LTC Properties (LTC) 10-Q 26 Oct 23 2023 Q3 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	9 Months Ended
	Sep. 30, 2023	Oct. 19, 2023
Document and Entity Information
Document Type	10-Q
Document Quarterly Report	true
Document Transition Report	false
Document Period End Date	Sep. 30, 2023
Entity File Number	1-11314
Entity Registrant Name	LTC PROPERTIES INC
Entity Incorporation, State or Country Code	MD
Entity Tax Identification Number	71-0720518
Entity Address, Address Line One	2829 Townsgate Road, Suite 350
Entity Address, City or Town	Westlake Village
Entity Address, State or Province	CA
Entity Address, Postal Zip Code	91361
City Area Code	805
Local Phone Number	981-8655
Title of 12(b) Security	Common stock, $.01 par value
Trading Symbol	LTC
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		41,411,693
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	Q3
Entity Central Index Key	0000887905
Amendment Flag	false

CONSOLIDATED BALANCE SHEETS

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Investments:
Land	$ 123,919	$ 124,665
Buildings and improvements	1,260,891	1,273,025
Accumulated depreciation and amortization	(386,483)	(389,182)
Operating real estate property, net	998,327	1,008,508
Properties held-for-sale, net of accumulated depreciation: 2023-$11,590; 2022-$2,305	9,448	10,710
Real property investments, net	1,007,775	1,019,218
Financing receivables, net of credit loss reserve: 2023-$1,981; 2022-$768	196,053	75,999
Mortgage loans receivable, net of credit loss reserve: 2023-$4,777; 2022-$3,930	473,567	389,728
Real estate investments, net	1,677,395	1,484,945
Notes receivable, net of credit loss reserve: 2023-$637; 2022-$589	63,056	58,383
Investments in unconsolidated joint ventures	19,340	19,340
Investments, net	1,759,791	1,562,668
Other assets:
Cash and cash equivalents	11,302	10,379
Debt issue costs related to revolving line of credit	1,719	2,321
Interest receivable	54,605	46,000
Straight-line rent receivable	20,068	21,847
Lease incentives	2,193	1,789
Prepaid expenses and other assets	18,185	11,099
Total assets	1,867,863	1,656,103
LIABILITIES
Revolving line of credit	362,250	130,000
Term loans, net of debt issue costs: 2023-$380; 2022-$489	99,620	99,511
Senior unsecured notes, net of debt issue costs: 2023-$1,307; 2022-$1,477	494,353	538,343
Accrued interest	3,893	5,234
Accrued expenses and other liabilities	47,364	32,708
Total liabilities	1,007,480	805,796
Stockholders' equity:
Common stock: $0.01 par value; 60,000 shares authorized; shares issued and outstanding: 2023-41,412; 2022-41,262	413	412
Capital in excess of par value	937,550	931,124
Cumulative net income	1,606,165	1,544,660
Accumulated other comprehensive income	8,596	8,719
Cumulative distributions	(1,727,315)	(1,656,548)
Total LTC Properties, Inc. stockholders' equity	825,409	828,367
Non-controlling interests	34,974	21,940
Total equity	860,383	850,307
Total liabilities and equity	$ 1,867,863	$ 1,656,103

CONSOLIDATED BALANCE SHEETS (Pa

CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) shares in Thousands, $ in Thousands	9 Months Ended	12 Months Ended
	Sep. 30, 2023	Dec. 31, 2022
Properties held-for-sale, accumulated depreciation	$ 11,590	$ 2,305
Financial receivable credit loss reserve	1,981	768
Mortgage loans receivable, loan loss reserve	4,777	3,930
Notes receivable, loan loss reserve	$ 637	$ 589
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, shares authorized	60,000	60,000
Common stock, shares issued	41,412	41,262
Common stock, shares outstanding	41,412	41,262
Term loans
Debt issue costs, net	$ 380	$ 489
Senior Unsecured Notes
Debt issue costs, net	$ 1,307	$ 1,477

CONSOLIDATED STATEMENTS OF INCO

CONSOLIDATED STATEMENTS OF INCOME - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Revenues:
Rental income	$ 31,589	$ 31,585	$ 94,861	$ 93,537
Interest income from financing receivables	3,832	357	11,413	357
Interest income from mortgage loans	12,247	10,379	35,417	30,112
Interest and other income	1,635	1,182	5,358	3,308
Total revenues	49,303	43,503	147,049	127,314
Expenses:
Interest expense	12,674	7,941	34,595	22,607
Depreciation and amortization	9,499	9,385	28,085	28,202
Impairment loss		1,286	12,510	1,286
Provision for credit losses	189	795	2,107	1,454
Transaction costs	329	629	537	728
Property tax expense	3,271	4,179	9,751	12,180
General and administrative expenses	5,959	5,888	18,344	17,407
Total expenses	31,921	30,103	105,929	83,864
Other operating income:
Gain (loss) on sale of real estate, net	4,870	(387)	20,545	37,809
Operating income	22,252	13,013	61,665	81,259
Income from unconsolidated joint ventures	375	376	1,127	1,127
Net income	22,627	13,389	62,792	82,386
Income allocated to non-controlling interests	(430)	(99)	(1,287)	(301)
Net income attributable to LTC Properties, Inc.	22,197	13,290	61,505	82,085
Income allocated to participating securities	(147)	(131)	(440)	(481)
Net income available to common stockholders	$ 22,050	$ 13,159	$ 61,065	$ 81,604
Earnings per common share:
Basic (in dollars per share)	$ 0.54	$ 0.33	$ 1.48	$ 2.06
Diluted (in dollars per share)	$ 0.54	$ 0.32	$ 1.48	$ 2.04
Weighted average shares used to calculate earnings per common share:
Basic (in shares)	41,153	40,270	41,127	39,658
Diluted (in shares)	41,211	40,552	41,185	39,939
Dividends declared and paid per common share (in dollars per share)	$ 0.57	$ 0.57	$ 1.71	$ 1.71

CONSOLIDATED STATEMENTS OF COMP

CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME
Net income	$ 22,627	$ 13,389	$ 62,792	$ 82,386
Unrealized gain on cash flow hedges before reclassification	1,034	3,501	2,629	9,361
(Gains) losses reclassified from accumulated other comprehensive income to interest expense	(1,006)	(195)	(2,752)	256
Comprehensive income	22,655	16,695	62,669	92,003
Less: Comprehensive income allocated to non-controlling interests	(430)	(99)	(1,287)	(301)
Comprehensive income attributable to LTC Properties, Inc.	$ 22,225	$ 16,596	$ 61,382	$ 91,702

CONSOLIDATED STATEMENTS OF EQUI

CONSOLIDATED STATEMENTS OF EQUITY - USD ($) shares in Thousands, $ in Thousands	Parent	Common Stock	Capital in Excess of Par Value	Cumulative Net Income	Accumulated OCI	Cumulative Distributions	Non-controlling Interests	Total
Balance at beginning of period at Dec. 31, 2021	$ 736,714	$ 394	$ 856,895	$ 1,444,636	$ (172)	$ (1,565,039)	$ 8,413	$ 745,127
Balance (in shares) at Dec. 31, 2021		39,374
Equity activity
Net income	14,412			14,412			95	14,507
Stock-based compensation expense	1,925		1,925					1,925
Non-controlling interest distributions							(95)	(95)
Common stock cash distributions	(22,480)					(22,480)		(22,480)
Cash paid for taxes in lieu of common shares	(1,255)		(1,255)					(1,255)
Cash paid for taxes in lieu of common shares (in shares)		(37)
Fair market valuation adjustment for interest rate swap	4,876				4,876			4,876
Other	(6)	$ 1	(7)					(6)
Other (in shares)		123
Balance at end of period at Mar. 31, 2022	734,186	$ 395	857,558	1,459,048	4,704	(1,587,519)	8,413	742,599
Balance (in shares) at Mar. 31, 2022		39,460
Balance at beginning of period at Dec. 31, 2021	736,714	$ 394	856,895	1,444,636	(172)	(1,565,039)	8,413	745,127
Balance (in shares) at Dec. 31, 2021		39,374
Equity activity
Net income								82,386
Balance at end of period at Sep. 30, 2022	803,250	$ 404	899,921	1,526,721	9,445	(1,633,241)	21,919	825,169
Balance (in shares) at Sep. 30, 2022		40,505
Balance at beginning of period at Mar. 31, 2022	734,186	$ 395	857,558	1,459,048	4,704	(1,587,519)	8,413	742,599
Balance (in shares) at Mar. 31, 2022		39,460
Equity activity
Issuance of common stock	33,693	$ 9	33,684					33,693
Issuance of common stock (in shares)		910
Net income	54,383			54,383			107	54,490
Stock-based compensation expense	2,012		2,012					2,012
Non-controlling interest distributions							(998)	(998)
Common stock cash distributions	(22,635)					(22,635)		(22,635)
Cash paid for taxes in lieu of common shares	(100)		(100)					(100)
Cash paid for taxes in lieu of common shares (in shares)		(2)
Fair market valuation adjustment for interest rate swap	1,435				1,435			1,435
Other (in shares)		12
Balance at end of period at Jun. 30, 2022	802,974	$ 404	893,154	1,513,431	6,139	(1,610,154)	7,522	810,496
Balance (in shares) at Jun. 30, 2022		40,380
Equity activity
Issuance of common stock	4,753		4,753					4,753
Issuance of common stock (in shares)		125
Net income	13,290			13,290			99	13,389
Stock-based compensation expense	2,014		2,014					2,014
Non-controlling interests contributions							14,375	14,375
Non-controlling interest distributions							(77)	(77)
Common stock cash distributions	(23,087)					(23,087)		(23,087)
Fair market valuation adjustment for interest rate swap	3,306				3,306			3,306
Balance at end of period at Sep. 30, 2022	803,250	$ 404	899,921	1,526,721	9,445	(1,633,241)	21,919	825,169
Balance (in shares) at Sep. 30, 2022		40,505
Balance at beginning of period at Dec. 31, 2022	828,367	$ 412	931,124	1,544,660	8,719	(1,656,548)	21,940	850,307
Balance (in shares) at Dec. 31, 2022		41,262
Equity activity
Issuance of common stock	1,697		1,697					1,697
Issuance of common stock (in shares)		48
Issuance of restricted stock		$ 1	(1)
Issuance of restricted stock (in shares)		128
Net income	33,134			33,134			427	33,561
Stock-based compensation expense	2,088		2,088					2,088
Non-controlling interests contributions							3,831	3,831
Non-controlling interest distributions							(406)	(406)
Common stock cash distributions	(23,563)					(23,563)		(23,563)
Cash paid for taxes in lieu of common shares	(1,538)		(1,538)					(1,538)
Cash paid for taxes in lieu of common shares (in shares)		(41)
Fair market valuation adjustment for interest rate swap	(1,362)				(1,362)			(1,362)
Other (in shares)		(1)
Balance at end of period at Mar. 31, 2023	838,823	$ 413	933,370	1,577,794	7,357	(1,680,111)	25,792	864,615
Balance (in shares) at Mar. 31, 2023		41,396
Balance at beginning of period at Dec. 31, 2022	828,367	$ 412	931,124	1,544,660	8,719	(1,656,548)	21,940	850,307
Balance (in shares) at Dec. 31, 2022		41,262
Equity activity
Net income								62,792
Balance at end of period at Sep. 30, 2023	825,409	$ 413	937,550	1,606,165	8,596	(1,727,315)	34,974	860,383
Balance (in shares) at Sep. 30, 2023		41,412
Balance at beginning of period at Mar. 31, 2023	838,823	$ 413	933,370	1,577,794	7,357	(1,680,111)	25,792	864,615
Balance (in shares) at Mar. 31, 2023		41,396
Equity activity
Issuance of restricted stock (in shares)		15
Net income	6,174			6,174			430	6,604
Stock-based compensation expense	2,138		2,138					2,138
Non-controlling interests contributions							9,133	9,133
Non-controlling interest distributions							(406)	(406)
Common stock cash distributions	(23,599)					(23,599)		(23,599)
Cash paid for taxes in lieu of common shares	(81)		(81)					(81)
Cash paid for taxes in lieu of common shares (in shares)		(2)
Fair market valuation adjustment for interest rate swap	1,211				1,211			1,211
Balance at end of period at Jun. 30, 2023	824,666	$ 413	935,427	1,583,968	8,568	(1,703,710)	34,949	859,615
Balance (in shares) at Jun. 30, 2023		41,409
Equity activity
Issuance of restricted stock (in shares)		3
Net income	22,197			22,197			430	22,627
Stock-based compensation expense	2,123		2,123					2,123
Non-controlling interest distributions							(405)	(405)
Common stock cash distributions	(23,605)					(23,605)		(23,605)
Fair market valuation adjustment for interest rate swap	28				28			28
Balance at end of period at Sep. 30, 2023	$ 825,409	$ 413	$ 937,550	$ 1,606,165	$ 8,596	$ (1,727,315)	$ 34,974	$ 860,383
Balance (in shares) at Sep. 30, 2023		41,412

CONSOLIDATED STATEMENTS OF EQ_2

CONSOLIDATED STATEMENTS OF EQUITY (Parenthetical) - $ / shares	3 Months Ended						9 Months Ended
	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2022	Jun. 30, 2022	Mar. 31, 2022	Sep. 30, 2023	Sep. 30, 2022
CONSOLIDATED STATEMENTS OF EQUITY
Common Stock cash distributions	$ 0.57	$ 0.57	$ 0.57	$ 0.57	$ 0.57	$ 0.57	$ 1.71	$ 1.71

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
OPERATING ACTIVITIES:
Net income	$ 62,792	$ 82,386
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	28,085	28,202
Stock-based compensation expense	6,349	5,951
Impairment loss	12,510	1,286
Gain on sale of real estate, net	(20,545)	(37,809)
Income from unconsolidated joint ventures	(1,127)	(1,127)
Income distributions from unconsolidated joint ventures		351
Straight-line rental adjustment	1,635	963
Exchange of prepayment fee for participating interest in mortgage loan	(1,380)
Adjustment for collectability of lease incentives and rental income	26	256
Amortization of lease incentives	584	665
Provision for credit losses	2,107	1,454
Application of interest reserve	(1,788)	(4,348)
Amortization of debt issue costs	900	841
Other non-cash items, net	71	(170)
Change in operating assets and liabilities
Lease incentives funded	(1,023)	(418)
Increase in interest receivable	(8,605)	(4,768)
Decrease in accrued interest payable	(1,341)	(625)
Net change in other assets and liabilities	(318)	(318)
Net cash provided by operating activities	78,932	72,772
INVESTING ACTIVITIES:
Investment in real estate properties	(43,759)	(51,815)
Investment in real estate developments		(105)
Investment in real estate capital improvements	(5,053)	(4,555)
Proceeds from sale of real estate, net	51,410	72,628
Investment in financing receivable	(112,712)	(61,661)
Investment in real estate mortgage loans receivable	(72,260)	(35,234)
Principal payments received on mortgage loans receivable	301	625
Advances and originations under notes receivable	(19,258)	(37,008)
Principal payments received on notes receivable	7,077	6,618
Net cash used in investing activities	(194,254)	(110,507)
FINANCING ACTIVITIES:
Borrowings from revolving line of credit	274,450	194,000
Repayment of revolving line of credit	(42,200)	(153,900)
Proceeds from issuance of senior unsecured notes		75,000
Principal payments on senior unsecured notes	(44,160)	(43,160)
Proceeds from common stock issued	1,777	38,957
Distributions paid to stockholders	(70,767)	(68,202)
Contribution from non-controlling interests		50
Distributions paid to non-controlling interests	(1,217)	(1,170)
Financing costs paid	(19)	(1,162)
Cash paid for taxes in lieu of shares upon vesting of restricted stock	(1,619)	(1,355)
Other		(6)
Net cash provided by financing activities	116,245	39,052
Increase in cash and cash equivalents	923	1,317
Cash and cash equivalents, beginning of period	10,379	5,161
Cash and cash equivalents, end of period	11,302	6,478
Supplemental disclosure of cash flow information:
Interest paid	35,036	22,391
Non-cash investing and financing transactions:
Contribution from non-controlling interest	12,965	14,325
Exchange of mezzanine loan and related prepayment fee for participating interest in mortgage loan	(8,841)
Reserves withheld at financing and mortgage loan receivable origination	(5,147)
Accretion of interest reserve recorded as mortgage loan receivable	1,788	4,348
(Decrease) increase in fair value of interest rate swap agreements	(123)	9,617
Mortgage loan receivable reserve withheld at origination	$ 1,506	$ 102

General

General	9 Months Ended
	Sep. 30, 2023
General
General	1. Genera l LTC Properties, Inc., a health care real estate investment trust (“REIT”), was incorporated on May 12, 1992 in the State of Maryland and commenced operations on August 25, 1992. We invest primarily in seniors housing and health care properties primarily through sale-leasebacks, mortgage financing, joint ventures and structured finance solutions including preferred equity and mezzanine lending. We conduct and manage our business as one operating segment, rather than multiple operating segments, for internal reporting and internal decision-making purposes. Our primary objectives are to create, sustain and enhance stockholder equity value and provide current income for distribution to stockholders through real estate investments in seniors housing and health care properties managed by experienced operators. Our primary seniors housing and health care property classifications include skilled nursing centers (“SNF”), assisted living communities (“ALF”), independent living communities (“ILF”), memory care communities (“MC”) and combinations thereof. We also invest in other (“OTH”) types of properties, such as land parcels, projects under development (“UDP”) and behavioral health care hospitals. To meet these objectives, we attempt to invest in properties that provide opportunity for additional value and current returns to our stockholders and diversify our investment portfolio by geographic location, operator, property classification and form of investment. We have prepared consolidated financial statements included herein without audit and in the opinion of management have included all adjustments necessary for a fair presentation of the consolidated financial statements pursuant to the rules and regulations of the Securities and Exchange Commission (“SEC”). Certain information and note disclosures normally included in financial statements prepared in accordance with U.S. generally accepted accounting principles (“GAAP”) have been condensed or omitted pursuant to rules and regulations governing the presentation of interim financial statements. The accompanying consolidated financial statements include the accounts of our company and its wholly-owned subsidiaries. All significant intercompany accounts and transactions have been eliminated in consolidation. The results of operations for the three and nine months ended September 30, 2023 and 2022 are not necessarily indicative of the results for a full year. No provision has been made for federal or state income taxes. Our company qualifies as a REIT under Sections 856 through 860 of the Internal Revenue Code of 1986, as amended. As such, we generally are not taxed on income that is distributed to our stockholders.

