sales price of $500.0 million of the Company’s common stock. The ATM equity program has a forward sale provision which allows us to sell shares of common stock to forward purchasers at a predetermined price at a future date. No shares were sold under the ATM equity program during the nine months ended September 30, 2024. Dividends The following table summarizes dividends declared by the Board of Directors or paid during the nine months ended September 30, 2024 and 2023: Nine Months Ended September 30, 2024 Date of Declaration Date of Record Date Paid/Payable Quarterly Dividend November 3, 2023 December 29, 2023 January 26, 2024 $0.90 February 16, 2024 March 28, 2024 May 3, 2024 $0.90 May 3, 2024 June 28, 2024 August 2, 2024 $0.90 August 2, 2024 September 27, 2024 November 1, 2024 $0.90 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

Share-Based Compensation

Share-Based Compensation	9 Months Ended
	Sep. 30, 2024
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, as amended and restated (the “2019 Plan”). During the nine months ended September 30, 2024, we granted options to purchase 431,000 shares of common stock under the 2019 Plan. In February 2024, 15,000 shares of restricted stock were issued to executive officers with a grant date fair value of $57.76 per share based on the market value of our common stock on the date of grant. The restricted stock vests 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. During the second quarter of 2024, 3,970 net shares of restricted stock vested. As of September 30, 2024, there were 31,800 non-vested shares of restricted stock outstanding. The weighted average fair value of options granted during the nine months ended September 30, 2024 and 2023 was $7.36 and $10.56 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: 2024 2023 Dividend yield 6.4% 6.9% Expected volatility 26.1% 39.0% Expected lives 2.9 years 2.9 years Risk-free interest rate 4.49% 4.56% 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, 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 Exercisable at September 30, 2023 2,078,827 $71.40 Options outstanding, January 1, 2024 2,447,171 $68.80 Options granted 431,000 $57.76 Options exercised (1,065,119) $58.24 Options expired (301,837) $79.96 Options outstanding, September 30, 2024 1,511,215 $70.87 2.02 Exercisable at September 30, 2024 1,170,521 $74.94 1.42 At September 30, 2024, the intrinsic value of stock options outstanding and exercisable was $23.4 million and $14.1 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, 2024 2023 2024 2023 Share-based compensation components: Restricted stock expense $ 166 $ 119 $ 510 $ 191 Stock option expense 504 747 3,002 3,549 Total share-based compensation expense $ 670 $ 866 $ 3,512 $ 3,740 As of September 30, 2024, unrecognized compensation expense totaling $2.3 million associated with stock-based awards was expected to be recognized over the following periods: remainder of 2024 - $0.7 million, 2025 - $1.1 million, 2026 - $0.3 million, 2027 - $0.1 million, and thereafter - $0.1 million.

Earnings Per Common Share

Earnings Per Common Share	9 Months Ended
	Sep. 30, 2024
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, 2024 2023 2024 2023 Net income $ 28,242 $ 29,033 $ 93,852 $ 102,662 Add: net loss attributable to noncontrolling interests 298 313 891 946 Net income attributable to stockholders 28,540 29,346 94,743 103,608 Less: net income attributable to unvested restricted stock awards (29) (19) (90) (38) Net income attributable to common stockholders - basic and diluted $ 28,511 $ 29,327 $ 94,653 $ 103,570 BASIC: Weighted average common shares outstanding 43,476,067 43,388,841 43,420,663 43,388,779 DILUTED: Weighted average common shares outstanding 43,476,067 43,388,841 43,420,663 43,388,779 Stock options 346,997 — 183,093 896 Forward equity sales agreements 164,008 — 54,669 — Weighted average dilutive common shares outstanding 43,987,072 43,388,841 43,658,425 43,389,675 Earnings per common share - basic $ 0.66 $ 0.68 $ 2.18 $ 2.39 Earnings per common share - diluted $ 0.65 $ 0.68 $ 2.17 $ 2.39 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 86,542 816,353 280,157 781,727 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, 2024
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, 2024 and December 31, 2023 in the Condensed Consolidated Balance Sheets are as follows ($ in thousands ): Carrying Amount Fair Value Measurement September 30, 2024 December 31, 2023 September 30, 2024 December 31, 2023 Level 2 Variable rate debt $ 515,494 $ 439,693 $ 519,000 $ 445,000 Fixed rate debt $ 620,808 $ 695,358 $ 562,234 $ 616,852 Level 3 Mortgage and other notes receivable, net $ 232,550 $ 245,271 $ 228,300 $ 237,646 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, 2024
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 HOSPs. Under the Real Estate Investments segment, we invest in senior housing and healthcare real estate through acquisition and financing of primarily single-tenant properties. Properties acquired are leased primarily 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. Our CODM 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, 2024 and 2023. Capital expenditures for the nine months ended September 30, 2024 were approximately $39.6 million for the Real Estate Investments segment and $7.5 million for the SHOP segment. 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. 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 in Note 2. Summary information for the reportable segments during the three and nine months ended September 30, 2024 and 2023 is as follows ( $ in thousands ): For the three months ended September 30, 2024: Real Estate Investments SHOP Non-segment/Corporate Total Rental income $ 63,318 $ — $ — $ 63,318 Resident fees and services — 13,771 — 13,771 Interest income and other 5,743 — 112 5,855 Total revenues 69,061 13,771 112 82,944 Senior housing operating expenses — 10,744 — 10,744 Taxes and insurance on leased properties 2,786 — — 2,786 NOI 66,275 3,027 112 69,414 Depreciation 15,168 2,591 9 17,768 Interest 768 — 14,171 14,939 Legal — — 240 240 Franchise, excise and other taxes — — 83 83 General and administrative — — 4,810 4,810 Loan and realty losses 3,434 — — 3,434 Gains on sales of real estate, net (102) — — (102) Net income (loss) $ 47,007 $ 436 $ (19,201) $ 28,242 Total assets $ 2,180,153 $ 266,789 $ 13,148 $ 2,460,090 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 nine months ended September 30, 2024: Real Estate Investments SHOP Non-segment/Corporate Total Rental income $ 191,265 $ — $ — $ 191,265 Resident fees and services — 40,416 — 40,416 Interest income and other 17,428 — 317 17,745 Total revenues 208,693 40,416 317 249,426 Senior housing operating expenses — 31,494 — 31,494 Taxes and insurance on leased properties 8,321 — — 8,321 NOI 200,372 8,922 317 209,611 Depreciation 45,218 7,517 28 52,763 Interest 2,292 — 42,371 44,663 Legal — — 641 641 Franchise, excise and other taxes — — (56) (56) General and administrative — — 15,318 15,318 Loan and realty losses 4,550 — — 4,550 Gains on sales of real estate, net (1,718) — — (1,718) Gains from equity method investment (402) — — (402) Net income (loss) $ 150,432 $ 1,405 $ (57,985) $ 93,852 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

Variable Interest Entities

Variable Interest Entities	9 Months Ended
	Sep. 30, 2024
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Variable Interest Entities	Variable Interest Entities Consolidated Variable Interest Entities SHOP - The assets of the SHOP 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 $260.7 million and $260.7 million of real estate properties, net, $3.9 million and $7.7 million of cash and cash equivalents, and $2.2 million and $1.7 million of other assets, net, as of September 30, 2024 and December 31, 2023, respectively. Liabilities of the consolidated SHOP ventures for which creditors do not have recourse to the general credit of the Company are $4.6 million and $4.7 million as of September 30, 2024 and December 31, 2023, respectively. Reference Notes 5 and 10 for further discussion of these ventures. Real Estate Partnerships - The aggregate assets of the two consolidated real estate partnerships that can be used only to settle obligations of each respective partnership as of September 30, 2024 and December 31, 2023 include approximately $246.4 million and $252.5 million of real estate properties, net, $9.9 million and $9.7 million in straight-line rent receivable, $3.0 million and $3.2 million of cash and cash equivalents and $5.9 million and $7.8 million of other assets, net, respectively. Liabilities of these partnerships for which creditors do not have recourse to the general credit of the Company are not material. Unconsolidated 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 rent receivable $ 82,886 $ 92,636 Notes 3, 4 2016 Senior Living Management Notes $ 24,500 $ 24,500 Notes 3, 4 2018 Bickford Notes $ 16,757 $ 29,111 Notes 3, 4 2019 Encore Various 1 $ 35,008 $ 35,076 — 2020 Timber Ridge OpCo Various 2 $ (658) $ 4,342 Notes 6, 7 2020 Watermark Retirement Notes and straight-line rent receivable $ 10,190 $ 11,964 — 2021 Montecito Medical Real Estate Notes and funding commitment $ 18,053 $ 50,064 Note 4 2021 Vizion Health Notes and straight-line rent receivable $ 15,636 $ 15,636 — 2021 Navion Senior Solutions Various 3 $ 7,839 $ 9,989 — 2023 Kindcare Senior Living Notes 4 $ 775 $ 775 — 1 Note, straight-line rent receivable, and lease receivables 2 Loan commitment, equity method investment, straight-line rent receivable and unamortized lease incentive 3 Straight-line rent 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, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Pay vs Performance Disclosure
Net Income (Loss)	$ 28,540	$ 29,346	$ 94,743	$ 103,608

Insider Trading Arrangements

Insider Trading Arrangements	3 Months Ended
	Sep. 30, 2024
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 (Policies)	9 Months Ended
	Sep. 30, 2024
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 notes 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, 2023, included in our Annual Report on Form 10-K for the year ended December 31, 2023 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. 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. Reference Notes 5 and 16 for further discussion of our SHOP ventures. We also consolidate two real estate partner ships formed with our partners, Discovery Senior Housing Investor XXIV, LLC, a related party of Discovery, and LCS Timber Ridge LLC (“LCS”), 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. Reference Note 16 for further discussion of these consolidated real estate partnerships. We use the equity method of accounting when we own an interest in an entity over which we can exert significant influence 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 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. 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, contributions, 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, 2024 and December 31, 2023, the Merrill SHOP venture noncontrolling interest was classified in the Condensed Consolidated Balance Sheets as mezzanine equity, as discussed further in Note 10.
Cash and Cash Equivalents and Restricted Cash	Cash and Cash Equivalents and Restricted Cash Cash equivalents consist of all highly liquid investments with original maturities 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 mortgage and other notes receivable consist primarily of secured loans on facilities. Our financial instruments, principally our investments in mortgage and other 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 mortgage and other 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.
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 collectable 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 of substantially all lease payments 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. Reference Note 3 for further discussion. Resident Fees and Services - Resident fee and services 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 recognizes 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 Interest income is recognized based on the interest rates and principal amounts outstanding on the notes receivable. We identify a mortgage note or other note receivable 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
Income Taxes	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. 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: Re al 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.
Forward Equity Sales	Forward Equity Sales The Company has and may continue to enter into forward sale agreements relating to shares of its common stock, either through its at-the-market (“ATM “) equity program or through underwritten public offerings. These agreements may be physically settled in stock, settled in cash or net share settled at the Company’s election. The forward sale price that we will receive upon physical settlement of the forward sale agreements will be subject to adjustment for (i) a floating interest rate factor equal to a specified daily rate less a spread, and (ii) scheduled dividends during the term of the forward sale agreement. The Company evaluated its forward sale agreements and concluded they meet the conditions to be classified within stockholders’ equity. Shares issuable under a forward equity sales agreement are reflected in the diluted earnings per share calculations for the applicable periods using the treasury stock method. Under this method, the number of our common shares used in calculating diluted earnings per share is deemed to be increased by the excess, if any, of the number of common shares that would be issued upon full physical settlement of the forward equity sales agreement over the number of common shares that could be purchased by us in the market (based on the average market price during the period) using the proceeds receivable upon full physical settlement (based on the average forward price during the reporting period).
Earnings Per Share	Earnings Per Share
Recent Accounting Pronouncements	Recent Accounting Pronouncements

Basis of Presentation and Sig_3

Basis of Presentation and Significant Accounting Policies (Tables)	9 Months Ended
	Sep. 30, 2024
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, 2024 September 30, 2023 Beginning of period: Cash and cash equivalents $ 22,347 $ 19,291 Restricted cash (included in Other assets, net) 2,270 2,225 Cash, cash equivalents, and restricted cash $ 24,617 $ 21,516 End of period: Cash and cash equivalents $ 15,550 $ 16,579 Restricted cash (included in Other assets, net) 2,217 1,916 Cash, cash equivalents, and restricted cash $ 17,767 $ 18,495
Schedule of 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, 2024 September 30, 2023 Beginning of period: Cash and cash equivalents $ 22,347 $ 19,291 Restricted cash (included in Other assets, net) 2,270 2,225 Cash, cash equivalents, and restricted cash $ 24,617 $ 21,516 End of period: Cash and cash equivalents $ 15,550 $ 16,579 Restricted cash (included in Other assets, net) 2,217 1,916 Cash, cash equivalents, and restricted cash $ 17,767 $ 18,495

Investment Activity (Tables)

Investment Activity (Tables)	9 Months Ended
	Sep. 30, 2024
Real Estate [Abstract]
Schedule of Assets Held for Sale and Long-Lived Assets	The following is a summary of our assets held for sale in our Real Estate Investments portfolio ( $ in thousands ): As of As of September 30, 2024 December 31, 2023 Number of facilities 2 1 Real estate, net $5,669 $5,004
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 as of and for the nine months ended September 30, 2024 and 2023, excluding $2.6 million for our corporate office, a credit loss reserve of $19.4 million and $354.9 million in real estate assets in the SHOP segment ( $ in thousands ): As of September 30, 2024 Revenues 1 Asset Class Gross Real Estate 2 Notes Receivable Nine Months Ended September 30, 2024 2023 Senior Living Communities, LLC (“Senior Living”) EFC $ 576,829 $ 42,896 $ 39,980 16% $ 38,466 16% Bickford Senior Living (“Bickford”) ALF 431,085 16,647 31,233 13% 29,280 12% National HealthCare Corporation (“NHC”) SNF 133,770 — 30,426 12% 28,159 12% All others, net Various 1,336,671 192,418 99,050 40% 99,867 41% Escrow funds received from tenants for property operating expenses Various — — 8,321 3% 8,738 4% $ 2,478,355 $ 251,961 209,010 204,510 Resident fees and services 3 40,416 16% 35,860 15% $ 249,426 $ 240,370 1 Includes interest income on notes receivable and rental income from properties classified as assets held for sale. 2 Amounts include any properties classified as held for sale. 3 There is no tenant concentration in “Resident fees and services” because these agreements are with individual residents.
Schedule of NHC Percentage Rent	The following table summarizes the percentage rent income from NHC ( $ in thousands ): Nine Months Ended September 30, 2024 2023 Current year $ 4,138 $ 2,896 Prior year final certification 1 1,656 630 Total percentage rent income $ 5,794 $ 3,526 1 For purposes of the percentage rent calculation described in the master lease agreement, NHC’s annual revenue by facility for a given year is certified to NHI by March 31 st of the following year.
Schedule of Cash Rents Received	Cash rents received from these tenants for the three and nine months ended September 30, 2024 and 2023 were as follows ( $ in thousands ): Three Months Ended September 30, Nine Months Ended September 30, 2024 2023 2024 2023 Bickford 1 $ 9,850 $ 8,607 $ 29,161 $ 24,534 All others 2 1,855 3,446 9,398 9,963 Total rental income from cash basis operators $ 11,705 $ 12,053 $ 38,559 $ 34,497 1 Excludes $2.5 million of rental income related to the reduction of pandemic-related rent deferrals recognized in connection with the acquisition of an ALF from Bickford in the first quarter of 2023. 2 In the second quarter of 2024, we received a $2.5 million lump sum payment from an operator for partial repayment of pandemic-related rent deferrals.
Schedule of Future Minimum Base Rent	Future minimum lease payments to be received by us under our operating leases at September 30, 2024, were as follows ( $ in thousands ): Remainder of 2024 $ 59,197 2025 239,285 2026 246,076 2027 199,386 2028 193,720 2029 182,170 Thereafter 712,948 $ 1,832,782
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, 2024 2023 2024 2023 Lease payments based on fixed escalators $ 57,682 $ 57,200 $ 174,383 $ 169,675 Lease payments based on variable escalators 2,412 1,830 8,663 5,879 Straight-line rent, net of write-offs 1,161 1,040 2,066 6,011 Escrow funds received from tenants for property operating expenses 2,786 2,908 8,321 8,738 Amortization of lease incentives (723) (723) (2,168) (1,798) Rental income $ 63,318 $ 62,255 $ 191,265 $ 188,505

Mortgage and Other Notes Rece_2

Mortgage and Other Notes Receivable (Tables)	9 Months Ended
	Sep. 30, 2024
Accounts, Notes, Loans and Financing Receivable, Gross, Allowance, and Net [Abstract]
Schedule of Financing Receivable Credit Quality Indicators	The credit quality indicator as of September 30, 2024 is presented below for the amortized cost, net by year of origination ( $ in thousands ): 2024 2023 2022 2021 2020 Prior Total Mortgages more than 1.5x $ 10,227 $ — $ 42,443 $ — $ — $ 39,068 $ 91,738 between 1.0x and 1.5x 14,870 930 28,368 — — — 44,168 less than 1.0x — 620 — — — 14,700 15,320 25,097 1,550 70,811 — — 53,768 151,226 Mezzanine more than 1.5x — 518 — 13,547 — — 14,065 between 1.0x and 1.5x — 226 — 21,521 — — 21,747 less than 1.0x — — — — — 25,000 25,000 — 744 — 35,068 — 25,000 60,812 Non-performing more than 1.5x — — — — — 10,000 10,000 between 1.0x and 1.5x — — — — — 14,500 14,500 less than 1.0x — — — — 1,947 — 1,947 — — — — 1,947 24,500 26,447 Revolver more than 1.5x 13,476 13,476 Credit loss reserve (19,411) $ 232,550
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, 2024 ( $ in thousands ): Balance at January 1, 2024 $ 15,476 Provision for expected credit losses 3,935 Balance at September 30, 2024 $ 19,411

Other Assets (Tables)

Other Assets (Tables)	9 Months Ended
	Sep. 30, 2024
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]
Schedule of Other Assets	Other assets, net consist of the following ( $ in thousands ): September 30, 2024 December 31, 2023 SHOP accounts receivable, net of allowance of $598 and $343, and other assets $ 2,160 $ 1,620 Real estate investments accounts receivable and prepaid expenses 4,077 3,296 Lease incentive payments, net 8,501 10,669 Regulatory escrows 6,208 6,208 Restricted cash 2,217 2,270 $ 23,163 $ 24,063

Debt (Tables)

Debt (Tables)	9 Months Ended
	Sep. 30, 2024
Debt Instruments [Abstract]
Schedule of Debt	Debt consisted of the following ( $ in thousands ): September 30, 2024 December 31, 2023 Revolving credit facility - unsecured $ 319,000 $ 245,000 Bank term loans - unsecured 200,000 200,000 2031 Senior Notes - unsecured, net of discount of $2,037 and $2,278 397,963 397,722 Private placement notes - unsecured 150,000 225,000 Fannie Mae term loans - secured, non-recourse 75,925 76,241 Unamortized loan costs (6,586) (8,912) $ 1,136,302 $ 1,135,051
Schedule of Maturities of Long-term Debt	Aggregate principal maturities of debt as of September 30, 2024 were as follows ( $ in thousands ): Remainder of 2024 $ 425 2025 325,500 2026 319,000 2027 100,000 2028 — 2029 — Thereafter 400,000 1,144,925 Less: discount (2,037) Less: unamortized loan costs (6,586) $ 1,136,302
Schedule of Unsecured Term Loans	Our unsecured private placement notes outstanding as of September 30, 2024, payable interest only, are summarized below ( $ in thousands ): Amount Inception Maturity Fixed Rate $ 50,000 November 2015 November 2025 4.33% 100,000 January 2015 January 2027 4.51% $ 150,000
Schedule of Interest Expense	The following table summarizes interest expense ($ in thousands ): Three Months Ended Nine Months Ended September 30, September 30, 2024 2023 2024 2023 Interest expense on debt at contractual rates $ 14,131 $ 14,387 $ 42,247 $ 41,439 Capitalized interest (65) (21) (152) (61) Amortization of debt issuance costs, debt discount and other 873 720 2,568 1,930 Total interest expense $ 14,939 $ 15,086 $ 44,663 $ 43,308

Commitments. Contingencies an_2

Commitments. Contingencies and Uncertainties (Tables)	9 Months Ended
	Sep. 30, 2024
Commitments and Contingencies Disclosure [Abstract]
Schedule of Off Balance Sheet, Credit Loss, Liability, Roll Forward	The liability for expected credit losses on our unfunded loan commitments reflected in “ Accounts payable and accrued expenses ” on the Condensed Consolidated Balance Sheets as of September 30, 2024 and December 31, 2023 is presented in the following table for the nine months ended September 30, 2024 ( $ in thousands ): Balance at January 1, 2024 $ 279 Provision for expected credit losses (39) Balance at September 30, 2024 $ 240

Redeemable Noncontrolling Int_2

Redeemable Noncontrolling Interest (Tables)	9 Months Ended
	Sep. 30, 2024
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, 2024 ( $ in thousands ): Nine Months Ended September 30, 2024 Balance at January 1, $ 9,656 Net loss (722) Distributions (9) Balance at September 30, $ 8,925

Equity and Dividends (Tables)

Equity and Dividends (Tables)	9 Months Ended
	Sep. 30, 2024
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, 2024 and 2023: Nine Months Ended September 30, 2024 Date of Declaration Date of Record Date Paid/Payable Quarterly Dividend November 3, 2023 December 29, 2023 January 26, 2024 $0.90 February 16, 2024 March 28, 2024 May 3, 2024 $0.90 May 3, 2024 June 28, 2024 August 2, 2024 $0.90 August 2, 2024 September 27, 2024 November 1, 2024 $0.90 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

Share-Based Compensation (Table

Share-Based Compensation (Tables)	9 Months Ended
	Sep. 30, 2024
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: 2024 2023 Dividend yield 6.4% 6.9% Expected volatility 26.1% 39.0% Expected lives 2.9 years 2.9 years Risk-free interest rate 4.49% 4.56%
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, 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 Exercisable at September 30, 2023 2,078,827 $71.40 Options outstanding, January 1, 2024 2,447,171 $68.80 Options granted 431,000 $57.76 Options exercised (1,065,119) $58.24 Options expired (301,837) $79.96 Options outstanding, September 30, 2024 1,511,215 $70.87 2.02 Exercisable at September 30, 2024 1,170,521 $74.94 1.42
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, 2024 2023 2024 2023 Share-based compensation components: Restricted stock expense $ 166 $ 119 $ 510 $ 191 Stock option expense 504 747 3,002 3,549 Total share-based compensation expense $ 670 $ 866 $ 3,512 $ 3,740