Real Estate Investments

Real Estate Investments	9 Months Ended
	Sep. 30, 2023
Real Estate Investments
Real Estate Investments	2. Real Estate Investments Assisted living communities, independent living communities, memory care communities and combinations thereof are included in the assisted living property classification (collectively “ALF”). Any reference to the number of properties or facilities, number of units, number of beds, number of operators and yield on investments in real estate are unaudited and outside the scope of our independent registered public accounting firm’s review of our consolidated financial statements in accordance with the standards of the Public Company Accounting Oversight Board. Owned Properties. The following table summarizes our investments in owned properties at September 30, 2023 (dollar amounts in thousands) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Average ​ ​ ​ ​ ​ Percentage ​ Number ​ Number of ​ Investment ​ ​ Gross ​ of ​ of ​ SNF ​ ALF ​ per Type of Property ​ Investment ​ Investment ​ Properties (1) ​ Beds ​ Units ​ Bed/Unit Assisted Living ​ $ 800,963 ​ 57.0 % 92 ​ — ​ 5,323 ​ $ 150.47 ​ Skilled Nursing ​ ​ 592,880 ​ 42.1 % 50 ​ 6,113 ​ 236 ​ $ 93.38 ​ Other (2) ​ ​ 12,005 ​ 0.9 % 1 ​ 118 ​ — ​ ​ — ​ Total ​ $ 1,405,848 ​ 100.0 % 143 ​ 6,231 ​ 5,559 ​ ​ ​ ​ (1) We own properties in 24 states that are leased to 22 different operators. ​ (2) Includes three parcels of land held-for-use, and one behavioral health care hospital. Many of our existing leases contain renewal options that, if exercised, could result in the amount of rent payable upon renewal being greater or less than that currently being paid. During 2023, Brookdale Senior Living Communities, Inc. (“Brookdale”) elected not to exercise its renewal option under a master lease that matures on December 31, 2023. We re-leased 10 of the 35 properties in the existing Brookdale portfolio to Brookdale under a new master lease. This new master lease includes six properties in Colorado and four in Kansas. The six-year master lease will commence on January 1, 2024. Rent in the first lease year is set at $8,000,000 escalating by approximately 2.0% annually. The lease includes a purchase option that can be exercised in 2029. We also agreed to fund $4,500,000 for capital expenditures for the first two years of the lease at an initial rate of 8.0%, escalating by approximately 2.0% annually thereafter. Subsequent to September 30, 2023, we added seven additional properties to the new Brookdale master lease commencing on January 1, 2024. One property is located in Ohio with 42 assisted living units and six are located in Texas with 235 assisted living units. These properties are currently included in the original Brookdale master lease. As a result of this amendment, Brookdale will operate 17 properties under the new master lease with the initial annual rent of $9,325,000 and the capital expenditure commitment will be $7,150,000. Additionally, the new master lease provides Brookdale with a purchase option on these seven properties. Also, subsequent to September 30, 2023, we leased six assisted living communities located in Oklahoma, with a total of 219 units, to a current LTC operator under a new master lease, expected to commence on November 1, subject to the issuance of licensure to the new operator. These properties are currently included in the original Brookdale master lease. The lease term is for three years, with one four-year extension period. Rent in the first year is set at $960,000, increasing to $984,000 in the second year and $1,150,000 in the third year. This master lease includes a purchase option that can be exercised starting in November 2027 through October 2029 if the lessee exercises its four-year extension option. Also, we entered into agreements to sell seven assisted living communities in the existing Brookdale portfolio. These properties were classified as held-for-sale as of September 30, 2023. Additionally, during 2023, a master lease covering two skilled nursing centers that was scheduled to mature in 2023 was renewed at the contractual rate for another five years extending the maturity to November 2028. The centers have a total of 216 beds and are located in Florida. Also, during 2023, a master lease covering two skilled nursing centers that was scheduled to mature in 2023 was renewed for another two years extending the maturity to December 2025. The master lease was renewed at the contractual annual cash rent of $1,005,000 increasing 2.5% per year. As amended, this master lease provides the lessee with a purchase option available through December 31, 2024. The centers have a total of 141 beds and are located in Tennessee. During 2023, we transitioned a portfolio of eight assisted living communities with 500 units in Illinois, Ohio and Michigan to Encore Senior Living (“Encore”). We agreed to provide assistance in the second quarter of 2023 to the former operator of this portfolio and as part of the transition, we received repayment of $1,250,000 of deferred rent which represents $934,000 of April and May 2023 deferred rent and $316,000 of unrecorded deferred rent provided in 2022. Cash rent under the new two-year We monitor the collectability of our receivable balances, including deferred rent receivable balances, on an ongoing basis. We write-off uncollectible operator receivable balances, including straight- line rent receivable and lease incentives balances, as a reduction to rental income in the period such balances are no longer probable of being collected. Therefore, recognition of rental income is limited to the lesser of the amount of cash collected or rental income reflected on a “straight-line” basis for those customer receivable balances deemed uncollectible. We wrote-off straight-line rent receivable and lease incentives balances of $26,000 and $256,000 for the nine months ended September 30, 2023 and 2022, respectively, as a result of property sales and lease terminations. We continue to take into account the current financial condition of our operators, including consideration of the pace of recovery from the impact of COVID-19, and inflation on the financial performance of our operators in our estimation of uncollectible accounts and deferred rents receivable at September 30, 2023. We are closely monitoring the collectability of such rents and will adjust future estimations as appropriate as further information becomes known. The following table summarizes components of our rental income for the nine months ended September 30, 2023 and 2022 (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended ​ Nine Months Ended ​ ​ September 30, ​ September 30, Rental Income ​ ​ 2023 ​ ​ 2022 ​ ​ 2023 ​ ​ 2022 ​ Contractual cash rental income ​ $ 29,121 (1) $ 28,180 ​ $ 87,260 (1) $ 83,203 ​ Variable cash rental income ​ ​ 3,386 (2) ​ 4,160 (2) ​ 9,846 (2) ​ 12,218 (2) Straight-line rent ​ ​ (747) (3) ​ (436) ​ ​ (1,635) (3) ​ (963) ​ Adjustment for collectability of lease incentives and rental income ​ ​ — ​ ​ (83) (4) ​ (26) ​ ​ (256) (5) Amortization of lease incentives ​ ​ (171) ​ ​ (236) ​ ​ (584) ​ ​ (665) ​ Total ​ $ 31,589 ​ $ 31,585 ​ $ 94,861 ​ $ 93,537 ​ (1) Increased primarily due to rental income from acquisitions and transitioned portfolios, repayment of deferred rent and annual rent escalations, partially offset by sold properties. ​ (2) The variable rental income for the three and nine months ended September 30, 2023 and the three and nine months ended September 30, 2022, primarily includes reimbursement of real estate taxes of our lessees. Decreased primarily due to property tax reassessment and sold properties partially offset by acquisitions. ​ (3) Decreased primarily due to deferred rent repayment and normal amortization. ​ (4) Represents lease incentive balances write-off related to two properties that were transitioned to another operator in our portfolio. ​ (5) Represents a lease incentive balance write-off related to a closed property and subsequent lease termination and (4) above. Some of our lease agreements provide purchase options allowing the lessees to purchase the properties they currently lease from us. The following table summarizes information about purchase options included in our lease agreements (dollar amounts in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Type ​ Number ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ of ​ of ​ ​ Gross ​ ​ Net Book ​ Option ​ State ​ Property ​ Properties ​ ​ Investments ​ ​ Value ​ Window ​ California ​ ALF/MC ​ 2 ​ $ 38,895 ​ $ 33,013 ​ 2023-2029 ​ Florida ​ MC ​ 1 ​ ​ 7,680 ​ ​ 4,681 ​ 2029 (1) Florida ​ SNF ​ 3 ​ ​ 76,712 ​ ​ 76,712 ​ 2025-2027 (2) North Carolina ​ ALF/MC ​ 11 ​ ​ 121,321 ​ ​ 121,321 ​ 2025-2028 (3) Ohio ​ MC ​ 1 ​ ​ 16,161 ​ ​ 13,598 ​ 2024-2025 ​ Ohio ​ ILF/ALF/MC ​ 1 ​ ​ 54,714 ​ ​ 53,990 ​ 2025-2027 ​ South Carolina ​ ALF/MC ​ 1 ​ ​ 11,680 ​ ​ 8,619 ​ 2029 ​ Tennessee ​ SNF ​ 2 ​ ​ 5,275 ​ ​ 2,298 ​ 2023-2024 ​ Texas ​ SNF ​ 4 ​ ​ 52,426 ​ ​ 50,438 ​ 2027-2029 (4) Total ​ ​ ​ ​ ​ $ 384,864 ​ $ 364,670 ​ ​ ​ (1) During 2023, we recorded an impairment loss of $7,522 . See Impairment Loss below for more information. ​ (2) During 2022, we entered into a joint venture (“JV”) to purchase three skilled nursing centers with a total of 299 beds. The JV leased the properties under a 10-year master lease. For more information regarding this transaction see Financing Receivables below. ​ (3) During 2023, we entered into a JV that purchased 11 ALFs and MCs with a total of 523 units and leased the communities under a 10-year master lease. The master lease provides the operator with the option to buy up to 50% of the properties at the beginning of the third lease year, and the remaining properties at the beginning of the fourth lease year through the end of the sixth lease year, with an exit IRR of 9.0% on any portion of the properties being purchased. For more information regarding this transaction see Financing Receivables below. ​ (4) During 2022, we purchased four skilled nursing centers and leased these properties under a 10-year lease with an existing operator. The lease allows the operator to elect either an earn-out payment or purchase option. If neither option is elected within the timeframe defined in the lease, both elections are terminated. For more information regarding the earn-out see Note 8. Commitments and Contingencies . Impairment Loss. Properties Held -for-Sale. dollar amounts in thousands ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Type ​ Number ​ Number ​ ​ ​ ​ ​ ​ ​ ​ ​ of ​ of ​ of ​ ​ Gross ​ ​ Accumulated ​ State ​ Property ​ Properties ​ Beds/units ​ ​ Investment ​ ​ Depreciation ​ FL ​ ALF ​ 4 ​ 176 ​ $ 12,215 ​ $ 7,213 ​ SC ​ ALF ​ 3 ​ 128 ​ ​ 8,823 ​ ​ 4,377 ​ ​ ​ ​ ​ 7 ​ 304 ​ $ 21,038 ​ $ 11,590 ​ ​ Acquisitions. The following table summarizes our acquisitions for the nine months ended September 30, 2023 and 2022 ( dollar amounts in thousands ): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Cash ​ ​ ​ ​ Non- ​ ​ ​ ​ ​ ​ Number ​ Number ​ ​ ​ ​ Paid at ​ Assumed ​ ​ Controlling ​ Transaction ​ ​ Assets ​ of ​ of Year ​ Type of Property ​ Acquisition ​ Liabilities ​ ​ Interest ​ Costs ​ ​ Acquired ​ Properties ​ Beds/Units 2023 ​ ALF (1) ​ $ 43,759 ​ $ 9,767 ​ $ 9,133 ​ $ 363 ​ $ 63,022 (2) 1 ​ 242 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 2022 ​ SNF (3) ​ $ 51,815 ​ $ — ​ $ — ​ $ — ​ $ 51,815 ​ 4 ​ 339 (1) We entered into a $54,134 Joint Venture (“JV”) and contributed $45,000 into the JV that purchased an ILF/ALF/MC in Ohio. Under the JV agreement, the seller, our JV partner, has the option to purchase the campus between the third and fourth lease years for LTC’s allocation of the JV investment plus an IRR of 9.75% . The campus was leased to Encore Senior Living (“Encore”) under a 10-year term with an initial yield of 8.25% on LTC’s allocation of the JV investment. LTC committed to fund $2,100 of lease incentives under the Encore lease of which $1,004 has been funded. ​ (2) Includes $8,309 tax abatement intangible included in the Prepaid expenses and other assets line item in our Consolidated Balance Sheets . ​ (3) The properties are located in Texas and are leased to an affiliate of an existing operator under a 10-year lease with two 5-year renewal options. Additionally, the lease provides either an earn-out payment or purchase option but not both. If neither option is elected within the timeframe defined in the lease, both elections are terminated. The earn-out payment is available, contingent on achieving certain thresholds per the lease, beginning at the end of the second lease year through the end of the fifth lease year. The purchase option is available beginning in the sixth lease year through the end of the seventh lease year. The initial cash yield is 8% for the first year, increasing to 8.25% for the second year, then increases annually by 2.0% to 4.0% based on the change in the Medicare Market Basket Rate. In connection with the transaction, we provided the lessee a 10-year working capital loan for up to $2,000 at 8% for first year, increasing to 8.25% for the second year, then increasing annually with the lease rate. During 2023, the working capital loan was fully repaid. Accordingly, the working capital commitment has been terminated. Intangible Assets. We make estimates as part of our allocation of the purchase price of acquisitions to various components of acquisition based upon the fair value of each component. In determining fair value, we use current appraisals or other third-party opinions of value. The most significant components of our allocations are typically the allocation of fair value to land and buildings, and for certain of our acquisitions, in-place leases and other intangible assets. In the case of the value of in-place leases, we make the best estimates based on the evaluation of the specific characteristics of each tenant’s lease. Factors considered include estimates of carrying costs during the hypothetical expected lease-up periods, market conditions and costs to execute similar leases. The following is a summary of the carrying amount of intangible assets as of September 30, 2023 (in thousands) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ September 30, 2023 ​ December 31,2022 ​ ​ ​ ​ ​ ​ ​ Accumulated ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Accumulated ​ ​ ​ ​ Assets ​ ​ Cost ​ ​ ​ Amortization ​ ​ ​ Net ​ ​ Cost ​ ​ ​ Amortization ​ ​ ​ Net In-place leases ​ $ 11,348 (1) ​ $ (5,886) (2) ​ $ 5,462 ​ $ 9,474 (1) ​ $ (5,362) (2) ​ $ 4,112 Tax abatement intangible ​ ​ 8,309 (3) ​ ​ (231) (3) ​ ​ 8,078 ​ ​ — (3) ​ ​ — (3) ​ ​ — (1) Included in the Buildings and improvements line item in our Consolidated Balance Sheets . ​ (2) Included in the Accumulated depreciation and amortization line item in our Consolidated Balance Sheets. ​ (3) Included in the Prepaid expenses and other assets line item in our Consolidated Balance Sheets. Improvements and Developments. During he following (in thousands) : ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Nine Months Ended September 30, ​ Type of Property ​ ​ 2023 ​ ​ ​ 2022 ​ ​ ​ Developments ​ Improvements ​ ​ Developments ​ Improvements ​ Assisted Living Communities ​ $ — ​ $ 2,418 ​ ​ $ 105 ​ $ 3,015 ​ Skilled Nursing Centers ​ ​ — ​ ​ 2,548 ​ ​ ​ — ​ ​ 981 ​ Other ​ ​ — ​ ​ 87 ​ ​ ​ — ​ ​ 559 ​ Total ​ $ — ​ $ 5,053 ​ ​ $ 105 ​ $ 4,555 ​ ​ Properties Sold (dollar amounts in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Type ​ Number ​ Number ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ of ​ of ​ of ​ ​ Sales ​ ​ Carrying ​ ​ Net ​ Year ​ State ​ Properties ​ Properties ​ Beds/Units ​ ​ Price ​ ​ Value ​ ​ Gain (Loss) (1) ​ 2023 ​ Florida ​ ALF ​ 1 ​ 70 ​ $ 4,850 ​ $ 4,082 ​ $ 65 ​ ​ ​ Kentucky ​ ALF ​ 1 ​ 60 ​ ​ 11,000 ​ ​ 10,720 ​ ​ 57 ​ ​ ​ New Jersey ​ ALF ​ 1 ​ 39 ​ ​ 2,000 ​ ​ 1,552 ​ ​ 266 ​ ​ ​ New Mexico ​ SNF ​ 2 ​ 235 ​ ​ 21,250 ​ ​ 5,523 ​ ​ 15,287 ​ ​ ​ Nebraska ​ ALF ​ 3 ​ 117 ​ ​ 2,984 ​ ​ 2,934 ​ ​ — ​ ​ ​ Pennsylvania ​ ALF ​ 2 ​ 130 ​ ​ 11,128 ​ ​ 6,054 ​ ​ 4,870 ​ Total 2023 ​ ​ ​ ​ ​ 10 ​ 651 ​ $ 53,212 ​ $ 30,865 ​ $ 20,545 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 2022 ​ California ​ ALF ​ 2 ​ 232 ​ $ 43,715 ​ $ 17,832 ​ $ 25,867 ​ ​ ​ California ​ SNF ​ 1 ​ 121 ​ ​ 13,250 ​ ​ 1,846 ​ ​ 10,846 ​ ​ ​ Texas ​ SNF ​ 1 ​ — ​ ​ 485 ​ ​ 697 ​ ​ (434) ​ ​ ​ Virginia ​ ALF ​ 1 ​ 74 ​ ​ 16,895 ​ ​ 15,549 ​ ​ 1,344 (2) ​ ​ n/a ​ n/a ​ — ​ — ​ ​ — ​ ​ — ​ ​ 186 (3) Total 2022 ​ ​ ​ ​ ​ 5 ​ 427 ​ $ 74,345 ​ $ 35,924 ​ $ 37,809 ​ ( (1) Calculation of net gain includes cost of sales and write-off of straight-line receivable and lease incentives, when applicable. ​ (2) In connection with this sale, the former operator paid us a lease termination fee of $1,181 which is not included in the gain on sale. ​ (3) We recognized additional gain due to the reassessment adjustment of the holdbacks related to properties sold during 2019 and 2020, under the expected value model per ASC Topic 606, Contracts with Customers (“ASC 606”). Financing Receivables. ASC Topic 842, Leases Financing receivables Consolidated Balance Sheets Interest income from financing receivables Consolidated Statements of Income Financing receivables Real property investments Consolidated Balance Sheets During 2023, we entered into a $121,321,000 JV with an affiliate of an existing operator and contributed $117,490,000 into the JV that purchased 11 assisted living and memory care communities from an affiliate of our JV partner. The JV leased the communities back to an affiliate of the seller under a 10-year master lease, with two five-year renewal options. The contractual initial cash yield of 7.25% increases to 7.5% in year three then escalates thereafter based on CPI subject to a floor of 2.0% and a ceiling of 4.0%. Additionally, the JV provided the seller-lessee with a purchase option to buy up to 50% of the properties at the beginning of the third lease year and the remaining properties at the beginning of the fourth lease year through the end of the sixth lease year, with an exit Internal Rate of Return (“IRR”) of 9.0%. During the three and nine months ended September 30, 2023, we recognized $2,427,000 and $7,198,000, respectively of Interest income from financing receivables $1,213,000 Provision for credit losses During 2022, we entered into a JV and contributed $61,661,000 into the JV that purchased three skilled nursing centers located in Florida for $75,825,000. The JV leased the centers back to an affiliate of the seller under a 10-year master lease, with two five-year renewal options and provided the seller-lessee with a purchase option, exercisable at the beginning of the fourth year through the end of the fifth year. During the three and nine months ended September 30, 2023, we recognized $1,405,000 and $4,215,000, respectively of Interest income from financing receivables Mortgage Loans. (dollar amounts in thousands) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Type ​ Percentage ​ Number of ​ Investment ​ ​ ​ ​ ​ ​ Gross ​ of ​ of ​ ​ ​ ​ ​ SNF ​ ALF ​ per Interest Rate ​ Maturity ​ State ​ Investment ​ Property ​ Investment ​ Loans (1) ​ Properties (2) ​ Beds ​ Units ​ Bed/Unit 7.5% ​ 2024 ​ MO ​ $ 1,961 ​ OTH ​ 0.4 % 1 ​ — (3) — ​ — ​ $ n/a 7.5% ​ 2024 ​ LA ​ ​ 29,346 ​ SNF ​ 6.1 % 1 ​ 1 ​ 189 ​ — ​ $ 155.27 7.5% ​ 2024 ​ GA ​ ​ 51,111 (4) ALF ​ 10.7 % 1 ​ 1 ​ — ​ 203 ​ $ 251.78 7.8% ​ 2025 ​ FL ​ ​ 16,706 ​ ALF ​ 3.5 % 1 ​ 1 ​ — ​ 68 ​ $ 245.68 7.3% ​ 2025 ​ NC ​ ​ 10,750 (4) ALF ​ 2.2 % 1 ​ 1 ​ — ​ 45 ​ $ 238.89 7.3% (5) ​ 2025 ​ NC/SC ​ ​ 58,331 ​ ALF ​ 12.2 % 1 ​ 13 ​ — ​ 523 ​ $ 111.53 7.3% (5) ​ 2026 ​ NC ​ ​ 34,043 ​ ALF ​ 7.1 % 1 ​ 4 ​ — ​ 217 ​ $ 156.88 7.3% (5) ​ 2026 ​ NC ​ ​ 826 ​ OTH ​ 0.2 % 1 ​ — (6) — ​ — ​ $ — 8.8% ​ 2028 ​ IL ​ ​ 16,500 (7) SNF ​ 3.5 % 1 ​ 1 ​ 150 ​ — ​ $ 110.00 10.6% (8) ​ 2043 ​ MI ​ ​ 184,220 ​ SNF ​ 38.5 % 1 ​ 15 ​ 1,875 ​ — ​ $ 98.25 9.7% (8) ​ 2045 ​ MI ​ ​ 40,000 ​ SNF ​ 8.4 % 1 ​ 4 ​ 480 — ​ $ 83.33 10.1% ​ 2045 ​ MI ​ 19,700 ​ SNF ​ 4.1 % 1 ​ 2 ​ 201 — ​ $ 98.01 10.3% (8) ​ 2045 ​ MI ​ ​ 14,850 ​ SNF ​ 3.1 % 1 ​ 1 ​ 146 ​ — ​ $ 101.71 Total ​ ​ ​ ​ ​ $ 478,344 (9) ​ ​ 100.0 % 13 ​ 44 ​ 3,041 1,056 ​ $ 116.75 (1) Some loans contain certain guarantees and provide for certain facility fees. ​ (2) Our mortgage loans are secured by properties located in eight states with seven borrowers. ​ (3) Represents a mortgage loan secured by a parcel of land for the future development of a 91 -bed post-acute SNF. ​ (4) During the first quarter of 2023, we originated a $10,750 mortgage loan secured by a 45 -unit MC located in North Carolina. The loan carries a two-year term with an interest-only rate of 7.25% and an IRR of 9.0% . Additionally, we invested $51,111 in an existing mortgage loan secured by a 203 -unit ILF, ALF and MC located in Georgia by acquiring a participating interest owned by existing lenders for $42,251 in addition to converting our $7,461 mezzanine loan in the property into a participating interest in the mortgage loan. The mortgage loan matures in October 2024 and our investment is at an initial rate of 7.5% with an IRR of 7.75% . We recorded $1,380 of additional interest income in connection with the effective prepayment of the mezzanine loan in the first quarter of 2023. ​ (5) Represents the initial rate with an IRR of 8% . ​ (6) Represents a mortgage loan secured by a parcel of land in North Carolina held for future development of a seniors housing community. (7) During the second quarter of 2023, we originated a $16,500 senior loan for the purchase of a 150 -bed SNF in Illinois. The mortgage loan matures in June 2028 and our investment is at an interest rate of 8.75% . ​ (8) Mortgage loans provide for 2.25% annual increases in the interest rate. ​ (9) During the third quarter of 2023, we committed to fund a $19,500 mortgage loan for the construction of an 85 -unit ALF and MC in Michigan. The borrower contributed $12,100 of equity which will initially fund the construction. Once all of the borrower’s equity has been drawn, we will begin funding the commitment. The loan term is approximately three years at a rate of 8.75% , and includes two , one-year extensions, each of which is contingent on certain coverage thresholds. The following table summarizes our mortgage loan activity for the nine months ended September 30, 2023 and 2022 (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Nine Months Ended September 30, ​ ​ 2023 ​ ​ 2022 ​ Originations and funding under mortgage loans receivable ​ $ 83,383 (1) ​ $ 35,234 (2) Application of interest reserve ​ ​ 1,609 ​ ​ ​ 4,348 ​ Scheduled principal payments received ​ ​ (301) ​ ​ ​ (625) ​ Mortgage loan premium amortization ​ ​ (5) ​ ​ ​ (4) ​ Provision for loan loss reserve ​ ​ (847) ​ ​ ​ (389) ​ Net increase in mortgage loans receivable ​ $ 83,839 ​ ​ $ 38,564 ​ (1) We originated the following: ​ (a) $10,750 mortgage loan secured by a 45 -unit MC located in North Carolina. The loan carries a two-year term with an interest-only rate of 7.25% and an IRR of 9.0% ; ​ (b) $51,111 mortgage loan investment secured by a 203 -unit ILF, ALF and MC located in Georgia. We acquired a participating interest owned by existing lenders for $42,251 in addition to converting our $7,461 mezzanine loan in the property into a participating interest in the mortgage loan. The mortgage loan matures in October 2024 and our investment is at an initial rate of 7.5% with an IRR of 7.75% . We recorded $1,380 of additional interest income in connection with the effective prepayment of the mezzanine loan in the first quarter of 2023; ​ (c) $16,500 senior loan for the purchase of a 150 -bed SNF in Illinois. The mortgage loan matures in June 2028 and our investment is at an interest rate of 8.75% ; ​ (d) 5,022 of additional funding under other mortgage loans receivable; and ​ (e) $19,500 mortgage loan commitment for the construction of an 85 -unit ALF and MC in Michigan. The borrower contributed $12,100 of equity which will initially fund the construction. Once all of the borrower’s equity has been drawn, we will begin funding the commitment. The loan term is approximately three years at a rate of 8.75% , and includes two , one-year extensions, each of which is contingent on certain coverage thresholds. ​ ​ (2) We originated two senior mortgage loans, secured by four ALFs operated by an existing operator, as well as a land parcel in North Carolina. The communities have a combined total of 217 units, with an average age of less than four years . The land parcel is approximately 7.6 acres adjacent to one of the ALFs and is being held for the future development of a seniors housing community. The mortgage loans have a four-year term, an interest rate of 7.25% and an IRR of 8% . We apply , Measurement of Credit Losses on Financial Instruments . As of September 30, 2023, the accrued interest receivable of $54,605,000 was not included in the measurement of expected credit losses on the financing receivables, mortgage loans receivable and notes receivable (see Note 4. Notes Receivable