Earnings Per Common Share (Tabl

Earnings Per Common Share (Tables)	9 Months Ended
	Sep. 30, 2024
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, 2024 2023 2024 2023 Net income $ 28,242 $ 29,033 $ 93,852 $ 102,662 Add: net loss attributable to noncontrolling interests 298 313 891 946 Net income attributable to stockholders 28,540 29,346 94,743 103,608 Less: net income attributable to unvested restricted stock awards (29) (19) (90) (38) Net income attributable to common stockholders - basic and diluted $ 28,511 $ 29,327 $ 94,653 $ 103,570 BASIC: Weighted average common shares outstanding 43,476,067 43,388,841 43,420,663 43,388,779 DILUTED: Weighted average common shares outstanding 43,476,067 43,388,841 43,420,663 43,388,779 Stock options 346,997 — 183,093 896 Forward equity sales agreements 164,008 — 54,669 — Weighted average dilutive common shares outstanding 43,987,072 43,388,841 43,658,425 43,389,675 Earnings per common share - basic $ 0.66 $ 0.68 $ 2.18 $ 2.39 Earnings per common share - diluted $ 0.65 $ 0.68 $ 2.17 $ 2.39 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 86,542 816,353 280,157 781,727 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, 2024
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, 2024 and December 31, 2023 in the Condensed Consolidated Balance Sheets are as follows ($ in thousands ): Carrying Amount Fair Value Measurement September 30, 2024 December 31, 2023 September 30, 2024 December 31, 2023 Level 2 Variable rate debt $ 515,494 $ 439,693 $ 519,000 $ 445,000 Fixed rate debt $ 620,808 $ 695,358 $ 562,234 $ 616,852 Level 3 Mortgage and other notes receivable, net $ 232,550 $ 245,271 $ 228,300 $ 237,646

Segment Reporting (Tables)

Segment Reporting (Tables)	9 Months Ended
	Sep. 30, 2024
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, 2024 and 2023 is as follows ( $ in thousands ): For the three months ended September 30, 2024: Real Estate Investments SHOP Non-segment/Corporate Total Rental income $ 63,318 $ — $ — $ 63,318 Resident fees and services — 13,771 — 13,771 Interest income and other 5,743 — 112 5,855 Total revenues 69,061 13,771 112 82,944 Senior housing operating expenses — 10,744 — 10,744 Taxes and insurance on leased properties 2,786 — — 2,786 NOI 66,275 3,027 112 69,414 Depreciation 15,168 2,591 9 17,768 Interest 768 — 14,171 14,939 Legal — — 240 240 Franchise, excise and other taxes — — 83 83 General and administrative — — 4,810 4,810 Loan and realty losses 3,434 — — 3,434 Gains on sales of real estate, net (102) — — (102) Net income (loss) $ 47,007 $ 436 $ (19,201) $ 28,242 Total assets $ 2,180,153 $ 266,789 $ 13,148 $ 2,460,090 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 nine months ended September 30, 2024: Real Estate Investments SHOP Non-segment/Corporate Total Rental income $ 191,265 $ — $ — $ 191,265 Resident fees and services — 40,416 — 40,416 Interest income and other 17,428 — 317 17,745 Total revenues 208,693 40,416 317 249,426 Senior housing operating expenses — 31,494 — 31,494 Taxes and insurance on leased properties 8,321 — — 8,321 NOI 200,372 8,922 317 209,611 Depreciation 45,218 7,517 28 52,763 Interest 2,292 — 42,371 44,663 Legal — — 641 641 Franchise, excise and other taxes — — (56) (56) General and administrative — — 15,318 15,318 Loan and realty losses 4,550 — — 4,550 Gains on sales of real estate, net (1,718) — — (1,718) Gains from equity method investment (402) — — (402) Net income (loss) $ 150,432 $ 1,405 $ (57,985) $ 93,852 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

Variable Interest Entities (Tab

Variable Interest Entities (Tables)	9 Months Ended
	Sep. 30, 2024
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 rent receivable $ 82,886 $ 92,636 Notes 3, 4 2016 Senior Living Management Notes $ 24,500 $ 24,500 Notes 3, 4 2018 Bickford Notes $ 16,757 $ 29,111 Notes 3, 4 2019 Encore Various 1 $ 35,008 $ 35,076 — 2020 Timber Ridge OpCo Various 2 $ (658) $ 4,342 Notes 6, 7 2020 Watermark Retirement Notes and straight-line rent receivable $ 10,190 $ 11,964 — 2021 Montecito Medical Real Estate Notes and funding commitment $ 18,053 $ 50,064 Note 4 2021 Vizion Health Notes and straight-line rent receivable $ 15,636 $ 15,636 — 2021 Navion Senior Solutions Various 3 $ 7,839 $ 9,989 — 2023 Kindcare Senior Living Notes 4 $ 775 $ 775 — 1 Note, straight-line rent receivable, and lease receivables 2 Loan commitment, equity method investment, straight-line rent receivable and unamortized lease incentive 3 Straight-line rent 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, 2024 USD ($) state property tenant mortgage unit jointVenture segment	Dec. 31, 2023 USD ($)
Real Estate Properties [Line Items]
Number of reportable segments | segment	2
Number of facilities	2
Number of mortgages | mortgage	9
Loans and leases receivable, gross | $	$ 251,961
Credit loss reserve | $	19,411	$ 15,476
Real Estate Investments
Real Estate Properties [Line Items]
Real estate investment property, portfolio assets | $	$ 2,500,000
Properties	161
Number of states in which entity operates | state	31
Number of lessees | tenant	25
Senior Housing Community | Real Estate Investments
Real Estate Properties [Line Items]
Properties	95
Skilled Nursing Facility
Real Estate Properties [Line Items]
Properties	32
Skilled Nursing Facility | Real Estate Investments
Real Estate Properties [Line Items]
Properties	65
Hospital | Real Estate Investments
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 | $	$ 354,900
Properties	15
Number of units in real estate property | unit	1,732

Basis of Presentation and Sig_4

Basis of Presentation and Significant Accounting Policies (Narrative) (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2024 USD ($) realEstatePartnership property operator jointVenture mortgage segment	Dec. 31, 2023 realEstatePartnership
Property, Plant and Equipment [Line Items]
Number of real estate partnerships | realEstatePartnership	2	2
Loans and leases receivable, gross | $	$ 251,961
Number of reportable segments | segment	2
Nonperforming Financial Instruments
Property, Plant and Equipment [Line Items]
Mortgage note receivables | mortgage	2
Number of operators/borrowers | operator	2
Nonperforming Financial Instruments | Mortgage Receivable And Mezzanine Loan
Property, Plant and Equipment [Line Items]
Loans and leases receivable, gross | $	$ 26,400
Minimum
Property, Plant and Equipment [Line Items]
Residency agreement, term	30 days
Maximum
Property, Plant and Equipment [Line Items]
Residency agreement, term	1 year
Independent Living Facility
Property, Plant and Equipment [Line Items]
Number of joint ventures | jointVenture	2
Properties | property	3
Independent Living Facility | SHOP
Property, Plant and Equipment [Line Items]
Properties | property	15

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, 2024	Dec. 31, 2023	Sep. 30, 2023	Dec. 31, 2022
Accounting Policies [Abstract]
Cash and cash equivalents	$ 15,550	$ 22,347	$ 16,579	$ 19,291
Restricted cash (included in Other assets, net)	2,217	2,270	1,916	2,225
Cash, cash equivalents, and restricted cash	$ 17,767	$ 24,617	$ 18,495	$ 21,516

Investment Activity (Asset Acqu

Investment Activity (Asset Acquisitions) (Details) - Encore $ in Millions	1 Months Ended
	Jun. 30, 2024 USD ($)	Sep. 30, 2024 unit
Real Estate [Line Items]
Annual lease escalator		2.21%
Encore
Real Estate [Line Items]
Number of units in real estate property | unit		110
Acquisition price	$ 32.1
Asset purchase transaction costs	0.1
Full payment of an outstanding construction note receivable	22.2
Master lease, term		15 years
Asset acquisition, initial lease rate		8.25%
Encore | Land
Real Estate [Line Items]
Acquisition price	1.3
Encore | Building Improvements
Real Estate [Line Items]
Acquisition price	$ 30.8

Investment Activity (Asset Disp

Investment Activity (Asset Dispositions) (Details) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024 USD ($) tenant	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($) tenant property	Sep. 30, 2023 USD ($)
Real Estate [Line Items]
Gains on sales of real estate, net	$ 102	$ 737	$ 1,718	$ 13,500
Assisted Living Facilities | Disposal Group, Disposed of by Sale, Not Discontinued Operations
Real Estate [Line Items]
Properties | property			2
Number of tenants leased on cash basis | tenant	1		1
Amount of real estate sold in cash consideration			$ 4,700
Gains on sales of real estate, net			$ 1,400

Investment Activity (Schedule o

Investment Activity (Schedule of Assets Held for Sale and Long-Lived Assets) (Details) $ in Thousands	Sep. 30, 2024 USD ($) property	Dec. 31, 2023 USD ($) property
Real Estate [Line Items]
Number of facilities	2
Disposal Group, Held-for-sale, Not Discontinued Operations | Real Estate Investments
Real Estate [Line Items]
Number of facilities	2	1
Real estate, net | $	$ 5,669	$ 5,004

Investment Activity (Assets Hel

Investment Activity (Assets Held for Sale and Long-Lived Assets Narrative) (Details) $ in Thousands	1 Months Ended	3 Months Ended		9 Months Ended
	Mar. 31, 2024 USD ($)	Sep. 30, 2024 USD ($)	Sep. 30, 2023 USD ($) property	Sep. 30, 2024 USD ($) property	Sep. 30, 2023 USD ($) property
Real Estate [Line Items]
Rental income		$ 63,318	$ 62,255	$ 191,265	$ 188,505
Asset Held For Sale In 2023
Real Estate [Line Items]
Rental income					1,500
Real Estate Investments
Real Estate [Line Items]
Impairment of real estate			$ 1,200	$ 700	$ 1,600
Number of real estate properties, impaired, sold or classified as held for sale | property			1	1	4
Disposal Group, Held-for-sale, Not Discontinued Operations
Real Estate [Line Items]
Rental income		200	$ 600	$ 1,100
Disposal Group, Held-for-sale, Not Discontinued Operations | Senior Living Campuses | 2024 Disposal Group
Real Estate [Line Items]
Purchase price	$ 38,500
Lease income, annual rent	$ 2,800
Net real estate balance		$ 19,300		$ 19,300

Investment Activity - (Fourth Q

Investment Activity - (Fourth Quarter 2024 Acquisitions Narrative) (Details) - 2024 Asset Acquisition - Subsequent Event $ in Millions	1 Months Ended
	Oct. 31, 2024 USD ($) extensionOption community
Real Estate [Line Items]
Number of units in real estate property | community	10
Acquisition price	$ 121
Asset purchase transaction costs	$ 0.3
Master lease, term	15 years
Asset acquisition, number of loan extensions | extensionOption	2
Asset acquisition, extension option renewal term	5 years
Asset acquisition, initial lease rate	8.25%
Annual lease escalator	2%
Asset acquisition, lease earnout incentives	$ 10

Investment Activity (Tenant Con

Investment Activity (Tenant Concentration Narrative) (Details) $ in Thousands

3 Months Ended

9 Months Ended

Apr. 01, 2024 USD ($)

Sep. 30, 2024 USD ($)

Jun. 30, 2024

Sep. 30, 2023 USD ($)

Sep. 30, 2024 USD ($)

Sep. 30, 2023 USD ($)

Sep. 30, 2024 property

Sep. 30, 2024 state

Sep. 30, 2024

Sep. 30, 2024 lease

Sep. 30, 2024 facility

Sep. 30, 2024 leaseAgreement

Sep. 30, 2024 boardMember

Dec. 31, 2023 USD ($)

Real Estate [Line Items]

Cost of corporate office

$ 2,600

$ 2,600

$ 2,600

$ 2,600

Credit loss reserve

(19,411)

(19,411)

$ (15,476)

Straight-line rent adjustments

(2,066)

(6,011)

Rental income

63,318

62,255

191,265

188,505

Number of board of directors | boardMember

2

Bickford Senior Living Acquisition

Real Estate [Line Items]

Asset acquisition, rent deferral deduction

2,500

Lease Extended Until 2026

Real Estate [Line Items]

Lease escalator minimum

2%

Annual lease cap

3%

Senior Living Communities, LLC (“Senior Living”)

Real Estate [Line Items]

Real estate properties | property

10

Lease comprising properties | lease

2

Leases extended maturity

2 years

Payments for capital improvements

10,000

Lease rate

0.085

Straight-line rent adjustments

(400)

(900)

Rental income

39,980

38,466

Bickford

Real Estate [Line Items]

Properties

1

39

Number of leases | leaseAgreement

4

Rental income

31,233

29,280

Maximum capital improvements commitment

$ 8,000

Annual rent increase

8%

Rent deferral

14,000

14,000

Bickford | Bickford Senior Living Acquisition

Real Estate [Line Items]

Payments for rent

1,100

$ 800

4,000

1,300

Bickford | Lease Extended Until 2026

Real Estate [Line Items]

Rental income

$ 34,500

National HealthCare Corporation (“NHC”)

Real Estate [Line Items]

Straight-line rent adjustments

(200)

(900)

Rental income

$ 30,426

$ 28,159

National HealthCare Corporation (“NHC”) | NHC - 1991 Lease

Real Estate [Line Items]

Percentage rent rate

4%

Revenue as % of Total, Exceeds 10%

Real Estate [Line Items]

Number of states in which entity operates | state

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

10.60%

Independent Living Facility

Real Estate [Line Items]

Number of states in which entity operates | state

8

Properties | property

3

Independent Living Facility | SHOP

Real Estate [Line Items]

Real estate investment property, portfolio assets

$ 354,900

$ 354,900

Properties | property

15

Skilled Nursing Facility

Real Estate [Line Items]

Properties | property

32

Skilled Nursing Facility | National HealthCare Corporation (“NHC”) | Subleased Facilities

Real Estate [Line Items]

Properties | property

4

Investment Activity (Schedule_2

Investment Activity (Schedule of Tenant Concentrations) (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023
Tenant Concentration [Line Items]
Gross Real Estate	$ 2,820,430		$ 2,820,430		$ 2,780,358
Total Gross Real Estate	2,478,355		2,478,355
Capitalized Notes and Receivable	251,961		251,961
Revenues	63,318	$ 62,255	191,265	$ 188,505
Escrow funds received from tenants for property operating expenses			8,321	8,738
Resident fees and services	13,771	12,367	40,416	35,860
Total revenues	82,944	$ 80,106	$ 249,426	$ 240,370
Percentage of continuing revenue			16%	15%
Senior Living Communities, LLC (“Senior Living”)
Tenant Concentration [Line Items]
Gross Real Estate	576,829		$ 576,829
Notes Receivable	42,896		42,896
Revenues			$ 39,980	$ 38,466
Percentage of continuing revenue			16%	16%
National HealthCare Corporation (“NHC”)
Tenant Concentration [Line Items]
Gross Real Estate	133,770		$ 133,770
Notes Receivable	0		0
Revenues			$ 30,426	$ 28,159
Percentage of continuing revenue			12%	12%
Bickford
Tenant Concentration [Line Items]
Gross Real Estate	431,085		$ 431,085
Notes Receivable	16,647		16,647
Revenues			$ 31,233	$ 29,280
Percentage of continuing revenue			13%	12%
All others, net
Tenant Concentration [Line Items]
Gross Real Estate	1,336,671		$ 1,336,671
Notes Receivable	$ 192,418		192,418
Revenues			$ 99,050	$ 99,867
Percentage of continuing revenue			40%	41%
Tenants With Escrow Funds
Tenant Concentration [Line Items]
Percentage of continuing revenue			3%	4%
More than 10% Operators
Tenant Concentration [Line Items]
Revenues			$ 209,010	$ 204,510

Investment Activity (Schedule_3

Investment Activity (Schedule of NHC Percentage Rent) (Details) - National HealthCare Corporation (“NHC”) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
Real Estate [Line Items]
Rent income from NHC	$ 5,794	$ 3,526
Current year
Real Estate [Line Items]
Rent income from NHC	4,138	2,896
Prior year final certification
Real Estate [Line Items]
Rent income (loss) from NHC	$ 1,656	$ 630

Investment Activity (Cash Basis

Investment Activity (Cash Basis Operators Narrative) (Details) $ in Thousands	3 Months Ended			9 Months Ended
	Sep. 30, 2024 USD ($) lease loan property	Jun. 30, 2024 USD ($)	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($) operator loan property lease	Sep. 30, 2023 USD ($)	Oct. 01, 2024 property lease
Real Estate [Line Items]
Net book value of leased properties	$ 5,000			$ 5,000
Rental income	$ 400	$ 300	$ 1,500	$ 2,500	$ 4,300
Number of non-performing notes receivable | loan	2			2
Cash Basis Lessees
Real Estate [Line Items]
Number of cash basis operators | operator				3
Number of properties classified as assets held for sale | property	1			1
Senior Living Management
Real Estate [Line Items]
Number of Leases | lease	4			4
Net book value of leased properties	$ 16,300			$ 16,300
Senior Living Management | Subsequent Event
Real Estate [Line Items]
Number of Leases | lease						3
Number of properties | property						1

Investment Activity (Schedule_4

Investment Activity (Schedule of Cash Rents Received) (Details) - USD ($) $ in Thousands	3 Months Ended				9 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Sep. 30, 2023	Mar. 31, 2023	Sep. 30, 2024	Sep. 30, 2023
Real Estate [Line Items]
Total rental income from cash basis operators	$ 63,318		$ 62,255		$ 191,265	$ 188,505
Cash Basis Lessees
Real Estate [Line Items]
Total rental income from cash basis operators	11,705		12,053		38,559	34,497
Lump sum payment		$ 2,500
Cash Basis Lessees | Bickford
Real Estate [Line Items]
Total rental income from cash basis operators	9,850		8,607		29,161	24,534
Lease income, rent deferral deduction				$ 2,500
Cash Basis Lessees | All others
Real Estate [Line Items]
Total rental income from cash basis operators	$ 1,855		$ 3,446		$ 9,398	$ 9,963

Investment Activity (Other Tena

Investment Activity (Other Tenant Transitions Narrative) (Details) - Skilled Nursing Facilities - USD ($) $ in Millions		3 Months Ended
	Nov. 05, 2024	Mar. 31, 2024
Real Estate [Line Items]
Straight-line rent adjustments		$ (0.8)
Subsequent Event
Real Estate [Line Items]
Straight-line rent adjustments	$ 0.8

Investment Activity (Tenant Pur

Investment Activity (Tenant Purchase Options Narrative) (Details) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024 USD ($) property	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($) property	Sep. 30, 2023 USD ($)	Dec. 31, 2023 USD ($)
Real Estate [Line Items]
Real estate properties, net	$ 2,096,824		$ 2,096,824		$ 2,107,082
Rental income	$ 63,318	$ 62,255	$ 191,265	$ 188,505
Lease Option
Real Estate [Line Items]
Properties | property	4		4
Lease Option, Between 2027 and 2028
Real Estate [Line Items]
Real estate properties, net	$ 77,800		$ 77,800
Rental income	$ 2,500	$ 1,800	$ 6,300	$ 5,400

Investment Activity (Schedule_5

Investment Activity (Schedule of Future Minimum Lease Payments) (Details) $ in Thousands	Sep. 30, 2024 USD ($)
Real Estate [Abstract]
Remainder of 2024	$ 59,197
2025	239,285
2026	246,076
2027	199,386
2028	193,720
2029	182,170
Thereafter	712,948
Future minimum lease payments	$ 1,832,782

Investment Activity (Schedule_6

Investment Activity (Schedule of Fixed and Variable Lease Payments) (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Fixed and Variable Lease Payments [Line Items]
Rental income	$ 63,318	$ 62,255	$ 191,265	$ 188,505
Straight-line rent adjustments			(2,066)	(6,011)
Lease payments based on fixed escalators
Fixed and Variable Lease Payments [Line Items]
Rental income	57,682	57,200	174,383	169,675
Lease payments based on variable escalators
Fixed and Variable Lease Payments [Line Items]
Rental income	2,412	1,830	8,663	5,879
Straight-line rent, net of write-offs
Fixed and Variable Lease Payments [Line Items]
Straight-line rent adjustments	(1,161)	(1,040)	(2,066)	(6,011)
Escrow funds received from tenants for property operating expenses
Fixed and Variable Lease Payments [Line Items]
Rental income	2,786	2,908	8,321	8,738
Amortization of lease incentives
Fixed and Variable Lease Payments [Line Items]
Amortization of lease incentives	$ (723)	$ (723)	$ (2,168)	$ (1,798)