Investment in Unconsolidated Jo

Investment in Unconsolidated Joint Ventures	9 Months Ended
	Sep. 30, 2023
Investment in Unconsolidated Joint Ventures
Investment in Unconsolidated Joint Ventures	3. Investment in Unconsolidated Joint Ventures We have preferred equity investments in two joint ventures. We determined that each of these JVs meets the accounting criteria to be considered a variable interest entity (“VIE”). We are not the primary beneficiary of the JVs as we do not have both: 1) the power to direct the activities that most significantly affect the JVs’ economic performance, and 2) the right to receive benefits from the VIE or the obligation to absorb losses of the VIE that could be significant to the VIE. However, we do have significant influence over the JVs. Therefore, we have accounted for the JVs using the equity method of accounting. The following table provides information regarding these preferred equity investments (dollar amounts in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Type ​ Type ​ Total ​ ​ Contractual ​ ​ Number ​ ​ ​ ​ ​ ​ of ​ of ​ Preferred ​ ​ Cash ​ ​ of ​ ​ Carrying ​ State ​ Properties ​ Investment ​ Return ​ ​ Portion ​ ​ Beds/ Units ​ ​ Value ​ Washington ​ ALF/MC ​ Preferred Equity (1) 12 % ​ 7 % ​ 95 ​ $ 6,340 (1) Washington ​ UDP ​ Preferred Equity (2) 14 % ​ 8 % ​ — ​ ​ 13,000 (2) Total ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 95 ​ $ 19,340 ​ (1) Represents a preferred equity interest in an entity that developed and owns a 95 -unit ALF and MC in Washington. Our investment represents 15.5% of the total investment. The preferred equity investment earns an initial cash rate of 7% increasing to 9% in year four until the internal rate of return (“IRR”) is 8% . After achieving an 8% IRR, the cash rate drops to 8% with an IRR ranging between 12% to 14% , depending upon timing of redemption. During the fourth quarter of 2021, the entity completed the development project and received its certificate of occupancy. We have the option to require the JV partner to purchase our preferred equity interest at any time between August 17, 2031 and December 31, 2036. ​ (2) Represents a preferred equity interest in an entity that will develop and own a 267 -unit ILF and ALF in Washington. Our investment represents 11.0% of the estimated total investment. The preferred equity investment earns an initial cash rate of 8% with an IRR of 14% . The JV partner has the option to buy out our investment at any time after August 31, 2023 at the IRR rate. Also, we have the option to require the JV partner to purchase our preferred equity interest at any time between August 31, 2027 and, upon project completion and leasing the property, prior to the end of the first renewal term of the lease. During the three and nine months ended September 30, 2023, we recognized $375,000 and $1,127,000, respectively, in income from unconsolidated joint ventures. During the three and nine months ended September 30, 2022, we recognized $376,000 and $1,127,000, respectively, in income from unconsolidated joint ventures. The following table summarizes our income recognized, and application of interest reserves related to our investments in unconsolidated joint ventures for the nine months ended September 30, 2023 and 2022 (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Type ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ of ​ ​ Income ​ ​ Cash Interest ​ ​ Application of ​ Year ​ Properties ​ ​ Recognized ​ ​ Earned ​ ​ Interest Reserve ​ 2023 ​ ALF/MC ​ $ 337 ​ $ — ​ $ 337 ​ ​ ​ UDP ​ ​ 790 ​ ​ — ​ ​ 790 ​ Total ​ ​ ​ $ 1,127 ​ $ — ​ $ 1,127 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 2022 ​ ALF/MC ​ $ 337 ​ $ — ​ $ 337 ​ ​ ​ UDP ​ ​ 790 ​ ​ 351 ​ ​ 439 ​ Total ​ ​ ​ $ 1,127 ​ $ 351 ​ $ 776 ​ ​

Notes Receivable

Notes Receivable	9 Months Ended
	Sep. 30, 2023
Notes Receivable.
Notes Receivable	4. Notes Receivable Notes receivable consist of a mezzanine loan and working capital loans. The following table sets forth information regarding our investment in notes receivable at September 30, 2023 ( dollar amounts in thousands ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Interest ​ ​ ​ ​ ​ ​ Type of ​ Gross ​ ​ ​ ​ Type of ​ Rate ​ IRR ​ ​ Maturity ​ Loan ​ Investment ​ ​ # of loans ​ Property ​ 5.0% ​ — ​ ​ 2024 ​ Working capital ​ $ 2,442 ​ ​ 1 ​ ALF ​ 4.0% ​ — ​ ​ 2024 ​ Working capital ​ ​ 13,531 ​ ​ 1 ​ SNF 5.0% ​ — ​ ​ 2025 ​ Working capital ​ ​ 732 ​ ​ 1 ​ ALF ​ 7.5% ​ — ​ ​ 2027 ​ Working capital ​ ​ 550 ​ ​ 1 ​ ALF ​ 8.0% ​ 11.0 % ​ 2027 ​ Mezzanine ​ ​ 25,000 ​ ​ 1 ​ ALF ​ 8.8% ​ 12.0 % ​ 2028 ​ Mezzanine ​ ​ 17,000 (1) ​ 1 ​ ALF ​ 6.5% ​ — ​ ​ 2030 ​ Working capital ​ ​ 138 ​ ​ 1 ​ SNF ​ 7.3% ​ — ​ ​ 2030 ​ Working capital ​ ​ 500 ​ ​ 1 ​ ALF ​ 7.3% ​ — ​ ​ 2030 ​ Working capital ​ ​ 1,107 ​ ​ 1 ​ ALF ​ 7.0% ​ — ​ ​ 2031 ​ Working capital ​ ​ 2,693 ​ ​ 1 ​ ALF ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ $ 63,693 (2) ​ 10 ​ ​ ​ (1) During the third quarter of 2023, we originated a mezzanine loan to recapitalize an existing 130 -unit ILF/ALF/MC in Georgia and construction of 89 additional units. The loan term is five years at an initial yield of 8.75% and an IRR of 12.0% . ​ (2) Excludes the impact of credit loss reserve. ​ The following table is a summary of our notes receivable components as of September 30, 2023 and December 31, 2022 (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ September 30, 2023 ​ December 31, 2022 Mezzanine loans $ 42,000 ​ $ 36,815 ​ Working capital loans ​ 21,693 ​ ​ 22,157 ​ Notes receivable credit loss reserve ​ (637) ​ ​ (589) ​ Total $ 63,056 ​ $ 58,383 ​ ​ The following table summarizes our notes receivable activity for the nine months ended September 30, 2023 and 2022 (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ Nine Months Ended September 30, ​ ​ 2023 ​ ​ 2022 ​ Advances under notes receivable $ 19,258 (1) $ 37,008 (3) Principal payments received under notes receivable ​ (14,537) (2) ​ (6,618) ​ Provision for credit losses ​ (48) ​ ​ (303) ​ Net increase in notes receivable $ 4,673 ​ $ 30,087 ​ (1) During the third quarter of 2023, we originated a mezzanine loan to recapitalize an existing 130 -unit ILF/ALF/MC in Georgia and construction of 89 additional units. The loan term is five years at an initial yield of 8.75% and an IRR of 12.0% . ​ (2) During 2023, we received $4,545 , which includes a prepayment fee and the exit IRR totaling $190 from a mezzanine loan prepayment. The mezzanine loan was on a 136 -unit ILF in Oregon. Additionally, another $7,461 mezzanine loan was effectively prepaid through converting it as part of our $51,111 investment in a participating interest in an existing mortgage loan that is secured by a 203 -unit ALF, ILF and MC located in Georgia. We recorded $1,380 of interest income in connection with the effective prepayment of the mezzanine loan. ​ (3) During 2022, we originated a $25,000 mezzanine loan for the recapitalization of a five -property seniors housing portfolio. The mezzanine loan has a term of approximately five years , with two one-year extension options and bears interest at 8% with an IRR of 11% . The five communities are located in Oregon and Montana, have a total of 621 units, and include independent living, assisted living and memory care.