Mortgage and Other Notes Rece_3

Mortgage and Other Notes Receivable (Narrative) (Details) $ in Thousands	1 Months Ended			3 Months Ended		9 Months Ended		12 Months Ended
	Aug. 31, 2024 USD ($) extensionOption	Jun. 30, 2024 USD ($) facility	Feb. 29, 2024 USD ($) extensionOption	Sep. 30, 2024 USD ($)	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($) property	Sep. 30, 2023 USD ($)	Dec. 31, 2023 USD ($)	Sep. 30, 2024 property	Sep. 30, 2024 unit	Sep. 30, 2024 facility	Sep. 30, 2024	Sep. 30, 2024 loan	Dec. 31, 2021 property
Accounts, Notes, Loans and Financing Receivable [Line Items]
Number of health care properties related to mortgage notes receivables | property									17
Mortgage and other notes receivable, net of reserve				$ 19,411		$ 19,411		$ 15,476
Financing receivable, after allowance for credit loss				232,550		232,550		245,271
Allowance for credit loss reserve				3,600
Loans and leases agreement						138,200
Number of underlying properties | property									2
Interest income and other				5,855	$ 5,484	17,745	$ 16,005
Increase rate in the amount of loss from a default												20%
Effective adjustment rate												44%
Nonperforming Financial Instruments
Accounts, Notes, Loans and Financing Receivable [Line Items]
Financing receivable, net				26,447		26,447
between 1.0x and 1.5x | Nonperforming Financial Instruments
Accounts, Notes, Loans and Financing Receivable [Line Items]
Financing receivable, net				14,500		14,500
Clear Sky Senior Living
Accounts, Notes, Loans and Financing Receivable [Line Items]
Mortgage and other notes receivable, net				1,100		1,100
Loans and leases agreement	$ 27,700
Term of loan agreement	4 years
Financing receivable, stated interest rate	9%
Number of loan extensions | extensionOption	2
Financing receivable, renewal term	1 year
Compass Senior Living , LLC
Accounts, Notes, Loans and Financing Receivable [Line Items]
Loans and leases agreement		$ 9,500
Term of loan agreement		5 years
Financing receivable, stated interest rate		8.50%
Number of mortgage facilities | facility		2
Carriage Crossing Senior Living
Accounts, Notes, Loans and Financing Receivable [Line Items]
Loans and leases agreement			$ 15,000
Term of loan agreement			5 years
Financing receivable, stated interest rate			8.75%
Number of loan extensions | extensionOption			2
Financing receivable, renewal term			1 year
Contingent incentive payments			$ 2,000
Montecito Medical Real Estate
Accounts, Notes, Loans and Financing Receivable [Line Items]
Mortgage and other notes receivable, net				18,000		18,000
Interest income and other				400	500	1,400	1,400
Loans and leases agreement						50,000
Principal repaid						2,100
Bickford
Accounts, Notes, Loans and Financing Receivable [Line Items]
Mortgage and other notes receivable, net				16,647		16,647
Properties									1		39
Interest income and other				300	1,000	300	1,000
Repayments of term loan				100	300	100	300
Senior Living Communities, LLC (“Senior Living”)
Accounts, Notes, Loans and Financing Receivable [Line Items]
Mortgage and other notes receivable, net				42,896		$ 42,896
Financing receivable, renewal term						1 year
Revolving amount line of credit				20,000		$ 20,000
Revolving note receivable, amount outstanding				10,300		$ 10,300
Loans receivable facility bears interest rate						8%
Purchase option at a stated minimum price				38,300		$ 38,300
Mezzanine
Accounts, Notes, Loans and Financing Receivable [Line Items]
Mortgage and other notes receivable, net of reserve				10,000		10,000
Nonperforming Financial Instruments
Accounts, Notes, Loans and Financing Receivable [Line Items]
Mortgage and other notes receivable, net of reserve				16,000		16,000		11,900
Mortgage notes receivable, designated as nonperforming						1,900		$ 2,100
Interest income and other				300	$ 500	1,300	$ 1,400
Secured By Real Estate
Accounts, Notes, Loans and Financing Receivable [Line Items]
Mortgage and other notes receivable, net				163,200		163,200
Not Secured By Real Estate
Accounts, Notes, Loans and Financing Receivable [Line Items]
Mortgage and other notes receivable, net				88,800		$ 88,800
Property Held by Fund | Montecito Medical Real Estate
Accounts, Notes, Loans and Financing Receivable [Line Items]
Number of medical office buildings | property						7
Combined purchase price of medical office buildings						$ 76,400
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]
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]
Mortgage increase from sale of real estate						12,400
Negotiations to sale | Bickford
Accounts, Notes, Loans and Financing Receivable [Line Items]
Properties | property														6
After 2021 | Senior Living Communities, LLC (“Senior Living”)
Accounts, Notes, Loans and Financing Receivable [Line Items]
Revolving amount line of credit				$ 15,000		15,000
July 2019 Transaction | Senior Living Communities, LLC (“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%
June 2019 Transaction | Senior Living Communities, LLC (“Senior Living”)
Accounts, Notes, Loans and Financing Receivable [Line Items]
Number of units in real estate property | unit										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, 2024	Dec. 31, 2023
Financing Receivable, Credit Quality Indicator [Line Items]
Credit loss reserve	$ (19,411)	$ (15,476)
Financing receivable, after allowance for credit loss	232,550	$ 245,271
Mortgages
Financing Receivable, Credit Quality Indicator [Line Items]
2024	25,097
2023	1,550
2022	70,811
2021	0
2020	0
Prior	53,768
Total	151,226
Mezzanine
Financing Receivable, Credit Quality Indicator [Line Items]
2024	0
2023	744
2022	0
2021	35,068
2020	0
Prior	25,000
Total	60,812
Nonperforming Financial Instruments
Financing Receivable, Credit Quality Indicator [Line Items]
2024	0
2023	0
2022	0
2021	0
2020	1,947
Prior	24,500
Total	26,447
Revolver
Financing Receivable, Credit Quality Indicator [Line Items]
Total	13,476
more than 1.5x | Mortgages
Financing Receivable, Credit Quality Indicator [Line Items]
2024	10,227
2023	0
2022	42,443
2021	0
2020	0
Prior	39,068
Total	91,738
more than 1.5x | Mezzanine
Financing Receivable, Credit Quality Indicator [Line Items]
2024	0
2023	518
2022	0
2021	13,547
2020	0
Prior	0
Total	14,065
more than 1.5x | Nonperforming Financial Instruments
Financing Receivable, Credit Quality Indicator [Line Items]
2024	0
2023	0
2022	0
2021	0
2020	0
Prior	10,000
Total	10,000
more than 1.5x | Revolver
Financing Receivable, Credit Quality Indicator [Line Items]
Total	13,476
between 1.0x and 1.5x | Mortgages
Financing Receivable, Credit Quality Indicator [Line Items]
2024	14,870
2023	930
2022	28,368
2021	0
2020	0
Prior	0
Total	44,168
between 1.0x and 1.5x | Mezzanine
Financing Receivable, Credit Quality Indicator [Line Items]
2024	0
2023	226
2022	0
2021	21,521
2020	0
Prior	0
Total	21,747
between 1.0x and 1.5x | Nonperforming Financial Instruments
Financing Receivable, Credit Quality Indicator [Line Items]
2024	0
2023	0
2022	0
2021	0
2020	0
Prior	14,500
Total	14,500
less than 1.0x | Mortgages
Financing Receivable, Credit Quality Indicator [Line Items]
2024	0
2023	620
2022	0
2021	0
2020	0
Prior	14,700
Total	15,320
less than 1.0x | Mezzanine
Financing Receivable, Credit Quality Indicator [Line Items]
2024	0
2023	0
2022	0
2021	0
2020	0
Prior	25,000
Total	25,000
less than 1.0x | Nonperforming Financial Instruments
Financing Receivable, Credit Quality Indicator [Line Items]
2024	0
2023	0
2022	0
2021	0
2020	1,947
Prior	0
Total	$ 1,947

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, 2024 USD ($)
Financing Receivable, Allowance for Credit Loss [Roll Forward]
Balance at January 1, 2024	$ 15,476
Provision for expected credit losses	3,935
Balance at September 30, 2024	$ 19,411

Senior Housing Operating Port_2

Senior Housing Operating Portfolio Structure (Details)	3 Months Ended		9 Months Ended
	Dec. 31, 2024 USD ($)	Jun. 30, 2024 USD ($)	Sep. 30, 2024 USD ($) property jointVenture
Senior Housing Operating Portfolio Formation Activities [Line Items]
Cash contributed for its common equity interest in the venture		$ 100,000
Forecast | Merrill
Senior Housing Operating Portfolio Formation Activities [Line Items]
Cash contributed for its common equity interest in the venture	$ 1,100,000
Minimum
Senior Housing Operating Portfolio Formation Activities [Line Items]
Management fee multiplier			$ 1,000
Merrill Gardens Managed Portfolio
Senior Housing Operating Portfolio Formation Activities [Line Items]
Interest in joint venture percentage			20%
Management fee			5%
Real estate services fee			5%
Merrill Gardens Managed Portfolio | Forecast
Senior Housing Operating Portfolio Formation Activities [Line Items]
Cash contributed for its common equity interest in the venture	$ 5,500,000
Discovery Managed Portfolio
Senior Housing Operating Portfolio Formation Activities [Line Items]
Management fee			5%
Common equity interest in venture			2%
Cash contributed for its common equity interest in the venture		$ 3,500,000
SHOP | New Venture
Senior Housing Operating Portfolio Formation Activities [Line Items]
Ownership percentage			100%
Independent Living Facility
Senior Housing Operating Portfolio Formation Activities [Line Items]
Number of joint ventures | jointVenture			2
Properties | property			3
Independent Living Facility | Merrill Gardens Managed Portfolio
Senior Housing Operating Portfolio Formation Activities [Line Items]
Properties | property			6
Independent Living Facility | Discovery Managed Portfolio
Senior Housing Operating Portfolio Formation Activities [Line Items]
Properties | property			9
Independent Living Facility | SHOP
Senior Housing Operating Portfolio Formation Activities [Line Items]
Properties | property			15

Equity Method Investment (Detai

Equity Method Investment (Details) $ in Thousands	1 Months Ended		3 Months Ended		9 Months Ended
	Feb. 28, 2023 USD ($)	Jan. 31, 2020 USD ($)	Sep. 30, 2024 USD ($)	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($) extensionOption	Sep. 30, 2023 USD ($)
Schedule of Equity Method Investments [Line Items]
Cumulative unrecognized equity method losses			$ (5,000)		$ (5,000)
Unrecognized equity method losses			(900)	$ (600)	(2,100)	$ (1,900)
Gains from equity method investment			$ 0	$ 0	$ 402	$ 0
Operating lease term			7 years		7 years
Number of renewal options | extensionOption					2
Renewal term			5 years		5 years
Balance secured by the deed and indenture			$ 11,100		$ 11,100
Timber Ridge OpCo
Schedule of Equity Method Investments [Line Items]
Financing receivable of revolving credit facility					5,000
Amortization and write-off of lease incentives	$ 2,500
Maximum exposure to loss			5,000		5,000
Timber Ridge OpCo
Schedule of Equity Method Investments [Line Items]
Mortgage and other notes receivable, net			0		0
Gains from equity method investment					400
Timber Ridge OpCo | Cumulative Amount
Schedule of Equity Method Investments [Line Items]
Cumulative unrecognized equity method losses			$ (11,600)		$ (11,600)
Timber Ridge OpCo | Noncontrolling Interests | Real Estate Operating Company
Schedule of Equity Method Investments [Line Items]
Investments in affiliates		$ 900
LCS Timber Ridge | Real Estate Operating Company
Schedule of Equity Method Investments [Line Items]
Equity interest in affiliates		25%

Other Assets (Details)

Other Assets (Details) - USD ($) $ in Thousands	1 Months Ended	9 Months Ended
	Feb. 28, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023	Dec. 31, 2022
Segment Reporting Information [Line Items]
Lease incentive payments, net		$ 8,501		$ 10,669
Regulatory escrows		6,208		6,208
Restricted cash		2,217	$ 1,916	2,270	$ 2,225
Other assets		23,163		24,063
Payment of lease incentive		0	$ 10,000
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		2,160		1,620
Allowance		598		343
Real Estate Investments
Segment Reporting Information [Line Items]
Accounts receivable and prepaid expenses		$ 4,077		$ 3,296

Debt (Schedule of Debt) (Detail

Debt (Schedule of Debt) (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Debt Instrument [Line Items]
Revolving credit facility - unsecured	$ 319,000	$ 245,000
Unamortized loan costs	(6,586)	(8,912)
Debt	1,136,302	1,135,051
Debt instrument, unamortized discount	(2,037)
Bank term loans - unsecured
Debt Instrument [Line Items]
Bank term loans - unsecured	200,000	200,000
2031 Senior Notes
Debt Instrument [Line Items]
Bank term loans - unsecured	397,963	397,722
Debt instrument, unamortized discount	(2,037)	(2,278)
Private placement notes - unsecured
Debt Instrument [Line Items]
Bank term loans - unsecured	150,000	225,000
Fannie Mae term loans - secured, non-recourse
Debt Instrument [Line Items]
Fannie Mae term loans - secured, non-recourse	$ 75,925	$ 76,241

Debt (Schedule of Maturities of

Debt (Schedule of Maturities of Long-term Debt) (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Debt Instruments [Abstract]
Remainder of 2024	$ 425
2025	325,500
2026	319,000
2027	100,000
2028	0
2029	0
Thereafter	400,000
Long-term debt, gross	1,144,925
Less: discount	(2,037)
Less: unamortized loan costs	(6,586)	$ (8,912)
Debt	$ 1,136,302	$ 1,135,051

Debt (Narrative) (Details)

Debt (Narrative) (Details) $ in Millions		1 Months Ended		9 Months Ended
	Oct. 24, 2024 extensionOption	Sep. 30, 2024 USD ($) property	Jan. 31, 2021 USD ($)	Sep. 30, 2024 USD ($) property extensionOption
Debt Instrument [Line Items]
Debt leverage limit				50%
Fannie Mae term loans - secured, non-recourse
Debt Instrument [Line Items]
Fixed Rate		3.79%		3.79%
Long-term debt		$ 60.1		$ 60.1
Term of debt				10 years
Net book value		$ 98.8		$ 98.8
Debt Instrument, Name, Fannie Mae Term Loans
Debt Instrument [Line Items]
Properties | property		11		11
FNMA Berkadia Note
Debt Instrument [Line Items]
Fixed Rate		4.60%		4.60%
Long-term debt		$ 15.8		$ 15.8
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%
Secured Debt | 2025 Term Loan
Debt Instrument [Line Items]
Aggregate principle amount issued		200		$ 200
Secured Debt | Secured Overnight Financing Rate (SOFR) | 2025 Term Loan
Debt Instrument [Line Items]
Basis spread on variable rate				0.10%
Senior Notes | 2031 Senior Notes
Debt Instrument [Line Items]
Aggregate principle amount issued			$ 400
Fixed Rate			3%
Percentage of issue price on face value			99.196%
Proceeds from issuance of senior notes			$ 392.3
Debt extinguishment amount		75
Revolving Credit Facility | Minimum | Secured Overnight Financing Rate (SOFR)
Debt Instrument [Line Items]
Basis spread on variable rate				0.725%
Revolving Credit Facility | Minimum | Base Rate
Debt Instrument [Line Items]
Basis spread on variable rate				0%
Revolving Credit Facility | Maximum | Secured Overnight Financing Rate (SOFR)
Debt Instrument [Line Items]
Basis spread on variable rate				1.40%
Revolving Credit Facility | Maximum | Base Rate
Debt Instrument [Line Items]
Basis spread on variable rate				0.40%
Revolving Credit Facility | Unsecured Debt
Debt Instrument [Line Items]
Unsecured revolving credit facility		700		$ 700
Debt instrument, extension period				6 months
Unused balance of the unsecured revolving credit facility		$ 381		$ 381
Revolving Credit Facility | Unsecured Debt | Subsequent Event
Debt Instrument [Line Items]
Debt instrument, extension period one	12 months
Revolving Credit Facility | Unsecured Debt | Minimum
Debt Instrument [Line Items]
Debt instrument, extension options | extensionOption				2
Revolving Credit Facility | Unsecured Debt | Minimum | Subsequent Event
Debt Instrument [Line Items]
Debt instrument, twelve month extension options | extensionOption	1

Debt (Schedule of Unsecured Ter

Debt (Schedule of Unsecured Term Loans) (Details) $ in Thousands	Sep. 30, 2024 USD ($)
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, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Debt Instruments [Abstract]
Interest expense on debt at contractual rates	$ 14,131	$ 14,387	$ 42,247	$ 41,439
Capitalized interest	(65)	(21)	(152)	(61)
Amortization of debt issuance costs, debt discount and other	873	720	2,568	1,930
Total interest expense	$ 14,939	$ 15,086	$ 44,663	$ 43,308

Commitments. Contingencies an_3

Commitments. Contingencies and Uncertainties (Narrative) (Details) $ in Millions	9 Months Ended
	Sep. 30, 2024 USD ($) property operator leaseAgreement
Commitment and Contingencies [Line Items]
Loans and leases agreement	$ 138.2
Development commitments for construction and renovation	33.5
Amount funded toward the development commitments	18.4
Amount funded on real estate investments	1
Contingent lease inducement commitments and contingent consideration of acquisitions	6.9
Discovery PropCo
Commitment and Contingencies [Line Items]
Development commitments for construction and renovation	$ 2
Loans Receivable
Commitment and Contingencies [Line Items]
Number of operators/tenants | operator	7
Notes Receivable Remain Unfunded
Commitment and Contingencies [Line Items]
Mortgage and other notes receivable, net	$ 63.4
Development Commitment
Commitment and Contingencies [Line Items]
Number of properties | property	6
Lease Inducement
Commitment and Contingencies [Line Items]
Number of leases | leaseAgreement	3

Commitments. Contingencies an_4

Commitments. Contingencies and Uncertainties (Schedule of Off Balance Sheet Credit Loss Liability Roll Forward Schedule) (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2024 USD ($)
Off Balance Sheet, Credit Loss [Roll Forward]
Provision for expected credit losses	$ (39)
Ending balance	240
Accounting Standards Update 2016-13
Off Balance Sheet, Credit Loss [Roll Forward]
Beginning balance	$ 279

Redeemable Noncontrolling Int_3

Redeemable Noncontrolling Interest (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Jun. 30, 2024	Jun. 30, 2023	Sep. 30, 2024
Redeemable Noncontrolling Interests [Roll Forward]
Beginning balance			$ 9,656		$ 9,656
Net loss	$ 244	$ 250	478	$ 575	722
Distributions			$ (9)		(9)
Ending balance	$ 8,925				$ 8,925

Equity and Dividends (Narrative

Equity and Dividends (Narrative) (Details) - USD ($) $ / shares in Units, $ in Millions			1 Months Ended		3 Months Ended		6 Months Ended		9 Months Ended
	Nov. 01, 2024	Feb. 16, 2024	Nov. 07, 2024	Aug. 31, 2024	Sep. 30, 2024	Sep. 30, 2023	Jun. 30, 2024	Jun. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023
Dividends Payable [Line Items]
Authorized repurchase amount		$ 160
Common stock, par value (in dollars per share)		$ 0.01			$ 0.01				$ 0.01		$ 0.01
Effective period of stock repurchase plan		1 year
Common stock repurchased (in shares)									0
Sale of stock, aggregate shares (in shares)				2,760,000					2,760,000
Sale of stock, exercise price (in dollars per share)				$ 68.40	$ 67.88				$ 67.88
Sale of stock, available shares (in shares)									187,300,000
At-the market shelf registration, equity offering sales agreement, aggregate sales price					$ 500				$ 500
Issuance of common stock (in shares)									0
Dividends to common stockholders (in dollars per share)					$ 0.90	$ 0.90	$ 1.80	$ 1.80	$ 2.70	$ 2.70
Subsequent Event
Dividends Payable [Line Items]
Sale of stock, additional purchase of shares (in shares)			1,800,000
Sale of stock, consideration received			$ 122.4
Dividends to common stockholders (in dollars per share)	$ 0.90

Equity and Dividends (Schedule

Equity and Dividends (Schedule of Dividends Declared) (Details) - $ / shares	3 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024	Dec. 31, 2023	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Dec. 31, 2022
Equity [Abstract]
Quarterly dividend (in dollars per share)	$ 0.90	$ 0.90	$ 0.90	$ 0.90	$ 0.90	$ 0.90	$ 0.90	$ 0.90

Share-Based Compensation (Narra

Share-Based Compensation (Narrative) (Details) $ / shares in Units, $ in Millions	1 Months Ended	3 Months Ended	9 Months Ended
	Feb. 29, 2024 $ / shares shares	Jun. 30, 2024 shares	Sep. 30, 2024 USD ($) plan $ / shares shares	Sep. 30, 2023 $ / shares shares	Dec. 31, 2023 USD ($)
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of incentive plans | plan			2
Options granted (in shares) | shares				385,500
Weighted average fair value of options granted (in US dollars per share) | $ / shares			$ 7.36	$ 10.56
Aggregate intrinsic value of stock options outstanding			$ 23.4		$ 14.1
Unrecognized compensation cost			$ 2.3
2019 Stock Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options granted (in shares) | shares			431,000
Restricted stock expense | Executive Officer | 2019 Stock Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares issued in period (in shares) | shares	15,000
Shares issued in period (in dollars per shares) | $ / shares	$ 57.76
Stock option plan, award vesting period	5 years
Restricted stock vested shares (in shares) | shares		3,970
Restricted stock non-vested shares (in shares) | shares			31,800
Restricted stock expense | Executive Officer | 2019 Stock Incentive Plan | Tranche One
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting rights, percentage	20%
Restricted stock expense | Executive Officer | 2019 Stock Incentive Plan | Tranche Two
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting rights, percentage	20%
Restricted stock expense | Executive Officer | 2019 Stock Incentive Plan | Tranche Three
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting rights, percentage	20%
Restricted stock expense | Executive Officer | 2019 Stock Incentive Plan | Tranche Four
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting rights, percentage	20%
Restricted stock expense | Executive Officer | 2019 Stock Incentive Plan | Tranche Five
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting rights, percentage	20%
Expected To Be Recognized Remainder Of 2024
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation cost			$ 0.7
Expected To Be Recognized During 2025
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation cost			1.1
Expected To Be Recognized During 2026
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation cost			0.3
Expected To Be Recognized During 2027
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation cost			0.1
Expected To Be Recognized During Thereafter
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation cost			$ 0.1

Share-Based Compensation (Sched

Share-Based Compensation (Schedule of Stock Option Valuation Assumptions) (Details)	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
Share-Based Payment Arrangement [Abstract]
Dividend yield	6.40%	6.90%
Expected volatility	26.10%	39%
Expected lives	2 years 10 months 24 days	2 years 10 months 24 days
Risk-free interest rate	4.49%	4.56%

Share-Based Compensation (Sch_2

Share-Based Compensation (Schedule of Stock Option Activity) (Details)	9 Months Ended
	Sep. 30, 2024 $ / shares shares	Sep. 30, 2023 $ / shares shares
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding [Roll Forward]
Options outstanding beginning balance (in shares) | shares	2,447,171	2,216,175
Options granted (in shares) | shares		385,500
Options exercised (in shares) | shares	(1,065,119)	(5,166)
Options forfeited (in shares) | shares		(61,168)
Options expired (in shares) | shares	(301,837)
Options outstanding, ending balance (in shares) | shares	1,511,215	2,447,171
Stock Options Weighted Average Exercise Price
Options outstanding (in dollars per share) | $ / shares	$ 68.80	$ 70.97
Options granted (in dollars per share) | $ / shares		54.73
Options exercised (in US dollars per share) | $ / shares	58.24	53.41
Options forfeited (in dollars per share) | $ / shares		66.44
Options expired (in dollars per share) | $ / shares	79.96
Options outstanding (in dollars per share) | $ / shares	$ 70.87	$ 68.80
Stock Options Additional Disclosures
Options exercisable (in shares) | shares	1,170,521	2,078,827
Options exercisable (in dollars per share) | $ / shares	$ 74.94	$ 71.40
Options outstanding (in years)	2 years 7 days
Options exercisable (in years)	1 year 5 months 1 day
2019 Stock Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding [Roll Forward]
Options granted (in shares) | shares	431,000
Options expired (in shares) | shares		(88,170)
Stock Options Weighted Average Exercise Price
Options granted (in dollars per share) | $ / shares	$ 57.76
Options expired (in dollars per share) | $ / shares		$ 64.33