Lease Incentives

Lease Incentives	9 Months Ended
	Sep. 30, 2023
Lease Incentives
Lease Incentives	5. Lease Incentives Our non-contingent lease incentive balances at September 30, 2023 and December 31, 2022 were $2,193,000 and $1,789,000, respectively. The following table summarizes our lease incentives activity for the nine months ended September 30, 2023 and 2022 (in thousands) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Nine Months Ended September 30, ​ ​ ​ 2023 ​ ​ 2022 ​ Lease incentives funded ​ $ 1,023 (1) $ 418 ​ Amortization of lease incentives ​ ​ (584) ​ ​ (665) ​ Adjustment for collectability of lease incentives ​ ​ — ​ ​ (256) (3) Other adjustments (2) ​ ​ (35) ​ ​ (174) ​ Net increase (decrease) in non-contingent lease incentives ​ $ 404 ​ $ (677) ​ (1) As part of our investment in a $54,134 JV, we committed to fund $2,100 of lease incentive, of which $1,004 was funded during the nine months ended September 30, 2023. ​ (2) Primarily relates to lease incentive balance write-off related to property sales. ​ (3) Represents the lease incentive balance write-off related to a closed property and subsequent lease termination and lease incentive balance write-off related to 12 assisted living communities transitioned to an existing operator. Non-contingent lease incentives represent payments made to our lessees for various reasons including entering into a new lease or lease amendments and extensions. Contingent lease incentives represent potential contingent earn-out payments that may be made to our lessees in the future, as part of our lease agreements. From time to time, we may commit to provide contingent payments to our lessees, upon our properties achieving certain rent coverage ratios. Once the contingent payment becomes probable and estimable, the contingent payment is recorded as a lease incentive. Lease incentives are amortized as a yield adjustment to rental income over the remaining life of the lease.

Debt Obligations

Debt Obligations	9 Months Ended
	Sep. 30, 2023
Debt Obligations
Debt Obligations	6. Debt Obligations Unsecured Credit Facility. Interest Rate Swap Agreements. In connection with entering into the Term Loans described above, we entered into four Consolidated Balance Sheets Prepaid expenses and other assets in the fair value of these instruments recognized in Accumulated other comprehensive income (loss) Consolidated Balance Sheets As of September 30, 2023 and December 31, 2022, the terms of the Interest Rate Swaps are as follows ( dollar amounts in thousands ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Notional ​ Fair Value at ​ Date Entered ​ Maturity Date ​ Swap Rate ​ Rate Index ​ ​ Amount ​ ​ September 30, 2023 ​ ​ ​ December 31, 2022 ​ November 2021 ​ November 19, 2025 ​ 2.62 % ​ 1-month SOFR ​ $ 50,000 ​ $ 3,776 ​ ​ $ 4,003 ​ November 2021 ​ November 19, 2026 ​ 2.76 % ​ 1-month SOFR ​ ​ 50,000 ​ ​ 4,820 ​ ​ ​ 4,716 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ $ 100,000 ​ $ 8,596 ​ ​ $ 8,719 ​ ​ Senior Unsecured Notes. The senior unsecured notes and the Credit Agreement, including the Revolving Line of Credit and the Term Loans, contain financial covenants, which are measured quarterly, that require us to maintain, among other things: ● a ratio of total indebtedness to total asset value not greater than 0.6 to 1.0; ​ ● a ratio of secured debt to total asset value not greater than 0.35 to 1.0; ​ ● a ratio of unsecured debt to the value of the unencumbered asset value not greater than 0.6 to 1.0; and ● a ratio of EBITDA, as calculated in the debt obligation, to fixed charges not less than 1.50 to 1.0. At September 30, 2023, we were in compliance with all applicable financial covenants. These debt obligations also contain additional customary covenants and events of default that are subject to a number of important and significant limitations, qualifications and exceptions. The following table sets forth information regarding debt obligations by component as of September 30, 2023 and December 31, 2022 ( dollar amounts in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ At September 30, 2023 ​ At December 31, 2022 ​ ​ ​ Applicable ​ ​ ​ Available ​ ​ ​ Available ​ ​ ​ Interest ​ Outstanding ​ for ​ Outstanding ​ for ​ Debt Obligations ​ Rate (1) ​ Balance ​ Borrowing ​ Balance ​ Borrowing ​ Revolving line of credit ​ 6.63% ​ $ 362,250 ​ $ 37,750 ​ $ 130,000 ​ $ 270,000 ​ Term loans, net of debt issue costs ​ 2.74% ​ ​ 99,620 ​ ​ — ​ ​ 99,511 ​ ​ — ​ Senior unsecured notes, net of debt issue costs ​ 4.20% ​ ​ 494,353 ​ ​ — ​ ​ 538,343 ​ ​ — ​ Total ​ 4.97% ​ $ 956,223 ​ $ 37,750 ​ $ 767,854 ​ $ 270,000 ​ (1) Represents weighted average of interest rate as of September 30, 2023. ​ ​ ​ During the nine months ended September 30, 2023 and 2022, our debt borrowings and repayments were as follows ( in thousands ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Nine Months Ended September 30, ​ ​ ​ 2023 ​ 2022 ​ Debt Obligations ​ ​ Borrowings ​ ​ Repayments ​ Borrowings ​ Repayments ​ Revolving line of credit ​ $ 274,450 ​ $ (42,200) ​ $ 194,000 ​ $ (153,900) ​ Senior unsecured notes ​ ​ — ​ ​ (44,160) ​ ​ 75,000 ​ ​ (43,160) ​ Total ​ $ 274,450 ​ $ (86,360) ​ $ 269,000 ​ $ (197,060) ​ ​

Equity

Equity	9 Months Ended
	Sep. 30, 2023
Equity
Equity	7. Equity Non-controlling Interests. As of September 30, 2023, we have the following consolidated VIEs (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Gross ​ ​ ​ ​ Investment ​ ​ ​ Property ​ ​ ​ ​ Consolidated ​ ​ Non-Controlling ​ Year ​ Purpose ​ Type ​ State ​ ​ Assets (1) ​ ​ Interests ​ 2023 ​ Owned real estate (2) ILF/ALF/MC ​ OH ​ $ 54,714 ​ $ 9,134 ​ 2023 ​ Owned real estate (3) ALF/MC ​ NC ​ ​ 121,321 ​ ​ 3,831 ​ 2022 ​ Owned real estate (4) SNF ​ FL ​ ​ 76,712 ​ ​ 14,325 ​ 2018 ​ Owned real estate ​ ILF ​ OR ​ ​ 14,650 ​ ​ 2,907 ​ 2018 ​ Owned real estate and development ​ ALF/MC ​ OR ​ ​ 18,452 ​ ​ 1,231 ​ 2017 ​ Owned real estate and development ​ ILF/ALF/MC ​ WI ​ ​ 22,007 ​ ​ 2,305 ​ 2017 ​ Owned real estate ​ ALF/MC ​ SC ​ ​ 11,680 ​ ​ 1,240 ​ Total ​ ​ ​ ​ ​ ​ ​ $ 319,536 ​ $ 34,973 ​ (1) Includes the total real estate investments and excludes intangible assets. ​ (2) During the second quarter of 2023, we entered into a JV that purchased an ILF/ALF/MC in Ohio with a total of 242 units. For more information see Acquisitions above in Note 2. ​ (3) During the first quarter of 2023, we entered into a JV that purchased 11 ALF and MC with a total of 523 units. For more information regarding this transaction see Financing Receivable above in Note 2. ​ (4) During 2022, we entered into a JV that purchased three SNFs with a total of 299 beds. For more information regarding this transaction see Financing Receivable above in Note 2. Common Stock. During the nine months ended September 30, 2023 and 2022, we acquired 43,933 shares and 39,463 shares, respectively, of common stock held by employees who tendered owned shares to satisfy tax withholding obligations. Available Shelf Registration. Distributions. (in thousands) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Nine Months Ended September 30, ​ ​ ​ 2023 ​ 2022 ​ ​ ​ ​ Declared ​ Paid ​ Declared ​ Paid ​ ​ Common Stock (1) ​ $ 70,767 ​ $ 70,767 ​ $ 68,202 ​ $ 68,202 ​ ​ (1) Represents $0.19 per share per month for the nine months ended September 30, 2023 and 2022. In October 2023, we declared a monthly cash dividend October November December Stock-Based Compensation outstanding During the nine months ended September 30, 2023 and 2022, no stock options were granted or exercised. The following table summarizes our restricted stock activity for the nine months ended September 30, 2023 and 2022 : ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Nine Months Ended September 30, ​ ​ 2023 ​ 2022 ​ Outstanding, January 1 ​ ​ 229,236 ​ ​ 197,422 ​ Granted ​ ​ 146,020 ​ ​ 135,210 ​ Vested ​ ​ (115,551) ​ ​ (103,396) ​ Cancelled ​ ​ (1,085) ​ ​ — ​ Outstanding, September 30 ​ ​ 258,620 ​ ​ 229,236 ​ ​ No performance-based stock units vested during the nine months ended September 30, 2023, and 2022. During the nine months ended September 30, 2023 and 2022, we granted restricted stock and performance-based stock units under the 2021 Plan as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ No. of ​ Price per ​ ​ ​ ​ ​ Year ​ Shares/Units ​ Share ​ Reward Type ​ Vesting Period ​ 2023 ​ 127,960 ​ $ 37.16 ​ Restricted stock ​ ratably over 3 years ​ ​ ​ 86,867 ​ $ 37.16 ​ Performance-based stock units ​ TSR targets (1) ​ ​ ​ 15,060 ​ $ 31.54 ​ Restricted stock ​ May 24,2024 ​ ​ ​ 3,000 ​ $ 35.45 ​ Restricted stock ​ July 25, 2024 ​ ​ ​ 232,887 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 2022 ​ 122,865 ​ $ 33.94 ​ Restricted stock ​ ratably over 3 years ​ ​ ​ 86,332 ​ $ 33.94 ​ Performance-based stock units ​ TSR targets (1) ​ ​ ​ 12,345 ​ $ 38.48 ​ Restricted stock ​ May 25, 2023 ​ ​ ​ 221,542 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ (1) Vesting is based on achieving certain total shareholder return (“TSR”) targets in 4 years with acceleration opportunity in 3 years . Compensation expense recognized related to the vesting of restricted common stock and performance-based stock units for the nine months ended September 30, 2023 and 2022 were $6,349,000 and $5,951,000 , respectively. At September 30, 2023, the remaining compensation expense to be recognized related to the future service period of unvested outstanding restricted common stock and performance-based stock units are as follows (in thousands): ​ ​ ​ ​ ​ ​ ​ Remaining ​ ​ Compensation Vesting Date ​ Expense October - December 2023 ​ $ 2,132 2024 ​ ​ 6,026 2025 ​ ​ 3,238 2026 ​ ​ 356 Total ​ $ 11,752 ​ ​

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
	Sep. 30, 2023
Commitments and Contingencies
Commitments and Contingencies	8. Commitments and Contingencies At September 30, 2023, we had commitments as follows (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Total ​ ​ ​ ​ ​ Investment ​ 2023 ​ Commitment ​ Remaining ​ ​ Commitment ​ Funding ​ Funded ​ Commitment Real estate properties ote 2. Real Estate Investments ​ $ 10,242 (1) $ 1,932 ​ $ 2,650 ​ $ 7,592 Accrued incentives and earn-out liabilities (Note 5. Lease Incentives) ​ ​ 21,100 (2) ​ 1,004 ​ ​ 1,004 ​ ​ 20,096 Mortgage loans (N ote 2. Real Estate Investments ​ ​ 43,598 (3) ​ 1,476 ​ ​ 7,178 ​ ​ 36,420 Notes receivable (N ote 4. Notes Receivable ​ ​ 28,950 (4) ​ 2,258 ​ ​ 15,973 ​ ​ 12,977 Total ​ $ 103,890 ​ $ 6,670 ​ $ 26,805 ​ $ 77,085 (1) Represents commitments to purchase land and improvements, if applicable, and to develop, re-develop, renovate or expand seniors housing and skilled nursing properties. ​ (2) Includes an earn-out payment of up to $3,000 to an operator under a master lease on four SNFs in Texas which were acquired during 2022. The master lease allows either an earn-out payment up to $3,000 or a purchase option. The earn-out payment is available, contingent on achieving certain thresholds per the lease, beginning at the end of the second lease year through the end of the fifth lease year. If neither option is elected within the timeframe defined in the lease, both elections are terminated. For more information regarding the purchase option see Note 2. Real Estate Investments . ​ (3) Represents $19,500 related to a construction loan, $6,098 of commitments for the expansion, renovation and working capital related to seniors housing and skilled nursing properties securing the mortgage loans and $18,000 of commitments which are contingent upon the borrower achieving certain coverage ratios. ​ (4) Represents working capital loan commitments. Additionally, some of our lease agreements provide purchase options allowing the lessee to purchase the properties they currently lease from us. See Note 2. Real Estate Investments We are a party from time to time to various general and professional liability claims and lawsuits asserted against the lessees or borrowers of our properties, which in our opinion are not singularly or in the aggregate material to our results of operations or financial condition. These types of claims and lawsuits may include matters involving general or professional liability, which we believe under applicable legal principles are not our responsibility as a non-possessory landlord or mortgage holder. We believe that these matters are the responsibility of our lessees and borrowers pursuant to general legal principles and pursuant to insurance and indemnification provisions in the applicable leases or mortgages. We intend to continue to vigorously defend such claims.

Major Operators

Major Operators	9 Months Ended
	Sep. 30, 2023
Major Operators
Major Operators	9. Major Operators We have one operator that represents 10% or more of our combined rental revenue and interest income from mortgage loans. The following table sets forth information regarding our major operator as of September 30, 2023: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Number of ​ Number of ​ Percentage of ​ ​ ​ ​ ​ ​ ​ SNF ​ ALF ​ Total ​ ​ Total ​ ​ Operator ​ SNF ​ ALF ​ Beds ​ Units ​ Revenues (1) ​ ​ Assets (2) ​ ​ Prestige Healthcare (3) ​ 24 ​ — ​ 2,820 ​ 93 ​ 16.6 % ​ 14.2 % ​ (1) During 2023, we agreed to defer up to $1,500 , or up to $300 per month for May through September 2023, in interest payments due on one of Prestige Healthcare’s mortgage loans secured by 15 skilled nursing centers in Michigan. We deferred $600 in interest payments during the second quarter of 2023 and $900 in interest payments during the third quarter of 2023. ​ (2) Represents the net carrying value of the mortgage loans and properties we own divided by the Total assets on the Consolidated Balance Sheets. ​ (3) The majority of the revenue derived from this operator relates to interest income from mortgage loans. Subsequent to September 30, 2023, we amended the loan with Prestige which was subject to a previously agreed interest deferral and is secured by 15 skilled nursing centers in Michigan. As part of the amendment, LTC has drawn down $2,767,000 of the approximate $4,945,000 letter of credit from Prestige to repay all deferred interest outstanding through October 2023. We will further draw down approximately $334,000 in each of November and December 2023 to be applied toward interest due on the loan at that point. As a result, we expect to receive all contractual interest of $19,539,000 due from Prestige in 2023. Beginning on January 1, 2024, the monthly minimum interest payment due to LTC will be set based on an annual current pay rate of 8.5% on the outstanding loan balance. The contractual interest rate of the loan remains unchanged. Our financial position and ability to make distributions may be adversely affected if Prestige Healthcare or any of our lessees and borrowers face financial difficulties, including any bankruptcies, inability to emerge from bankruptcy, insolvency or general downturn in business of any such operator, continuing impact upon services or occupancy levels due to COVID-19, or in the event any such operator does not renew and/or extend its relationship with us.

Earnings per Share

Earnings per Share	9 Months Ended
	Sep. 30, 2023
Earnings per Share
Earnings per Share	10. Earnings per Share The following table sets forth the computation of basic and diluted net income per share ( in thousands, except per share amounts ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended ​ Nine Months Ended ​ ​ September 30, ​ September 30, ​ ​ 2023 ​ 2022 ​ 2023 ​ 2022 ​ Net income ​ $ 22,627 ​ $ 13,389 ​ $ 62,792 ​ $ 82,386 ​ Less income allocated to non-controlling interests ​ (430) ​ (99) ​ (1,287) ​ (301) ​ Less income allocated to participating securities: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Non-forfeitable dividends on participating securities ​ ​ (147) ​ ​ (131) ​ ​ (440) ​ ​ (401) ​ Income allocated to participating securities ​ ​ — ​ ​ — ​ ​ — ​ ​ (80) ​ Total net income allocated to participating securities ​ ​ (147) ​ ​ (131) ​ ​ (440) ​ ​ (481) ​ Net income available to common stockholders ​ ​ 22,050 ​ ​ 13,159 ​ ​ 61,065 ​ ​ 81,604 ​ Effect of dilutive securities: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Participating securities (1) ​ ​ — ​ ​ — ​ ​ — ​ ​ — ​ Net income for diluted net income per share ​ $ 22,050 ​ $ 13,159 ​ $ 61,065 ​ $ 81,604 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Shares for basic net income per share ​ ​ 41,153 ​ ​ 40,270 ​ ​ 41,127 ​ ​ 39,658 ​ Effect of dilutive securities: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Stock options (2) ​ ​ — ​ ​ 1 ​ ​ — ​ ​ — ​ Performance-based stock units ​ ​ 58 ​ ​ 281 ​ ​ 58 ​ ​ 281 ​ Participating securities (1) ​ ​ — ​ ​ — ​ ​ — ​ ​ — ​ Total effect of dilutive securities ​ ​ 58 ​ ​ 282 ​ ​ 58 ​ ​ 281 ​ Shares for diluted net income per share ​ ​ 41,211 ​ ​ 40,552 ​ ​ 41,185 ​ ​ 39,939 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Basic net income per share ​ $ 0.54 ​ $ 0.33 ​ $ 1.48 ​ $ 2.06 ​ Diluted net income per share ​ $ 0.54 ​ $ 0.32 ​ $ 1.48 ​ $ 2.04 ​ (1) For the three and nine months ended September 30, 2023 and 2022, the participating securities have been excluded from the computation of diluted net income per share as such inclusion would be anti-dilutive. ​ (2) For the three and nine months ended September 30, 2023 and the nine months ended September 30, 2022, the stock options have been excluded from the computation of diluted net income per share as such inclusion would be anti-dilutive.

Fair Value Measurements

Fair Value Measurements	9 Months Ended
	Sep. 30, 2023
Fair Value Measurements
Fair Value Measurements	11. Fair Value Measurements In accordance with the accounting guidance regarding the fair value option for financial assets and financial liabilities, entities are permitted to choose to measure certain financial assets and liabilities at fair value, with the change in unrealized gains and losses reported in earnings. We did not elect the fair value option for any of our financial assets and financial liabilities. The carrying amount of cash and cash equivalents approximates their fair value because of the short-term maturity of these instruments. We do not invest our cash in auction rate securities. The carrying value and estimated fair value of our financial instruments as of September 30, 2023 and December 31, 2022 were as follows ( in thousands ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ At September 30, 2023 ​ At December 31, 2022 ​ ​ ​ Carrying ​ Fair ​ Carrying ​ Fair ​ ​ ​ Value ​ Value ​ Value ​ Value ​ Financing receivable, net of credit loss reserve ​ $ 196,053 ​ $ 199,050 (1) $ 75,999 ​ $ 76,033 (1) Mortgage loans receivable, net of credit loss reserve ​ ​ 473,567 ​ ​ 560,808 (2) ​ 389,728 ​ ​ 461,276 (2) Notes receivable, net of credit loss reserve ​ 63,056 ​ 70,482 (3) 58,383 ​ 61,858 (3) Revolving line of credit ​ 362,250 ​ ​ 362,250 (4) ​ 130,000 ​ ​ 130,000 (4) Term loans, net of debt issue costs ​ ​ 99,620 ​ ​ 100,000 (4) ​ 99,511 ​ ​ 100,000 (4) Senior unsecured notes, net of debt issue costs ​ 494,353 ​ ​ 429,534 (5) ​ 538,343 ​ ​ 477,653 (5) (1) Our investment in financing receivables is classified as Level 3. The fair value is determined using a widely accepted valuation technique, discounted cash flow analysis on the expected cash flows. The discount rate used to value our future cash inflows of the financing receivables at September 30, 2023 and December 31, 2022 was 7.6% . ​ (2) Our investment in mortgage loans receivable is classified as Level 3. The fair value is determined using a widely accepted valuation technique, discounted cash flow analysis on the expected cash flows. The discount rate is determined using our assumption on market conditions adjusted for market and credit risk and current returns on our investments. The discount rate used to value our future cash inflows of the mortgage loans receivable at September 30, 2023 and December 31, 2022 was 9.1% and 9.3% , respectively. ​ (3) Our investments in notes receivable are classified as Level 3. The discount rate is determined using our assumption on market conditions adjusted for market and credit risk and current returns on our investments. The discount rate used to value our future cash flows of the notes receivable at September 30, 2023 and December 31, 2022, were 6.8% and 7.1% , respectively. ​ (4) Our revolving line of credit and term loans bear interest at a variable interest rate. The estimated fair value of our revolving line of credit and term loans approximated their carrying values at September 30, 2023 and December 31, 2022 based upon prevailing market interest rates for similar debt arrangements. ​ (5) Our obligation under our senior unsecured notes is classified as Level 3 and thus the fair value is determined using a widely accepted valuation technique, discounted cash flow analysis on the expected cash flows. The discount rate is measured based upon management’s estimates of rates currently prevailing for comparable loans available to us, and instruments of comparable maturities. At September 30, 2023, the discount rate used to value our future cash outflow of our senior unsecured notes was 7.25% for those maturing before year 2030 and 7.50% for those maturing at or beyond year 2030. At December 31, 2022, the discount rate used to value our future cash outflow of our senior unsecured notes was 6.50% for those maturing before year 2030 and 7.00% for those maturing at or beyond year 2030.

Subsequent Events

Subsequent Events	9 Months Ended
	Sep. 30, 2023
Subsequent Events
Subsequent Events	12. Subsequent Events Subsequent to September 30, 2023, the following events occurred: Real Estate: through October 2029 if the lessee exercises its four-year extension option. Furthermore, we amended the loan with Prestige which was subject to a previously agreed interest deferral and is secured by 15 skilled nursing centers in Michigan. As part of the amendment, LTC has drawn down $2,767,000 of the approximate $4,945,000 letter of credit from Prestige to repay all deferred interest outstanding through October 2023. We will further draw down approximately $334,000 in each of November and December 2023 to be applied toward interest due on the loan at that point. As a result, we expect to receive all contractual interest of $19,539,000 due from Prestige in 2023. Beginning on January 1, 2024, the monthly minimum interest payment due to LTC will be set based on an annual current pay rate of 8.5% on the outstanding loan balance. The contractual interest rate of the loan remains unchanged. Equity: cash dividend October November December ​

General (Policies)

General (Policies)	9 Months Ended
	Sep. 30, 2023
General
Basis of Presentation	We have prepared consolidated financial statements included herein without audit and in the opinion of management have included all adjustments necessary for a fair presentation of the consolidated financial statements pursuant to the rules and regulations of the Securities and Exchange Commission (“SEC”). Certain information and note disclosures normally included in financial statements prepared in accordance with U.S. generally accepted accounting principles (“GAAP”) have been condensed or omitted pursuant to rules and regulations governing the presentation of interim financial statements. The accompanying consolidated financial statements include the accounts of our company and its wholly-owned subsidiaries.
Reclassifications	All significant intercompany accounts and transactions have been eliminated in consolidation. The results of operations for the three and nine months ended September 30, 2023 and 2022 are not necessarily indicative of the results for a full year.
Income taxes	No provision has been made for federal or state income taxes. Our company qualifies as a REIT under Sections 856 through 860 of the Internal Revenue Code of 1986, as amended. As such, we generally are not taxed on income that is distributed to our stockholders.