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, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Non-cash share-based compensation	$ 670	$ 866	$ 3,512	$ 3,740
Restricted stock expense
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Non-cash share-based compensation	166	119	510	191
Stock option expense
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Non-cash share-based compensation	$ 504	$ 747	$ 3,002	$ 3,549

Earnings Per Common Share (Deta

Earnings Per Common Share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		6 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Jun. 30, 2024	Jun. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Earnings Per Share [Abstract]
Net income	$ 28,242	$ 29,033			$ 93,852	$ 102,662
Add: net loss attributable to noncontrolling interests	298	313			891	946
Net income attributable to stockholders	28,540	29,346			94,743	103,608
Less: net income attributable to unvested restricted stock awards	(29)	(19)			(90)	(38)
Net Income (Loss) Available to Common Stockholders, Diluted	28,511	29,327			94,653	103,570
Net income attributable to common stockholders - basic and diluted	$ 28,511	$ 29,327			$ 94,653	$ 103,570
BASIC:
Weighted average common shares outstanding (in shares)	43,476,067	43,388,841			43,420,663	43,388,779
DILUTED:
Weighted average common shares outstanding (in shares)	43,476,067	43,388,841			43,420,663	43,388,779
Stock options (in shares)	346,997	0			183,093	896
Net forward share contract (in shares)	164,008	0			54,669	0
Weighed average dilutive common shares outstanding (in shares)	43,987,072	43,388,841			43,658,425	43,389,675
Earnings per common share - basic (in dollars per share)	$ 0.66	$ 0.68			$ 2.18	$ 2.39
Earnings per common share - diluted (in dollars per share)	$ 0.65	$ 0.68			$ 2.17	$ 2.39
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)	86,542	816,353			280,157	781,727
Regular dividends declared per common share (in 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 (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Level 3 | Carrying Amount
Fair Value of Financial Instruments [Line Items]
Mortgage and other notes receivable, net	$ 232,550	$ 245,271
Level 3 | Fair Value Measurement
Fair Value of Financial Instruments [Line Items]
Mortgage and other notes receivable, net	228,300	237,646
Variable rate debt | Level 2 | Carrying Amount
Fair Value of Financial Instruments [Line Items]
Debt instrument, fair value disclosure	515,494	439,693
Variable rate debt | Level 2 | Fair Value Measurement
Fair Value of Financial Instruments [Line Items]
Debt instrument, fair value disclosure	519,000	445,000
Fixed rate debt | Level 2 | Carrying Amount
Fair Value of Financial Instruments [Line Items]
Debt instrument, fair value disclosure	620,808	695,358
Fixed rate debt | Level 2 | Fair Value Measurement
Fair Value of Financial Instruments [Line Items]
Debt instrument, fair value disclosure	$ 562,234	$ 616,852

Segment Reporting (Narrative) (

Segment Reporting (Narrative) (Details) $ in Millions	9 Months Ended
	Sep. 30, 2024 USD ($) operatingSegment	Sep. 30, 2023 USD ($)
Segment Reporting Information [Line Items]
Number of operating segments | operatingSegment	2
Real Estate Investments
Segment Reporting Information [Line Items]
Capital expenditures	$ 39.6	$ 56.5
SHOP
Segment Reporting Information [Line Items]
Capital expenditures	$ 7.5	$ 6.3

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, 2024		Sep. 30, 2023	Sep. 30, 2024		Sep. 30, 2023	Dec. 31, 2023	[1]
Segment Reporting Information [Line Items]
Rental income	$ 63,318		$ 62,255	$ 191,265		$ 188,505
Resident fees and services	13,771		12,367	40,416		35,860
Interest income and other	5,855		5,484	17,745		16,005
Total revenues	82,944		80,106	249,426		240,370
Senior housing operating expenses	10,744		10,045	31,494		29,525
Taxes and insurance on leased properties	2,786		2,908	8,321		8,738
NOI	69,414		67,153	209,611		202,107
Depreciation	17,768		17,515	52,763		52,862
Interest Expense, Nonoperating	14,939
Interest	14,939		15,086	44,663		43,308
Legal	240		67	641		364
Franchise, excise and other taxes	83		2	(56)		443
General and administrative	4,810		4,430	15,318		14,390
Loan and realty losses	3,434		1,959	4,550		1,727
Gains on sales of real estate, net	(102)		(737)	(1,718)		(13,500)
Gain on operations transfer, net	0		0	0		(20)
Other non-operating income	0		(202)	0		(202)
Loss on early retirement of debt	0		0	0		73
Gains from equity method investment	0		0	(402)		0
Net income	28,242		29,033	93,852		102,662
Total assets	2,460,090	[1]	2,499,090	2,460,090	[1]	2,499,090	$ 2,488,480
Operating Segments | Real Estate Investments
Segment Reporting Information [Line Items]
Rental income	63,318		62,255	191,265		188,505
Resident fees and services	0		0	0		0
Interest income and other	5,743		5,337	17,428		15,727
Total revenues	69,061		67,592	208,693		204,232
Senior housing operating expenses	0		0	0		0
Taxes and insurance on leased properties	2,786		2,908	8,321		8,738
NOI	66,275		64,684	200,372		195,494
Depreciation	15,168		15,211	45,218		46,064
Interest Expense, Nonoperating	768
Interest			773	2,292		2,298
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	3,434		1,959	4,550		1,727
Gains on sales of real estate, net	(102)		(737)	(1,718)		(13,500)
Gain on operations transfer, net						(20)
Other non-operating income			(202)			(202)
Loss on early retirement of debt						0
Gains from equity method investment				(402)
Net income	47,007		47,680	150,432		159,127
Total assets	2,180,153		2,218,699	2,180,153		2,218,699
Operating Segments | SHOP
Segment Reporting Information [Line Items]
Rental income	0		0	0		0
Resident fees and services	13,771		12,367	40,416		35,860
Interest income and other	0		0	0		0
Total revenues	13,771		12,367	40,416		35,860
Senior housing operating expenses	10,744		10,045	31,494		29,525
Taxes and insurance on leased properties	0		0	0		0
NOI	3,027		2,322	8,922		6,335
Depreciation	2,591		2,292	7,517		6,757
Interest Expense, Nonoperating	0
Interest			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
Other non-operating income			0			0
Loss on early retirement of debt						0
Gains from equity method investment				0
Net income	436		30	1,405		(422)
Total assets	266,789		277,014	266,789		277,014
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	112		147	317		278
Total revenues	112		147	317		278
Senior housing operating expenses	0		0	0		0
Taxes and insurance on leased properties	0		0	0		0
NOI	112		147	317		278
Depreciation	9		12	28		41
Interest Expense, Nonoperating	14,171
Interest			14,313	42,371		41,010
Legal	240		67	641		364
Franchise, excise and other taxes	83		2	(56)		443
General and administrative	4,810		4,430	15,318		14,390
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
Other non-operating income			0			0
Loss on early retirement of debt						73
Gains from equity method investment				0
Net income	(19,201)		(18,677)	(57,985)		(56,043)
Total assets	$ 13,148		$ 3,377	$ 13,148		$ 3,377
[1] The Condensed Consolidated Balance Sheets include the following amounts related to our consolidated variable interest entities: $507.1 million and $513.2 million of Real estate properties, net; $6.9 million and $10.9 million of Cash and cash equivalents; $9.9 million and $9.7 million of Straight-line rent receivable; $8.1 million and $9.4 million of Other assets, net; and $4.6 million and $4.7 million of Accounts payable and accrued expenses, in each case as of September 30, 2024 and December 31, 2023, respectively.

Variable Interest Entities (Nar

Variable Interest Entities (Narrative) (Details) $ in Thousands	9 Months Ended	12 Months Ended
	Sep. 30, 2024 USD ($) realEstatePartnership	Dec. 31, 2023 USD ($) realEstatePartnership	Sep. 30, 2023 USD ($)	Dec. 31, 2022 USD ($)
Variable Interest Entity [Line Items]
Real estate properties, net	$ 2,096,824	$ 2,107,082
Cash and cash equivalents	$ 15,550	$ 22,347	$ 16,579	$ 19,291
Number of real estate partnerships | realEstatePartnership	2	2
Other assets, net	$ 23,163	$ 24,063
Subsidiaries
Variable Interest Entity [Line Items]
Real estate properties, net	246,400	252,500
Cash and cash equivalents	3,000	3,200
Straight line receivables	9,900	9,700
Other assets, net	5,900	7,800
SHOP
Variable Interest Entity [Line Items]
Real estate properties, net	260,700	260,700
Cash and cash equivalents	3,900	7,700
Prepaid expense	2,200	1,700
Credit liabilities of SHOP	$ 4,600	$ 4,700

Variable Interest Entities (Sch

Variable Interest Entities (Schedule of Variable Interest Entities) (Details) $ in Thousands	Sep. 30, 2024 USD ($) loan
Variable Interest Entity [Line Items]
Number of mezzanine loans | loan	2
Senior Living | Straight-Line Rent Receivable
Variable Interest Entity [Line Items]
Carrying Amount	$ 82,886
Maximum Exposure to Loss	92,636
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	16,757
Maximum Exposure to Loss	29,111
Encore | Notes Receivable
Variable Interest Entity [Line Items]
Carrying Amount	35,008
Maximum Exposure to Loss	35,076
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	(658)
Maximum Exposure to Loss	4,342
Watermark Retirement | Notes Receivable
Variable Interest Entity [Line Items]
Carrying Amount	10,190
Maximum Exposure to Loss	11,964
Montecito Medical Real Estate | Notes Receivable
Variable Interest Entity [Line Items]
Carrying Amount	18,053
Maximum Exposure to Loss	50,064
Vizion Health | Notes Receivable
Variable Interest Entity [Line Items]
Carrying Amount	15,636
Maximum Exposure to Loss	15,636
Navion Senior Solutions | Notes Receivable
Variable Interest Entity [Line Items]
Carrying Amount	7,839
Maximum Exposure to Loss	9,989
Kindcare Senior Living | Notes Receivable
Variable Interest Entity [Line Items]
Carrying Amount	775
Maximum Exposure to Loss	$ 775