Real Estate Investments (Tables

Real Estate Investments (Tables)	9 Months Ended
	Sep. 30, 2023
Real Estate Investments
Summary of investments in owned properties	The following table summarizes our investments in owned properties at September 30, 2023 (dollar amounts in thousands) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Average ​ ​ ​ ​ ​ Percentage ​ Number ​ Number of ​ Investment ​ ​ Gross ​ of ​ of ​ SNF ​ ALF ​ per Type of Property ​ Investment ​ Investment ​ Properties (1) ​ Beds ​ Units ​ Bed/Unit Assisted Living ​ $ 800,963 ​ 57.0 % 92 ​ — ​ 5,323 ​ $ 150.47 ​ Skilled Nursing ​ ​ 592,880 ​ 42.1 % 50 ​ 6,113 ​ 236 ​ $ 93.38 ​ Other (2) ​ ​ 12,005 ​ 0.9 % 1 ​ 118 ​ — ​ ​ — ​ Total ​ $ 1,405,848 ​ 100.0 % 143 ​ 6,231 ​ 5,559 ​ ​ ​ ​ (1) We own properties in 24 states that are leased to 22 different operators. ​ (2) Includes three parcels of land held-for-use, and one behavioral health care hospital.
Summary of components of our rental income	The following table summarizes components of our rental income for the nine months ended September 30, 2023 and 2022 (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended ​ Nine Months Ended ​ ​ September 30, ​ September 30, Rental Income ​ ​ 2023 ​ ​ 2022 ​ ​ 2023 ​ ​ 2022 ​ Contractual cash rental income ​ $ 29,121 (1) $ 28,180 ​ $ 87,260 (1) $ 83,203 ​ Variable cash rental income ​ ​ 3,386 (2) ​ 4,160 (2) ​ 9,846 (2) ​ 12,218 (2) Straight-line rent ​ ​ (747) (3) ​ (436) ​ ​ (1,635) (3) ​ (963) ​ Adjustment for collectability of lease incentives and rental income ​ ​ — ​ ​ (83) (4) ​ (26) ​ ​ (256) (5) Amortization of lease incentives ​ ​ (171) ​ ​ (236) ​ ​ (584) ​ ​ (665) ​ Total ​ $ 31,589 ​ $ 31,585 ​ $ 94,861 ​ $ 93,537 ​ (1) Increased primarily due to rental income from acquisitions and transitioned portfolios, repayment of deferred rent and annual rent escalations, partially offset by sold properties. ​ (2) The variable rental income for the three and nine months ended September 30, 2023 and the three and nine months ended September 30, 2022, primarily includes reimbursement of real estate taxes of our lessees. Decreased primarily due to property tax reassessment and sold properties partially offset by acquisitions. ​ (3) Decreased primarily due to deferred rent repayment and normal amortization. ​ (4) Represents lease incentive balances write-off related to two properties that were transitioned to another operator in our portfolio. ​ (5) Represents a lease incentive balance write-off related to a closed property and subsequent lease termination and (4) above.
Summary of information about purchase options included in our lease agreements	The following table summarizes information about purchase options included in our lease agreements (dollar amounts in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Type ​ Number ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ of ​ of ​ ​ Gross ​ ​ Net Book ​ Option ​ State ​ Property ​ Properties ​ ​ Investments ​ ​ Value ​ Window ​ California ​ ALF/MC ​ 2 ​ $ 38,895 ​ $ 33,013 ​ 2023-2029 ​ Florida ​ MC ​ 1 ​ ​ 7,680 ​ ​ 4,681 ​ 2029 (1) Florida ​ SNF ​ 3 ​ ​ 76,712 ​ ​ 76,712 ​ 2025-2027 (2) North Carolina ​ ALF/MC ​ 11 ​ ​ 121,321 ​ ​ 121,321 ​ 2025-2028 (3) Ohio ​ MC ​ 1 ​ ​ 16,161 ​ ​ 13,598 ​ 2024-2025 ​ Ohio ​ ILF/ALF/MC ​ 1 ​ ​ 54,714 ​ ​ 53,990 ​ 2025-2027 ​ South Carolina ​ ALF/MC ​ 1 ​ ​ 11,680 ​ ​ 8,619 ​ 2029 ​ Tennessee ​ SNF ​ 2 ​ ​ 5,275 ​ ​ 2,298 ​ 2023-2024 ​ Texas ​ SNF ​ 4 ​ ​ 52,426 ​ ​ 50,438 ​ 2027-2029 (4) Total ​ ​ ​ ​ ​ $ 384,864 ​ $ 364,670 ​ ​ ​ (1) During 2023, we recorded an impairment loss of $7,522 . See Impairment Loss below for more information. ​ (2) During 2022, we entered into a joint venture (“JV”) to purchase three skilled nursing centers with a total of 299 beds. The JV leased the properties under a 10-year master lease. For more information regarding this transaction see Financing Receivables below. ​ (3) During 2023, we entered into a JV that purchased 11 ALFs and MCs with a total of 523 units and leased the communities under a 10-year master lease. The master lease provides the operator with the option to buy up to 50% of the properties at the beginning of the third lease year, and the remaining properties at the beginning of the fourth lease year through the end of the sixth lease year, with an exit IRR of 9.0% on any portion of the properties being purchased. For more information regarding this transaction see Financing Receivables below. ​ (4) During 2022, we purchased four skilled nursing centers and leased these properties under a 10-year lease with an existing operator. The lease allows the operator to elect either an earn-out payment or purchase option. If neither option is elected within the timeframe defined in the lease, both elections are terminated. For more information regarding the earn-out see Note 8. Commitments and Contingencies .
Schedule of properties held-for-sale	Properties Held -for-Sale. dollar amounts in thousands ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Type ​ Number ​ Number ​ ​ ​ ​ ​ ​ ​ ​ ​ of ​ of ​ of ​ ​ Gross ​ ​ Accumulated ​ State ​ Property ​ Properties ​ Beds/units ​ ​ Investment ​ ​ Depreciation ​ FL ​ ALF ​ 4 ​ 176 ​ $ 12,215 ​ $ 7,213 ​ SC ​ ALF ​ 3 ​ 128 ​ ​ 8,823 ​ ​ 4,377 ​ ​ ​ ​ ​ 7 ​ 304 ​ $ 21,038 ​ $ 11,590 ​
Summary of acquisitions	Acquisitions. The following table summarizes our acquisitions for the nine months ended September 30, 2023 and 2022 ( dollar amounts in thousands ): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Cash ​ ​ ​ ​ Non- ​ ​ ​ ​ ​ ​ Number ​ Number ​ ​ ​ ​ Paid at ​ Assumed ​ ​ Controlling ​ Transaction ​ ​ Assets ​ of ​ of Year ​ Type of Property ​ Acquisition ​ Liabilities ​ ​ Interest ​ Costs ​ ​ Acquired ​ Properties ​ Beds/Units 2023 ​ ALF (1) ​ $ 43,759 ​ $ 9,767 ​ $ 9,133 ​ $ 363 ​ $ 63,022 (2) 1 ​ 242 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 2022 ​ SNF (3) ​ $ 51,815 ​ $ — ​ $ — ​ $ — ​ $ 51,815 ​ 4 ​ 339 (1) We entered into a $54,134 Joint Venture (“JV”) and contributed $45,000 into the JV that purchased an ILF/ALF/MC in Ohio. Under the JV agreement, the seller, our JV partner, has the option to purchase the campus between the third and fourth lease years for LTC’s allocation of the JV investment plus an IRR of 9.75% . The campus was leased to Encore Senior Living (“Encore”) under a 10-year term with an initial yield of 8.25% on LTC’s allocation of the JV investment. LTC committed to fund $2,100 of lease incentives under the Encore lease of which $1,004 has been funded. ​ (2) Includes $8,309 tax abatement intangible included in the Prepaid expenses and other assets line item in our Consolidated Balance Sheets . ​ (3) The properties are located in Texas and are leased to an affiliate of an existing operator under a 10-year lease with two 5-year renewal options. Additionally, the lease provides either an earn-out payment or purchase option but not both. If neither option is elected within the timeframe defined in the lease, both elections are terminated. The earn-out payment is available, contingent on achieving certain thresholds per the lease, beginning at the end of the second lease year through the end of the fifth lease year. The purchase option is available beginning in the sixth lease year through the end of the seventh lease year. The initial cash yield is 8% for the first year, increasing to 8.25% for the second year, then increases annually by 2.0% to 4.0% based on the change in the Medicare Market Basket Rate. In connection with the transaction, we provided the lessee a 10-year working capital loan for up to $2,000 at 8% for first year, increasing to 8.25% for the second year, then increasing annually with the lease rate. During 2023, the working capital loan was fully repaid. Accordingly, the working capital commitment has been terminated.
Schedule of improvement projects	Improvements and Developments. During he following (in thousands) : ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Nine Months Ended September 30, ​ Type of Property ​ ​ 2023 ​ ​ ​ 2022 ​ ​ ​ Developments ​ Improvements ​ ​ Developments ​ Improvements ​ Assisted Living Communities ​ $ — ​ $ 2,418 ​ ​ $ 105 ​ $ 3,015 ​ Skilled Nursing Centers ​ ​ — ​ ​ 2,548 ​ ​ ​ — ​ ​ 981 ​ Other ​ ​ — ​ ​ 87 ​ ​ ​ — ​ ​ 559 ​ Total ​ $ — ​ $ 5,053 ​ ​ $ 105 ​ $ 4,555 ​
Schedule of property sold	The following table summarizes property sales during the nine months ended September 30, 2023 and 2022 (dollar amounts in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Type ​ Number ​ Number ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ of ​ of ​ of ​ ​ Sales ​ ​ Carrying ​ ​ Net ​ Year ​ State ​ Properties ​ Properties ​ Beds/Units ​ ​ Price ​ ​ Value ​ ​ Gain (Loss) (1) ​ 2023 ​ Florida ​ ALF ​ 1 ​ 70 ​ $ 4,850 ​ $ 4,082 ​ $ 65 ​ ​ ​ Kentucky ​ ALF ​ 1 ​ 60 ​ ​ 11,000 ​ ​ 10,720 ​ ​ 57 ​ ​ ​ New Jersey ​ ALF ​ 1 ​ 39 ​ ​ 2,000 ​ ​ 1,552 ​ ​ 266 ​ ​ ​ New Mexico ​ SNF ​ 2 ​ 235 ​ ​ 21,250 ​ ​ 5,523 ​ ​ 15,287 ​ ​ ​ Nebraska ​ ALF ​ 3 ​ 117 ​ ​ 2,984 ​ ​ 2,934 ​ ​ — ​ ​ ​ Pennsylvania ​ ALF ​ 2 ​ 130 ​ ​ 11,128 ​ ​ 6,054 ​ ​ 4,870 ​ Total 2023 ​ ​ ​ ​ ​ 10 ​ 651 ​ $ 53,212 ​ $ 30,865 ​ $ 20,545 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 2022 ​ California ​ ALF ​ 2 ​ 232 ​ $ 43,715 ​ $ 17,832 ​ $ 25,867 ​ ​ ​ California ​ SNF ​ 1 ​ 121 ​ ​ 13,250 ​ ​ 1,846 ​ ​ 10,846 ​ ​ ​ Texas ​ SNF ​ 1 ​ — ​ ​ 485 ​ ​ 697 ​ ​ (434) ​ ​ ​ Virginia ​ ALF ​ 1 ​ 74 ​ ​ 16,895 ​ ​ 15,549 ​ ​ 1,344 (2) ​ ​ n/a ​ n/a ​ — ​ — ​ ​ — ​ ​ — ​ ​ 186 (3) Total 2022 ​ ​ ​ ​ ​ 5 ​ 427 ​ $ 74,345 ​ $ 35,924 ​ $ 37,809 ​ ( (1) Calculation of net gain includes cost of sales and write-off of straight-line receivable and lease incentives, when applicable. ​ (2) In connection with this sale, the former operator paid us a lease termination fee of $1,181 which is not included in the gain on sale. ​ (3) We recognized additional gain due to the reassessment adjustment of the holdbacks related to properties sold during 2019 and 2020, under the expected value model per ASC Topic 606, Contracts with Customers (“ASC 606”).
Summary of investments in mortgage loans secured by first mortgages	Mortgage Loans. (dollar amounts in thousands) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Type ​ Percentage ​ Number of ​ Investment ​ ​ ​ ​ ​ ​ Gross ​ of ​ of ​ ​ ​ ​ ​ SNF ​ ALF ​ per Interest Rate ​ Maturity ​ State ​ Investment ​ Property ​ Investment ​ Loans (1) ​ Properties (2) ​ Beds ​ Units ​ Bed/Unit 7.5% ​ 2024 ​ MO ​ $ 1,961 ​ OTH ​ 0.4 % 1 ​ — (3) — ​ — ​ $ n/a 7.5% ​ 2024 ​ LA ​ ​ 29,346 ​ SNF ​ 6.1 % 1 ​ 1 ​ 189 ​ — ​ $ 155.27 7.5% ​ 2024 ​ GA ​ ​ 51,111 (4) ALF ​ 10.7 % 1 ​ 1 ​ — ​ 203 ​ $ 251.78 7.8% ​ 2025 ​ FL ​ ​ 16,706 ​ ALF ​ 3.5 % 1 ​ 1 ​ — ​ 68 ​ $ 245.68 7.3% ​ 2025 ​ NC ​ ​ 10,750 (4) ALF ​ 2.2 % 1 ​ 1 ​ — ​ 45 ​ $ 238.89 7.3% (5) ​ 2025 ​ NC/SC ​ ​ 58,331 ​ ALF ​ 12.2 % 1 ​ 13 ​ — ​ 523 ​ $ 111.53 7.3% (5) ​ 2026 ​ NC ​ ​ 34,043 ​ ALF ​ 7.1 % 1 ​ 4 ​ — ​ 217 ​ $ 156.88 7.3% (5) ​ 2026 ​ NC ​ ​ 826 ​ OTH ​ 0.2 % 1 ​ — (6) — ​ — ​ $ — 8.8% ​ 2028 ​ IL ​ ​ 16,500 (7) SNF ​ 3.5 % 1 ​ 1 ​ 150 ​ — ​ $ 110.00 10.6% (8) ​ 2043 ​ MI ​ ​ 184,220 ​ SNF ​ 38.5 % 1 ​ 15 ​ 1,875 ​ — ​ $ 98.25 9.7% (8) ​ 2045 ​ MI ​ ​ 40,000 ​ SNF ​ 8.4 % 1 ​ 4 ​ 480 — ​ $ 83.33 10.1% ​ 2045 ​ MI ​ 19,700 ​ SNF ​ 4.1 % 1 ​ 2 ​ 201 — ​ $ 98.01 10.3% (8) ​ 2045 ​ MI ​ ​ 14,850 ​ SNF ​ 3.1 % 1 ​ 1 ​ 146 ​ — ​ $ 101.71 Total ​ ​ ​ ​ ​ $ 478,344 (9) ​ ​ 100.0 % 13 ​ 44 ​ 3,041 1,056 ​ $ 116.75 (1) Some loans contain certain guarantees and provide for certain facility fees. ​ (2) Our mortgage loans are secured by properties located in eight states with seven borrowers. ​ (3) Represents a mortgage loan secured by a parcel of land for the future development of a 91 -bed post-acute SNF. ​ (4) During the first quarter of 2023, we originated a $10,750 mortgage loan secured by a 45 -unit MC located in North Carolina. The loan carries a two-year term with an interest-only rate of 7.25% and an IRR of 9.0% . Additionally, we invested $51,111 in an existing mortgage loan secured by a 203 -unit ILF, ALF and MC located in Georgia by acquiring a participating interest owned by existing lenders for $42,251 in addition to converting our $7,461 mezzanine loan in the property into a participating interest in the mortgage loan. The mortgage loan matures in October 2024 and our investment is at an initial rate of 7.5% with an IRR of 7.75% . We recorded $1,380 of additional interest income in connection with the effective prepayment of the mezzanine loan in the first quarter of 2023. ​ (5) Represents the initial rate with an IRR of 8% . ​ (6) Represents a mortgage loan secured by a parcel of land in North Carolina held for future development of a seniors housing community. (7) During the second quarter of 2023, we originated a $16,500 senior loan for the purchase of a 150 -bed SNF in Illinois. The mortgage loan matures in June 2028 and our investment is at an interest rate of 8.75% . ​ (8) Mortgage loans provide for 2.25% annual increases in the interest rate. ​ (9) During the third quarter of 2023, we committed to fund a $19,500 mortgage loan for the construction of an 85 -unit ALF and MC in Michigan. The borrower contributed $12,100 of equity which will initially fund the construction. Once all of the borrower’s equity has been drawn, we will begin funding the commitment. The loan term is approximately three years at a rate of 8.75% , and includes two , one-year extensions, each of which is contingent on certain coverage thresholds.
Summary of the carrying amount of intangible assets	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ September 30, 2023 ​ December 31,2022 ​ ​ ​ ​ ​ ​ ​ Accumulated ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Accumulated ​ ​ ​ ​ Assets ​ ​ Cost ​ ​ ​ Amortization ​ ​ ​ Net ​ ​ Cost ​ ​ ​ Amortization ​ ​ ​ Net In-place leases ​ $ 11,348 (1) ​ $ (5,886) (2) ​ $ 5,462 ​ $ 9,474 (1) ​ $ (5,362) (2) ​ $ 4,112 Tax abatement intangible ​ ​ 8,309 (3) ​ ​ (231) (3) ​ ​ 8,078 ​ ​ — (3) ​ ​ — (3) ​ ​ — (1) Included in the Buildings and improvements line item in our Consolidated Balance Sheets . ​ (2) Included in the Accumulated depreciation and amortization line item in our Consolidated Balance Sheets. ​ (3) Included in the Prepaid expenses and other assets line item in our Consolidated Balance Sheets.
Schedule of mortgage loan activity	The following table summarizes our mortgage loan activity for the nine months ended September 30, 2023 and 2022 (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Nine Months Ended September 30, ​ ​ 2023 ​ ​ 2022 ​ Originations and funding under mortgage loans receivable ​ $ 83,383 (1) ​ $ 35,234 (2) Application of interest reserve ​ ​ 1,609 ​ ​ ​ 4,348 ​ Scheduled principal payments received ​ ​ (301) ​ ​ ​ (625) ​ Mortgage loan premium amortization ​ ​ (5) ​ ​ ​ (4) ​ Provision for loan loss reserve ​ ​ (847) ​ ​ ​ (389) ​ Net increase in mortgage loans receivable ​ $ 83,839 ​ ​ $ 38,564 ​ (1) We originated the following: ​ (a) $10,750 mortgage loan secured by a 45 -unit MC located in North Carolina. The loan carries a two-year term with an interest-only rate of 7.25% and an IRR of 9.0% ; ​ (b) $51,111 mortgage loan investment secured by a 203 -unit ILF, ALF and MC located in Georgia. We acquired a participating interest owned by existing lenders for $42,251 in addition to converting our $7,461 mezzanine loan in the property into a participating interest in the mortgage loan. The mortgage loan matures in October 2024 and our investment is at an initial rate of 7.5% with an IRR of 7.75% . We recorded $1,380 of additional interest income in connection with the effective prepayment of the mezzanine loan in the first quarter of 2023; ​ (c) $16,500 senior loan for the purchase of a 150 -bed SNF in Illinois. The mortgage loan matures in June 2028 and our investment is at an interest rate of 8.75% ; ​ (d) 5,022 of additional funding under other mortgage loans receivable; and ​ (e) $19,500 mortgage loan commitment for the construction of an 85 -unit ALF and MC in Michigan. The borrower contributed $12,100 of equity which will initially fund the construction. Once all of the borrower’s equity has been drawn, we will begin funding the commitment. The loan term is approximately three years at a rate of 8.75% , and includes two , one-year extensions, each of which is contingent on certain coverage thresholds. ​ ​ (2) We originated two senior mortgage loans, secured by four ALFs operated by an existing operator, as well as a land parcel in North Carolina. The communities have a combined total of 217 units, with an average age of less than four years . The land parcel is approximately 7.6 acres adjacent to one of the ALFs and is being held for the future development of a seniors housing community. The mortgage loans have a four-year term, an interest rate of 7.25% and an IRR of 8% .

Investment in Unconsolidated _2

Investment in Unconsolidated Joint Ventures (Tables)	9 Months Ended
	Sep. 30, 2023
Investment in Unconsolidated Joint Ventures
Summary of the preferred equity investments	The following table provides information regarding these preferred equity investments (dollar amounts in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Type ​ Type ​ Total ​ ​ Contractual ​ ​ Number ​ ​ ​ ​ ​ ​ of ​ of ​ Preferred ​ ​ Cash ​ ​ of ​ ​ Carrying ​ State ​ Properties ​ Investment ​ Return ​ ​ Portion ​ ​ Beds/ Units ​ ​ Value ​ Washington ​ ALF/MC ​ Preferred Equity (1) 12 % ​ 7 % ​ 95 ​ $ 6,340 (1) Washington ​ UDP ​ Preferred Equity (2) 14 % ​ 8 % ​ — ​ ​ 13,000 (2) Total ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 95 ​ $ 19,340 ​ (1) Represents a preferred equity interest in an entity that developed and owns a 95 -unit ALF and MC in Washington. Our investment represents 15.5% of the total investment. The preferred equity investment earns an initial cash rate of 7% increasing to 9% in year four until the internal rate of return (“IRR”) is 8% . After achieving an 8% IRR, the cash rate drops to 8% with an IRR ranging between 12% to 14% , depending upon timing of redemption. During the fourth quarter of 2021, the entity completed the development project and received its certificate of occupancy. We have the option to require the JV partner to purchase our preferred equity interest at any time between August 17, 2031 and December 31, 2036. ​ (2) Represents a preferred equity interest in an entity that will develop and own a 267 -unit ILF and ALF in Washington. Our investment represents 11.0% of the estimated total investment. The preferred equity investment earns an initial cash rate of 8% with an IRR of 14% . The JV partner has the option to buy out our investment at any time after August 31, 2023 at the IRR rate. Also, we have the option to require the JV partner to purchase our preferred equity interest at any time between August 31, 2027 and, upon project completion and leasing the property, prior to the end of the first renewal term of the lease.
Summary of capital contributions, income recognized and cash interest received from investments in unconsolidated joint ventures	During the three and nine months ended September 30, 2023, we recognized $375,000 and $1,127,000, respectively, in income from unconsolidated joint ventures. During the three and nine months ended September 30, 2022, we recognized $376,000 and $1,127,000, respectively, in income from unconsolidated joint ventures. The following table summarizes our income recognized, and application of interest reserves related to our investments in unconsolidated joint ventures for the nine months ended September 30, 2023 and 2022 (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Type ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ of ​ ​ Income ​ ​ Cash Interest ​ ​ Application of ​ Year ​ Properties ​ ​ Recognized ​ ​ Earned ​ ​ Interest Reserve ​ 2023 ​ ALF/MC ​ $ 337 ​ $ — ​ $ 337 ​ ​ ​ UDP ​ ​ 790 ​ ​ — ​ ​ 790 ​ Total ​ ​ ​ $ 1,127 ​ $ — ​ $ 1,127 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 2022 ​ ALF/MC ​ $ 337 ​ $ — ​ $ 337 ​ ​ ​ UDP ​ ​ 790 ​ ​ 351 ​ ​ 439 ​ Total ​ ​ ​ $ 1,127 ​ $ 351 ​ $ 776 ​ ​

Notes Receivable (Tables)

Notes Receivable (Tables)	9 Months Ended
	Sep. 30, 2023
Notes Receivable.
Summary of investments in notes receivable	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Interest ​ ​ ​ ​ ​ ​ Type of ​ Gross ​ ​ ​ ​ Type of ​ Rate ​ IRR ​ ​ Maturity ​ Loan ​ Investment ​ ​ # of loans ​ Property ​ 5.0% ​ — ​ ​ 2024 ​ Working capital ​ $ 2,442 ​ ​ 1 ​ ALF ​ 4.0% ​ — ​ ​ 2024 ​ Working capital ​ ​ 13,531 ​ ​ 1 ​ SNF 5.0% ​ — ​ ​ 2025 ​ Working capital ​ ​ 732 ​ ​ 1 ​ ALF ​ 7.5% ​ — ​ ​ 2027 ​ Working capital ​ ​ 550 ​ ​ 1 ​ ALF ​ 8.0% ​ 11.0 % ​ 2027 ​ Mezzanine ​ ​ 25,000 ​ ​ 1 ​ ALF ​ 8.8% ​ 12.0 % ​ 2028 ​ Mezzanine ​ ​ 17,000 (1) ​ 1 ​ ALF ​ 6.5% ​ — ​ ​ 2030 ​ Working capital ​ ​ 138 ​ ​ 1 ​ SNF ​ 7.3% ​ — ​ ​ 2030 ​ Working capital ​ ​ 500 ​ ​ 1 ​ ALF ​ 7.3% ​ — ​ ​ 2030 ​ Working capital ​ ​ 1,107 ​ ​ 1 ​ ALF ​ 7.0% ​ — ​ ​ 2031 ​ Working capital ​ ​ 2,693 ​ ​ 1 ​ ALF ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ $ 63,693 (2) ​ 10 ​ ​ ​ (1) During the third quarter of 2023, we originated a mezzanine loan to recapitalize an existing 130 -unit ILF/ALF/MC in Georgia and construction of 89 additional units. The loan term is five years at an initial yield of 8.75% and an IRR of 12.0% . ​ (2) Excludes the impact of credit loss reserve.
Summary of mezzanine loans and other loan arrangements	The following table is a summary of our notes receivable components as of September 30, 2023 and December 31, 2022 (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ September 30, 2023 ​ December 31, 2022 Mezzanine loans $ 42,000 ​ $ 36,815 ​ Working capital loans ​ 21,693 ​ ​ 22,157 ​ Notes receivable credit loss reserve ​ (637) ​ ​ (589) ​ Total $ 63,056 ​ $ 58,383 ​
Summary of notes receivable activity	The following table summarizes our notes receivable activity for the nine months ended September 30, 2023 and 2022 (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ Nine Months Ended September 30, ​ ​ 2023 ​ ​ 2022 ​ Advances under notes receivable $ 19,258 (1) $ 37,008 (3) Principal payments received under notes receivable ​ (14,537) (2) ​ (6,618) ​ Provision for credit losses ​ (48) ​ ​ (303) ​ Net increase in notes receivable $ 4,673 ​ $ 30,087 ​ (1) During the third quarter of 2023, we originated a mezzanine loan to recapitalize an existing 130 -unit ILF/ALF/MC in Georgia and construction of 89 additional units. The loan term is five years at an initial yield of 8.75% and an IRR of 12.0% . ​ (2) During 2023, we received $4,545 , which includes a prepayment fee and the exit IRR totaling $190 from a mezzanine loan prepayment. The mezzanine loan was on a 136 -unit ILF in Oregon. Additionally, another $7,461 mezzanine loan was effectively prepaid through converting it as part of our $51,111 investment in a participating interest in an existing mortgage loan that is secured by a 203 -unit ALF, ILF and MC located in Georgia. We recorded $1,380 of interest income in connection with the effective prepayment of the mezzanine loan. ​ (3) During 2022, we originated a $25,000 mezzanine loan for the recapitalization of a five -property seniors housing portfolio. The mezzanine loan has a term of approximately five years , with two one-year extension options and bears interest at 8% with an IRR of 11% . The five communities are located in Oregon and Montana, have a total of 621 units, and include independent living, assisted living and memory care.

Lease Incentives (Tables)

Lease Incentives (Tables)	9 Months Ended
	Sep. 30, 2023
Lease Incentives
Summary of lease incentive activity	at September 30, 2023 and December 31, 2022 were $2,193,000 and $1,789,000, respectively. The following table summarizes our lease incentives activity for the nine months ended September 30, 2023 and 2022 (in thousands) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Nine Months Ended September 30, ​ ​ ​ 2023 ​ ​ 2022 ​ Lease incentives funded ​ $ 1,023 (1) $ 418 ​ Amortization of lease incentives ​ ​ (584) ​ ​ (665) ​ Adjustment for collectability of lease incentives ​ ​ — ​ ​ (256) (3) Other adjustments (2) ​ ​ (35) ​ ​ (174) ​ Net increase (decrease) in non-contingent lease incentives ​ $ 404 ​ $ (677) ​ (1) As part of our investment in a $54,134 JV, we committed to fund $2,100 of lease incentive, of which $1,004 was funded during the nine months ended September 30, 2023. ​ (2) Primarily relates to lease incentive balance write-off related to property sales. ​ (3) Represents the lease incentive balance write-off related to a closed property and subsequent lease termination and lease incentive balance write-off related to 12 assisted living communities transitioned to an existing operator.

Debt Obligations (Tables)

Debt Obligations (Tables)	9 Months Ended
	Sep. 30, 2023
Debt Obligations
Schedule of interest rate swaps	As of September 30, 2023 and December 31, 2022, the terms of the Interest Rate Swaps are as follows ( dollar amounts in thousands ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Notional ​ Fair Value at ​ Date Entered ​ Maturity Date ​ Swap Rate ​ Rate Index ​ ​ Amount ​ ​ September 30, 2023 ​ ​ ​ December 31, 2022 ​ November 2021 ​ November 19, 2025 ​ 2.62 % ​ 1-month SOFR ​ $ 50,000 ​ $ 3,776 ​ ​ $ 4,003 ​ November 2021 ​ November 19, 2026 ​ 2.76 % ​ 1-month SOFR ​ ​ 50,000 ​ ​ 4,820 ​ ​ ​ 4,716 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ $ 100,000 ​ $ 8,596 ​ ​ $ 8,719 ​
Schedule of Debt Obligations	The following table sets forth information regarding debt obligations by component as of September 30, 2023 and December 31, 2022 ( dollar amounts in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ At September 30, 2023 ​ At December 31, 2022 ​ ​ ​ Applicable ​ ​ ​ Available ​ ​ ​ Available ​ ​ ​ Interest ​ Outstanding ​ for ​ Outstanding ​ for ​ Debt Obligations ​ Rate (1) ​ Balance ​ Borrowing ​ Balance ​ Borrowing ​ Revolving line of credit ​ 6.63% ​ $ 362,250 ​ $ 37,750 ​ $ 130,000 ​ $ 270,000 ​ Term loans, net of debt issue costs ​ 2.74% ​ ​ 99,620 ​ ​ — ​ ​ 99,511 ​ ​ — ​ Senior unsecured notes, net of debt issue costs ​ 4.20% ​ ​ 494,353 ​ ​ — ​ ​ 538,343 ​ ​ — ​ Total ​ 4.97% ​ $ 956,223 ​ $ 37,750 ​ $ 767,854 ​ $ 270,000 ​ (1) Represents weighted average of interest rate as of September 30, 2023. ​ ​ ​
Schedule of borrowings and repayments	During the nine months ended September 30, 2023 and 2022, our debt borrowings and repayments were as follows ( in thousands ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Nine Months Ended September 30, ​ ​ ​ 2023 ​ 2022 ​ Debt Obligations ​ ​ Borrowings ​ ​ Repayments ​ Borrowings ​ Repayments ​ Revolving line of credit ​ $ 274,450 ​ $ (42,200) ​ $ 194,000 ​ $ (153,900) ​ Senior unsecured notes ​ ​ — ​ ​ (44,160) ​ ​ 75,000 ​ ​ (43,160) ​ Total ​ $ 274,450 ​ $ (86,360) ​ $ 269,000 ​ $ (197,060) ​ ​

Equity (Tables)

Equity (Tables)	9 Months Ended
	Sep. 30, 2023
Equity
Schedule of consolidated VIEs	As of September 30, 2023, we have the following consolidated VIEs (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Gross ​ ​ ​ ​ Investment ​ ​ ​ Property ​ ​ ​ ​ Consolidated ​ ​ Non-Controlling ​ Year ​ Purpose ​ Type ​ State ​ ​ Assets (1) ​ ​ Interests ​ 2023 ​ Owned real estate (2) ILF/ALF/MC ​ OH ​ $ 54,714 ​ $ 9,134 ​ 2023 ​ Owned real estate (3) ALF/MC ​ NC ​ ​ 121,321 ​ ​ 3,831 ​ 2022 ​ Owned real estate (4) SNF ​ FL ​ ​ 76,712 ​ ​ 14,325 ​ 2018 ​ Owned real estate ​ ILF ​ OR ​ ​ 14,650 ​ ​ 2,907 ​ 2018 ​ Owned real estate and development ​ ALF/MC ​ OR ​ ​ 18,452 ​ ​ 1,231 ​ 2017 ​ Owned real estate and development ​ ILF/ALF/MC ​ WI ​ ​ 22,007 ​ ​ 2,305 ​ 2017 ​ Owned real estate ​ ALF/MC ​ SC ​ ​ 11,680 ​ ​ 1,240 ​ Total ​ ​ ​ ​ ​ ​ ​ $ 319,536 ​ $ 34,973 ​ (1) Includes the total real estate investments and excludes intangible assets. ​ (2) During the second quarter of 2023, we entered into a JV that purchased an ILF/ALF/MC in Ohio with a total of 242 units. For more information see Acquisitions above in Note 2. ​ (3) During the first quarter of 2023, we entered into a JV that purchased 11 ALF and MC with a total of 523 units. For more information regarding this transaction see Financing Receivable above in Note 2. ​ (4) During 2022, we entered into a JV that purchased three SNFs with a total of 299 beds. For more information regarding this transaction see Financing Receivable above in Note 2.
Schedule of cash dividends declared and paid	Distributions. (in thousands) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Nine Months Ended September 30, ​ ​ ​ 2023 ​ 2022 ​ ​ ​ ​ Declared ​ Paid ​ Declared ​ Paid ​ ​ Common Stock (1) ​ $ 70,767 ​ $ 70,767 ​ $ 68,202 ​ $ 68,202 ​ ​ (1) Represents $0.19 per share per month for the nine months ended September 30, 2023 and 2022.
Schedule of restricted stock activity	The following table summarizes our restricted stock activity for the nine months ended September 30, 2023 and 2022 : ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Nine Months Ended September 30, ​ ​ 2023 ​ 2022 ​ Outstanding, January 1 ​ ​ 229,236 ​ ​ 197,422 ​ Granted ​ ​ 146,020 ​ ​ 135,210 ​ Vested ​ ​ (115,551) ​ ​ (103,396) ​ Cancelled ​ ​ (1,085) ​ ​ — ​ Outstanding, September 30 ​ ​ 258,620 ​ ​ 229,236 ​
Schedule of restricted stock granted	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ No. of ​ Price per ​ ​ ​ ​ ​ Year ​ Shares/Units ​ Share ​ Reward Type ​ Vesting Period ​ 2023 ​ 127,960 ​ $ 37.16 ​ Restricted stock ​ ratably over 3 years ​ ​ ​ 86,867 ​ $ 37.16 ​ Performance-based stock units ​ TSR targets (1) ​ ​ ​ 15,060 ​ $ 31.54 ​ Restricted stock ​ May 24,2024 ​ ​ ​ 3,000 ​ $ 35.45 ​ Restricted stock ​ July 25, 2024 ​ ​ ​ 232,887 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 2022 ​ 122,865 ​ $ 33.94 ​ Restricted stock ​ ratably over 3 years ​ ​ ​ 86,332 ​ $ 33.94 ​ Performance-based stock units ​ TSR targets (1) ​ ​ ​ 12,345 ​ $ 38.48 ​ Restricted stock ​ May 25, 2023 ​ ​ ​ 221,542 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ (1) Vesting is based on achieving certain total shareholder return (“TSR”) targets in 4 years with acceleration opportunity in 3 years .
Schedule of restricted common stock and performance-based stock unit scheduled to vest and remaining compensation expense	At September 30, 2023, the remaining compensation expense to be recognized related to the future service period of unvested outstanding restricted common stock and performance-based stock units are as follows (in thousands): ​ ​ ​ ​ ​ ​ ​ Remaining ​ ​ Compensation Vesting Date ​ Expense October - December 2023 ​ $ 2,132 2024 ​ ​ 6,026 2025 ​ ​ 3,238 2026 ​ ​ 356 Total ​ $ 11,752

Commitments and Contingencies (

Commitments and Contingencies (Tables)	9 Months Ended
	Sep. 30, 2023
Commitments and Contingencies
Schedule of commitments	At September 30, 2023, we had commitments as follows (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Total ​ ​ ​ ​ ​ Investment ​ 2023 ​ Commitment ​ Remaining ​ ​ Commitment ​ Funding ​ Funded ​ Commitment Real estate properties ote 2. Real Estate Investments ​ $ 10,242 (1) $ 1,932 ​ $ 2,650 ​ $ 7,592 Accrued incentives and earn-out liabilities (Note 5. Lease Incentives) ​ ​ 21,100 (2) ​ 1,004 ​ ​ 1,004 ​ ​ 20,096 Mortgage loans (N ote 2. Real Estate Investments ​ ​ 43,598 (3) ​ 1,476 ​ ​ 7,178 ​ ​ 36,420 Notes receivable (N ote 4. Notes Receivable ​ ​ 28,950 (4) ​ 2,258 ​ ​ 15,973 ​ ​ 12,977 Total ​ $ 103,890 ​ $ 6,670 ​ $ 26,805 ​ $ 77,085 (1) Represents commitments to purchase land and improvements, if applicable, and to develop, re-develop, renovate or expand seniors housing and skilled nursing properties. ​ (2) Includes an earn-out payment of up to $3,000 to an operator under a master lease on four SNFs in Texas which were acquired during 2022. The master lease allows either an earn-out payment up to $3,000 or a purchase option. The earn-out payment is available, contingent on achieving certain thresholds per the lease, beginning at the end of the second lease year through the end of the fifth lease year. If neither option is elected within the timeframe defined in the lease, both elections are terminated. For more information regarding the purchase option see Note 2. Real Estate Investments . ​ (3) Represents $19,500 related to a construction loan, $6,098 of commitments for the expansion, renovation and working capital related to seniors housing and skilled nursing properties securing the mortgage loans and $18,000 of commitments which are contingent upon the borrower achieving certain coverage ratios. ​ (4) Represents working capital loan commitments.

Major Operators (Tables)

Major Operators (Tables)	9 Months Ended
	Sep. 30, 2023
Major Operators
Schedule of concentration of risk by major operators	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Number of ​ Number of ​ Percentage of ​ ​ ​ ​ ​ ​ ​ SNF ​ ALF ​ Total ​ ​ Total ​ ​ Operator ​ SNF ​ ALF ​ Beds ​ Units ​ Revenues (1) ​ ​ Assets (2) ​ ​ Prestige Healthcare (3) ​ 24 ​ — ​ 2,820 ​ 93 ​ 16.6 % ​ 14.2 % ​ (1) During 2023, we agreed to defer up to $1,500 , or up to $300 per month for May through September 2023, in interest payments due on one of Prestige Healthcare’s mortgage loans secured by 15 skilled nursing centers in Michigan. We deferred $600 in interest payments during the second quarter of 2023 and $900 in interest payments during the third quarter of 2023. ​ (2) Represents the net carrying value of the mortgage loans and properties we own divided by the Total assets on the Consolidated Balance Sheets. ​ (3) The majority of the revenue derived from this operator relates to interest income from mortgage loans.

Earnings per Share (Tables)

Earnings per Share (Tables)	9 Months Ended
	Sep. 30, 2023
Earnings per Share
Schedule of basic and diluted net income per share	The following table sets forth the computation of basic and diluted net income per share ( in thousands, except per share amounts ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended ​ Nine Months Ended ​ ​ September 30, ​ September 30, ​ ​ 2023 ​ 2022 ​ 2023 ​ 2022 ​ Net income ​ $ 22,627 ​ $ 13,389 ​ $ 62,792 ​ $ 82,386 ​ Less income allocated to non-controlling interests ​ (430) ​ (99) ​ (1,287) ​ (301) ​ Less income allocated to participating securities: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Non-forfeitable dividends on participating securities ​ ​ (147) ​ ​ (131) ​ ​ (440) ​ ​ (401) ​ Income allocated to participating securities ​ ​ — ​ ​ — ​ ​ — ​ ​ (80) ​ Total net income allocated to participating securities ​ ​ (147) ​ ​ (131) ​ ​ (440) ​ ​ (481) ​ Net income available to common stockholders ​ ​ 22,050 ​ ​ 13,159 ​ ​ 61,065 ​ ​ 81,604 ​ Effect of dilutive securities: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Participating securities (1) ​ ​ — ​ ​ — ​ ​ — ​ ​ — ​ Net income for diluted net income per share ​ $ 22,050 ​ $ 13,159 ​ $ 61,065 ​ $ 81,604 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Shares for basic net income per share ​ ​ 41,153 ​ ​ 40,270 ​ ​ 41,127 ​ ​ 39,658 ​ Effect of dilutive securities: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Stock options (2) ​ ​ — ​ ​ 1 ​ ​ — ​ ​ — ​ Performance-based stock units ​ ​ 58 ​ ​ 281 ​ ​ 58 ​ ​ 281 ​ Participating securities (1) ​ ​ — ​ ​ — ​ ​ — ​ ​ — ​ Total effect of dilutive securities ​ ​ 58 ​ ​ 282 ​ ​ 58 ​ ​ 281 ​ Shares for diluted net income per share ​ ​ 41,211 ​ ​ 40,552 ​ ​ 41,185 ​ ​ 39,939 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Basic net income per share ​ $ 0.54 ​ $ 0.33 ​ $ 1.48 ​ $ 2.06 ​ Diluted net income per share ​ $ 0.54 ​ $ 0.32 ​ $ 1.48 ​ $ 2.04 ​ (1) For the three and nine months ended September 30, 2023 and 2022, the participating securities have been excluded from the computation of diluted net income per share as such inclusion would be anti-dilutive. ​ (2) For the three and nine months ended September 30, 2023 and the nine months ended September 30, 2022, the stock options have been excluded from the computation of diluted net income per share as such inclusion would be anti-dilutive.