Uncategorized Items - nhi-20240

Label	Element	Value
Stock Issued During Period, Value, Stock Dividend	us-gaap_StockIssuedDuringPeriodValueStockDividend	$ 39,260,000
Stock Issued During Period, Value, Stock Dividend	us-gaap_StockIssuedDuringPeriodValueStockDividend	78,180,000
Stock Issued During Period, Value, Stock Dividend	us-gaap_StockIssuedDuringPeriodValueStockDividend	78,119,000
Stock Issued During Period, Value, Stock Dividend	us-gaap_StockIssuedDuringPeriodValueStockDividend	39,069,000
Stock Issued During Period, Value, Stock Options Exercised	us-gaap_StockIssuedDuringPeriodValueStockOptionsExercised	2,000
Adjustments to Additional Paid in Capital, Stock Issued, Issuance Costs	us-gaap_AdjustmentsToAdditionalPaidInCapitalStockIssuedIssuanceCosts	275,000
Noncontrolling Interest, Increase from Subsidiary Equity Issuance	us-gaap_NoncontrollingInterestIncreaseFromSubsidiaryEquityIssuance	70,000
Noncontrolling Interest, Increase from Subsidiary Equity Issuance	us-gaap_NoncontrollingInterestIncreaseFromSubsidiaryEquityIssuance	2,000,000
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(9,300,000)
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(15,820,000)
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(10,088,000)
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	122,000
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	670,000
APIC, Share-Based Payment Arrangement, Increase for Cost Recognition	us-gaap_AdjustmentsToAdditionalPaidInCapitalSharebasedCompensationRequisiteServicePeriodRecognitionValue	2,842,000
APIC, Share-Based Payment Arrangement, Increase for Cost Recognition	us-gaap_AdjustmentsToAdditionalPaidInCapitalSharebasedCompensationRequisiteServicePeriodRecognitionValue	2,874,000
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	299,000
Noncontrolling Interest, Decrease from Distributions to Noncontrolling Interest Holders	us-gaap_MinorityInterestDecreaseFromDistributionsToNoncontrollingInterestHolders	563,000
Noncontrolling Interest, Decrease from Distributions to Noncontrolling Interest Holders	us-gaap_MinorityInterestDecreaseFromDistributionsToNoncontrollingInterestHolders	508,000
Net Income (Loss), Excluding Gain (Loss) Attributable to Redeemable Noncontrolling Interest	nhi_NetIncomeLossExcludingGainLossAttributableToRedeemableNoncontrollingInterest	29,283,000
Net Income (Loss), Excluding Gain (Loss) Attributable to Redeemable Noncontrolling Interest	nhi_NetIncomeLossExcludingGainLossAttributableToRedeemableNoncontrollingInterest	28,486,000
Net Income (Loss), Excluding Gain (Loss) Attributable to Redeemable Noncontrolling Interest	nhi_NetIncomeLossExcludingGainLossAttributableToRedeemableNoncontrollingInterest	74,205,000
Net Income (Loss), Excluding Gain (Loss) Attributable to Redeemable Noncontrolling Interest	nhi_NetIncomeLossExcludingGainLossAttributableToRedeemableNoncontrollingInterest	66,088,000
Share-Based Payment Arrangement, Decrease for Tax Withholding Obligation	us-gaap_AdjustmentsRelatedToTaxWithholdingForShareBasedCompensation	5,419,000
Retained Earnings, Appropriated [Member]
Stock Issued During Period, Value, Stock Dividend	us-gaap_StockIssuedDuringPeriodValueStockDividend	78,180,000
Stock Issued During Period, Value, Stock Dividend	us-gaap_StockIssuedDuringPeriodValueStockDividend	78,119,000
Stock Issued During Period, Value, Stock Dividend	us-gaap_StockIssuedDuringPeriodValueStockDividend	39,069,000
Stock Issued During Period, Value, Stock Dividend	us-gaap_StockIssuedDuringPeriodValueStockDividend	39,260,000
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(39,260,000)
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(78,180,000)
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(78,119,000)
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(39,069,000)
Common Stock [Member]
Stock Issued During Period, Value, Stock Options Exercised	us-gaap_StockIssuedDuringPeriodValueStockOptionsExercised	$ 2,000
Share-Based Compensation Arrangement by Share-Based Payment Award, Options, Exercises in Period	us-gaap_StockIssuedDuringPeriodSharesStockOptionsExercised	18,238
Share-Based Compensation Arrangement by Share-Based Payment Award, Options, Exercises in Period	us-gaap_StockIssuedDuringPeriodSharesStockOptionsExercised	99
Share-Based Compensation Arrangement by Share-Based Payment Award, Options, Exercises in Period	us-gaap_StockIssuedDuringPeriodSharesStockOptionsExercised	179,215
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	$ 2,000
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	0
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	0
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	$ 0
Stock Issued During Period, Shares, Period Increase (Decrease)	us-gaap_StockIssuedDuringPeriodSharesPeriodIncreaseDecrease	179,215
Stock Issued During Period, Shares, Period Increase (Decrease)	us-gaap_StockIssuedDuringPeriodSharesPeriodIncreaseDecrease	33,008
Stock Issued During Period, Shares, Period Increase (Decrease)	us-gaap_StockIssuedDuringPeriodSharesPeriodIncreaseDecrease	21,099
Stock Issued During Period, Shares, Period Increase (Decrease)	us-gaap_StockIssuedDuringPeriodSharesPeriodIncreaseDecrease	0
Share-Based Payment Arrangement, Decrease for Tax Withholding Obligation	us-gaap_AdjustmentsRelatedToTaxWithholdingForShareBasedCompensation	$ 400,000
Share-Based Payment Arrangement, Shares Withheld for Tax Withholding Obligation	us-gaap_SharesPaidForTaxWithholdingForShareBasedCompensation	0
Share-Based Payment Arrangement, Shares Withheld for Tax Withholding Obligation	us-gaap_SharesPaidForTaxWithholdingForShareBasedCompensation	230
Stock Issued During Period, Shares, Restricted Stock Award, Gross	us-gaap_StockIssuedDuringPeriodSharesRestrictedStockAwardGross	21,000
Stock Issued During Period, Shares, Restricted Stock Award, Gross	us-gaap_StockIssuedDuringPeriodSharesRestrictedStockAwardGross	15,000
Retained Earnings [Member]
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	$ 28,540,000
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	66,203,000
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	74,263,000
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	29,346,000
Net Income (Loss), Excluding Gain (Loss) Attributable to Redeemable Noncontrolling Interest	nhi_NetIncomeLossExcludingGainLossAttributableToRedeemableNoncontrollingInterest	29,346,000
Net Income (Loss), Excluding Gain (Loss) Attributable to Redeemable Noncontrolling Interest	nhi_NetIncomeLossExcludingGainLossAttributableToRedeemableNoncontrollingInterest	28,540,000
Net Income (Loss), Excluding Gain (Loss) Attributable to Redeemable Noncontrolling Interest	nhi_NetIncomeLossExcludingGainLossAttributableToRedeemableNoncontrollingInterest	74,263,000
Net Income (Loss), Excluding Gain (Loss) Attributable to Redeemable Noncontrolling Interest	nhi_NetIncomeLossExcludingGainLossAttributableToRedeemableNoncontrollingInterest	66,203,000
Parent [Member]
Stock Issued During Period, Value, Stock Dividend	us-gaap_StockIssuedDuringPeriodValueStockDividend	39,260,000
Stock Issued During Period, Value, Stock Dividend	us-gaap_StockIssuedDuringPeriodValueStockDividend	78,180,000
Stock Issued During Period, Value, Stock Dividend	us-gaap_StockIssuedDuringPeriodValueStockDividend	78,119,000
Stock Issued During Period, Value, Stock Dividend	us-gaap_StockIssuedDuringPeriodValueStockDividend	39,069,000
Stock Issued During Period, Value, Stock Options Exercised	us-gaap_StockIssuedDuringPeriodValueStockOptionsExercised	2,000
Adjustments to Additional Paid in Capital, Stock Issued, Issuance Costs	us-gaap_AdjustmentsToAdditionalPaidInCapitalStockIssuedIssuanceCosts	275,000
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(15,467,000)
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(9,535,000)
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(1,257,000)
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(8,857,000)
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	670,000
APIC, Share-Based Payment Arrangement, Increase for Cost Recognition	us-gaap_AdjustmentsToAdditionalPaidInCapitalSharebasedCompensationRequisiteServicePeriodRecognitionValue	2,842,000
APIC, Share-Based Payment Arrangement, Increase for Cost Recognition	us-gaap_AdjustmentsToAdditionalPaidInCapitalSharebasedCompensationRequisiteServicePeriodRecognitionValue	2,874,000
Net Income (Loss), Excluding Gain (Loss) Attributable to Redeemable Noncontrolling Interest	nhi_NetIncomeLossExcludingGainLossAttributableToRedeemableNoncontrollingInterest	29,346,000
Net Income (Loss), Excluding Gain (Loss) Attributable to Redeemable Noncontrolling Interest	nhi_NetIncomeLossExcludingGainLossAttributableToRedeemableNoncontrollingInterest	28,540,000
Net Income (Loss), Excluding Gain (Loss) Attributable to Redeemable Noncontrolling Interest	nhi_NetIncomeLossExcludingGainLossAttributableToRedeemableNoncontrollingInterest	74,263,000
Net Income (Loss), Excluding Gain (Loss) Attributable to Redeemable Noncontrolling Interest	nhi_NetIncomeLossExcludingGainLossAttributableToRedeemableNoncontrollingInterest	66,203,000
Share-Based Payment Arrangement, Decrease for Tax Withholding Obligation	us-gaap_AdjustmentsRelatedToTaxWithholdingForShareBasedCompensation	5,419,000
Share-Based Payment Arrangement, Decrease for Tax Withholding Obligation	us-gaap_AdjustmentsRelatedToTaxWithholdingForShareBasedCompensation	400,000
Noncontrolling Interest [Member]
Noncontrolling Interest, Increase from Subsidiary Equity Issuance	us-gaap_NoncontrollingInterestIncreaseFromSubsidiaryEquityIssuance	2,000,000
Noncontrolling Interest, Increase from Subsidiary Equity Issuance	us-gaap_NoncontrollingInterestIncreaseFromSubsidiaryEquityIssuance	70,000
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(443,000)
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(353,000)
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(553,000)
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	1,379,000
Noncontrolling Interest, Decrease from Distributions to Noncontrolling Interest Holders	us-gaap_MinorityInterestDecreaseFromDistributionsToNoncontrollingInterestHolders	508,000
Noncontrolling Interest, Decrease from Distributions to Noncontrolling Interest Holders	us-gaap_MinorityInterestDecreaseFromDistributionsToNoncontrollingInterestHolders	299,000
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	563,000
Net Income (Loss), Excluding Gain (Loss) Attributable to Redeemable Noncontrolling Interest	nhi_NetIncomeLossExcludingGainLossAttributableToRedeemableNoncontrollingInterest	(63,000)
Net Income (Loss), Excluding Gain (Loss) Attributable to Redeemable Noncontrolling Interest	nhi_NetIncomeLossExcludingGainLossAttributableToRedeemableNoncontrollingInterest	(54,000)
Net Income (Loss), Excluding Gain (Loss) Attributable to Redeemable Noncontrolling Interest	nhi_NetIncomeLossExcludingGainLossAttributableToRedeemableNoncontrollingInterest	(58,000)
Net Income (Loss), Excluding Gain (Loss) Attributable to Redeemable Noncontrolling Interest	nhi_NetIncomeLossExcludingGainLossAttributableToRedeemableNoncontrollingInterest	(115,000)
Additional Paid-in Capital [Member]
Adjustments to Additional Paid in Capital, Stock Issued, Issuance Costs	us-gaap_AdjustmentsToAdditionalPaidInCapitalStockIssuedIssuanceCosts	275,000
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	(4,749,000)
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	2,442,000
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	2,599,000
Stockholders' Equity, Period Increase (Decrease)	us-gaap_StockholdersEquityPeriodIncreaseDecrease	866,000
APIC, Share-Based Payment Arrangement, Increase for Cost Recognition	us-gaap_AdjustmentsToAdditionalPaidInCapitalSharebasedCompensationRequisiteServicePeriodRecognitionValue	2,842,000
APIC, Share-Based Payment Arrangement, Increase for Cost Recognition	us-gaap_AdjustmentsToAdditionalPaidInCapitalSharebasedCompensationRequisiteServicePeriodRecognitionValue	670,000
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
Share-Based Payment Arrangement, Decrease for Tax Withholding Obligation	us-gaap_AdjustmentsRelatedToTaxWithholdingForShareBasedCompensation	5,419,000
Share-Based Payment Arrangement, Decrease for Tax Withholding Obligation	us-gaap_AdjustmentsRelatedToTaxWithholdingForShareBasedCompensation	$ 400,000