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	9 Months Ended
	Sep. 30, 2023
Fair Value Measurements
Schedule of carrying value and fair value of the entity's financial instruments	The carrying value and estimated fair value of our financial instruments as of September 30, 2023 and December 31, 2022 were as follows ( in thousands ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ At September 30, 2023 ​ At December 31, 2022 ​ ​ ​ Carrying ​ Fair ​ Carrying ​ Fair ​ ​ ​ Value ​ Value ​ Value ​ Value ​ Financing receivable, net of credit loss reserve ​ $ 196,053 ​ $ 199,050 (1) $ 75,999 ​ $ 76,033 (1) Mortgage loans receivable, net of credit loss reserve ​ ​ 473,567 ​ ​ 560,808 (2) ​ 389,728 ​ ​ 461,276 (2) Notes receivable, net of credit loss reserve ​ 63,056 ​ 70,482 (3) 58,383 ​ 61,858 (3) Revolving line of credit ​ 362,250 ​ ​ 362,250 (4) ​ 130,000 ​ ​ 130,000 (4) Term loans, net of debt issue costs ​ ​ 99,620 ​ ​ 100,000 (4) ​ 99,511 ​ ​ 100,000 (4) Senior unsecured notes, net of debt issue costs ​ 494,353 ​ ​ 429,534 (5) ​ 538,343 ​ ​ 477,653 (5) (1) Our investment in financing receivables is classified as Level 3. The fair value is determined using a widely accepted valuation technique, discounted cash flow analysis on the expected cash flows. The discount rate used to value our future cash inflows of the financing receivables at September 30, 2023 and December 31, 2022 was 7.6% . ​ (2) Our investment in mortgage loans receivable is classified as Level 3. The fair value is determined using a widely accepted valuation technique, discounted cash flow analysis on the expected cash flows. The discount rate is determined using our assumption on market conditions adjusted for market and credit risk and current returns on our investments. The discount rate used to value our future cash inflows of the mortgage loans receivable at September 30, 2023 and December 31, 2022 was 9.1% and 9.3% , respectively. ​ (3) Our investments in notes receivable are classified as Level 3. The discount rate is determined using our assumption on market conditions adjusted for market and credit risk and current returns on our investments. The discount rate used to value our future cash flows of the notes receivable at September 30, 2023 and December 31, 2022, were 6.8% and 7.1% , respectively. ​ (4) Our revolving line of credit and term loans bear interest at a variable interest rate. The estimated fair value of our revolving line of credit and term loans approximated their carrying values at September 30, 2023 and December 31, 2022 based upon prevailing market interest rates for similar debt arrangements. ​ (5) Our obligation under our senior unsecured notes is classified as Level 3 and thus the fair value is determined using a widely accepted valuation technique, discounted cash flow analysis on the expected cash flows. The discount rate is measured based upon management’s estimates of rates currently prevailing for comparable loans available to us, and instruments of comparable maturities. At September 30, 2023, the discount rate used to value our future cash outflow of our senior unsecured notes was 7.25% for those maturing before year 2030 and 7.50% for those maturing at or beyond year 2030. At December 31, 2022, the discount rate used to value our future cash outflow of our senior unsecured notes was 6.50% for those maturing before year 2030 and 7.00% for those maturing at or beyond year 2030.

General (Details)

General (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2023 USD ($) segment
General
Number of operating segments | segment	1
Provision for federal or state income taxes | $	$ 0

Real Estate Investments - Owned

Real Estate Investments - Owned Properties (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2023 USD ($) item property state $ / item	Sep. 30, 2022 item
Real Estate [Line Items]
Gross Investment | $	$ 1,405,848
Percentage of Investment	100%
Number of properties | property	143
Number of beds/units		217
Number of states | state	24
Number of operators	22
SNF Beds
Real Estate [Line Items]
Number of beds/units	6,231
ALF Units
Real Estate [Line Items]
Number of beds/units	5,559
ALF
Real Estate [Line Items]
Gross Investment | $	$ 800,963
Percentage of Investment	57%
Number of properties | property	92
Average Investment per Bed/Unit | $ / item	150.47
ALF | ALF Units
Real Estate [Line Items]
Number of beds/units	5,323
SNF
Real Estate [Line Items]
Gross Investment | $	$ 592,880
Percentage of Investment	42.10%
Number of properties | property	50
Average Investment per Bed/Unit | $ / item	93.38
SNF | SNF Beds
Real Estate [Line Items]
Number of beds/units	6,113
SNF | ALF Units
Real Estate [Line Items]
Number of beds/units	236
Other
Real Estate [Line Items]
Gross Investment | $	$ 12,005
Percentage of Investment	0.90%
Number of properties | property	1
Number of parcels of land	3
Other | SNF Beds
Real Estate [Line Items]
Number of beds/units	118
Hospital
Real Estate [Line Items]
Number of properties | property	1

Real Estate Investments - Lease

Real Estate Investments - Lease (Details) $ in Thousands	1 Months Ended	2 Months Ended	3 Months Ended					9 Months Ended		12 Months Ended
	Oct. 31, 2023 USD ($) property item	May 31, 2023 USD ($)	Sep. 30, 2023 USD ($) property item	Jun. 30, 2023 USD ($) item	Mar. 31, 2023 USD ($) item	Dec. 31, 2022 USD ($) item	Sep. 30, 2022 USD ($) item property	Sep. 30, 2023 USD ($) Center property item lease	Sep. 30, 2022 USD ($) property item	Dec. 31, 2022 USD ($) lease item Center
Real estate investments
Number of properties | property			143					143
Write-off of straight-line rent and lease incentives balances								$ 26	$ 256
Gross Investment			$ 1,405,848					1,405,848
Net book value			1,007,775			$ 1,019,218		1,007,775		$ 1,019,218
Impairment loss					$ 434	$ 1,222	$ 1,286	$ 12,510	1,286
Number of properties with lease incentives write-offs | property								2
Income and Expenses, Lessor [Abstract]
Contractual cash rental income			29,121				28,180	$ 87,260	83,203
Variable cash rental income			3,386				4,160	9,846	12,218
Straight-line rent			(747)				(436)	(1,635)	(963)
Adjustment for collectability of lease incentives and rental income							(83)	(26)	(256)
Amortization of lease incentives			(171)				(236)	(584)	(665)
Total Rental Income			$ 31,589				$ 31,585	$ 94,861	$ 93,537
Number of units | item							217		217
Properties held-for-sale
Real estate investments
Number of properties held for sale | property			7					7
Purchase Option in Lease Arrangements
Real estate investments
Gross Investment			$ 384,864					$ 384,864
Net book value			$ 364,670					$ 364,670
Master lease agreement | Brookdale Senior Living
Real estate investments
Number of Re leased properties | property			10					10
Number of properties | property			35					35
Lease term			6 years					6 years
Rental income to be received in first year								$ 8,000
Specified annual increase over the prior year's rent (as a percent)								2%
Fund for capital expenditures			$ 4,500					$ 4,500
Tenure for funding capital expenditure								2 years
Initial rate for capital expenditure by lessor (as a percent)								8%
Annual increase in rate for capital expenditure by lessor (as a percent)								2%
Master lease agreement | Brookdale Senior Living | Subsequent Event
Real estate investments
Number of properties | property	7
Lease term	3 years
Rental income to be received in first year	$ 960
Rental income to be received in second year	984
Rental income to be received in third year	$ 1,150
Lease renewal term	4 years
Master lease agreement | Colorado | Brookdale Senior Living
Real estate investments
Number of properties | property			6					6
Master lease agreement | Kansas | Brookdale Senior Living
Real estate investments
Number of properties | property			4					4
Master lease agreement | Ohio | Brookdale Senior Living | Subsequent Event
Real estate investments
Number of properties | property	1
Master lease agreement | Texas | Brookdale Senior Living | Subsequent Event
Real estate investments
Number of properties | property	6
Master lease agreement | Oklahoma | Brookdale Senior Living | Subsequent Event
Real estate investments
Number of properties | property	6
Master lease agreement | Properties held-for-sale | Brookdale Senior Living
Real estate investments
Number of properties held for sale | property			7					7
New master lease agreement | Brookdale Senior Living | Subsequent Event
Real estate investments
Number of properties | property	17
Rental income to be received in first year	$ 9,325
Fund for capital expenditures	$ 7,150
ALF
Real estate investments
Number of properties | property			92					92
Gross Investment			$ 800,963					$ 800,963
Number of properties acquired | property								1
Number of properties with lease incentives write-offs | property								12
Income and Expenses, Lessor [Abstract]
Percentage of cash return								9.75%
ALF | Encore Senior Living
Real estate investments
Lease term			10 years					10 years
ALF | Florida
Real estate investments
Impairment loss				$ 12,076
ALF | North Carolina
Real estate investments
Number of properties | property							4		4
ALF | Illinois, Ohio and Michigan | Encore Senior Living
Real estate investments
Lease term				2 years
Number of assisted living communities transitioned to another operator | item				8
Repayments received from deferred rent		$ 934		$ 1,250
Unrecorded deferred rent				$ 316
Income and Expenses, Lessor [Abstract]
Number of units | item				500
ALF | Properties held-for-sale | Florida
Real estate investments
Number of properties held for sale | property			4					4
ALF | Master lease agreement | Ohio | Brookdale Senior Living | Subsequent Event
Income and Expenses, Lessor [Abstract]
Number of units | item	42
ALF | Master lease agreement | Texas | Brookdale Senior Living | Subsequent Event
Income and Expenses, Lessor [Abstract]
Number of units | item	235
ALF | Master lease agreement | Oklahoma | Brookdale Senior Living | Subsequent Event
Income and Expenses, Lessor [Abstract]
Number of units | item	219
MC | Purchase Option in Lease Arrangements | Florida
Real estate investments
Number of properties | property			1					1
Gross Investment			$ 7,680					$ 7,680
Net book value			$ 4,681					4,681
Impairment loss								$ 7,522
MC | Purchase Option in Lease Arrangements | Ohio
Real estate investments
Number of properties | property			1					1
Gross Investment			$ 16,161					$ 16,161
Net book value			$ 13,598					$ 13,598
ALF & MC
Real estate investments
Lease term			10 years					10 years
Lease renewal term			5 years					5 years
Number of operating lease renewals | lease								2
Income and Expenses, Lessor [Abstract]
Number of assisted living and memory care communities | item			11					11
Maximum percentage of purchase option to buy properties								50%
Percentage of cash return								9%
ALF & MC | North Carolina
Income and Expenses, Lessor [Abstract]
Number of assisted living and memory care communities | item					11
Number of units | item					523
ALF & MC | Purchase Option in Lease Arrangements | California
Real estate investments
Number of properties | property			2					2
Gross Investment			$ 38,895					$ 38,895
Net book value			$ 33,013					$ 33,013
ALF & MC | Purchase Option in Lease Arrangements | North Carolina
Real estate investments
Number of properties | property			11					11
Lease term			10 years					10 years
Gross Investment			$ 121,321					$ 121,321
Net book value			$ 121,321					$ 121,321
Income and Expenses, Lessor [Abstract]
Number of assisted living and memory care communities | item			11					11
Number of units | item			523					523
Maximum percentage of purchase option to buy properties								50%
Percentage of cash return								9%
ALF & MC | Purchase Option in Lease Arrangements | South Carolina
Real estate investments
Number of properties | property			1					1
Gross Investment			$ 11,680					$ 11,680
Net book value			$ 8,619					$ 8,619
SNF
Real estate investments
Number of properties | property			50					50
Lease term						10 years				10 years
Lease renewal term						5 years				5 years
Number of operating lease renewals | lease										2
Skilled nursing center purchased | Center										3
Gross Investment			$ 592,880					$ 592,880
Number of properties acquired | property									4
SNF | Brookdale Senior Living
Real estate investments
Skilled nursing center purchased | Center								2
Additional term of lessor's operating lease renewal								5 years
SNF | Florida
Real estate investments
Skilled nursing center purchased | item										3
Income and Expenses, Lessor [Abstract]
Number of units | item						299				299
SNF | Florida | Brookdale Senior Living
Income and Expenses, Lessor [Abstract]
Number of units | item			216					216
SNF | Texas
Real estate investments
Lease term							10 years		10 years
SNF | Tennessee | Brookdale Senior Living
Real estate investments
Skilled nursing center purchased | Center								2
Additional term of lessor's operating lease renewal								2 years
Contractual annual cash rent								$ 1,005
Percentage of increase in contractual annual cash rent								2.50%
Income and Expenses, Lessor [Abstract]
Number of units | item			141					141
SNF | Purchase Option in Lease Arrangements | Florida
Real estate investments
Number of properties | property			3					3
Lease term						10 years				10 years
Gross Investment			$ 76,712					$ 76,712
Net book value			$ 76,712					$ 76,712
Number of properties acquired | item										3
Income and Expenses, Lessor [Abstract]
Number of units | item						299				299
SNF | Purchase Option in Lease Arrangements | Texas
Real estate investments
Number of properties | property			4					4
Lease term						10 years				10 years
Gross Investment			$ 52,426					$ 52,426
Net book value			$ 50,438					$ 50,438
Number of properties acquired | item										4
SNF | Purchase Option in Lease Arrangements | Tennessee
Real estate investments
Number of properties | property			2					2
Gross Investment			$ 5,275					$ 5,275
Net book value			$ 2,298					$ 2,298
ILF/ALF/MC | Ohio
Income and Expenses, Lessor [Abstract]
Number of units | item				242
ILF/ALF/MC | Purchase Option in Lease Arrangements | Ohio
Real estate investments
Number of properties | property			1					1
Gross Investment			$ 54,714					$ 54,714
Net book value			$ 53,990					$ 53,990

Real Estate Investments - Held-

Real Estate Investments - Held-For-Sale Properties (Details)	3 Months Ended				9 Months Ended
	Jun. 30, 2023 USD ($)	Mar. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)	Sep. 30, 2022 USD ($)	Sep. 30, 2023 USD ($) item property	Sep. 30, 2022 USD ($) item
Real Estate Properties [Line Items]
Impairment loss		$ 434,000	$ 1,222,000	$ 1,286,000	$ 12,510,000	$ 1,286,000
Accumulated depreciation			$ 389,182,000		$ 386,483,000
Properties held-for-sale
Real Estate Properties [Line Items]
Number of Properties | property					7
Number of Beds/units | item					304
Gross Investment					$ 21,038,000
Accumulated depreciation					11,590,000
Properties sold
Real Estate Properties [Line Items]
Sales price					$ 53,212,000	$ 74,345,000
Number of beds or units in property sold | item					651	427
ALF | Florida
Real Estate Properties [Line Items]
Impairment loss	$ 12,076,000
Number of properties recoverability analysis performed	2
Number of Beds/units | item					70
ALF | Properties held-for-sale | Florida
Real Estate Properties [Line Items]
Number of Properties | property					4
Number of Beds/units | item					176
Gross Investment					$ 12,215,000
Accumulated depreciation					$ 7,213,000
ALF | Properties held-for-sale | Pennsylvania
Real Estate Properties [Line Items]
Number of Properties | property					3
Number of Beds/units | item					128
Gross Investment					$ 8,823,000
Accumulated depreciation					4,377,000
ALF | Properties sold | Kentucky
Real Estate Properties [Line Items]
Sales price					$ 11,000,000
Number of beds or units in property sold | item					60
ALF | Properties sold | Florida
Real Estate Properties [Line Items]
Sales price	$ 4,850,000				$ 4,850,000
Number of beds or units in property sold | item					70
ALF | Properties sold | Pennsylvania
Real Estate Properties [Line Items]
Sales price					$ 11,128,000
Number of beds or units in property sold | item					130
SNF | Properties sold | New Mexico
Real Estate Properties [Line Items]
Sales price					$ 21,250,000
Number of beds or units in property sold | item					235

Real Estate Investments - Acqui

Real Estate Investments - Acquisitions (Details) $ in Thousands	3 Months Ended			9 Months Ended		12 Months Ended
	Jun. 30, 2023 USD ($)	Mar. 31, 2023 USD ($)	Sep. 30, 2022 USD ($)	Sep. 30, 2023 USD ($) property item	Sep. 30, 2022 USD ($) property item	Dec. 31, 2022 USD ($)
Real estate investments
Non-Controlling Interest	$ 9,133	$ 3,831	$ 14,375
SNF
Real estate investments
Cash Paid at Acquisition					$ 51,815
Assets Acquired			$ 51,815		$ 51,815
Number of properties acquired | property					4
Number of beds/units acquired | item					339
Lease term						10 years
Contribution to JV						$ 61,661
SNF | Texas
Real estate investments
Lease term			10 years		10 years
Renewal term			5 years		5 years
Number of options available for renewal | item					2
Cash yield percentage					8%
Cash yield percentage year two					8.25%
SNF | Texas | Minimum
Real estate investments
Annual increase in cash yield percentage					2%
SNF | Texas | Maximum
Real estate investments
Working capital loan funded					$ 2,000
Annual increase in cash yield percentage					4%
ALF
Real estate investments
Cash Paid at Acquisition				$ 43,759
Assumed Liabilities				9,767
Non-Controlling Interest				9,133
Transaction Costs				363
Assets Acquired				$ 63,022
Number of properties acquired | property				1
Number of beds/units acquired | item				242
Amount of joint venture investment				$ 54,134
Contribution to JV				$ 45
Percentage of cash return				9.75%
Amount committed to fund				$ 2,100
Amount funded under lease incentives				1,004
Tax abatement intangible				$ 8,309
ALF | Encore Senior Living
Real estate investments
Lease term				10 years
Percentage of contractual initial cash yield				8.25%
Amount committed to fund				$ 2,100
Amount funded under lease incentives				$ 1,004

Real Estate Investments - Carry

Real Estate Investments - Carrying amount of intangible assets (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
In-place leases
Real estate investments
Cost	$ 11,348	$ 9,474
Accumulated Amortization	(5,886)	(5,362)
Net	5,462	$ 4,112
Tax abatement intangible
Real estate investments
Cost	8,309
Accumulated Amortization	(231)
Net	$ 8,078

Real Estate Investments - Impro

Real Estate Investments - Improvements (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Real estate investments
Invested in projects	$ 6,670
Development | Development and Improvement Commitments
Real estate investments
Invested in projects		$ 105
Improvements | Development and Improvement Commitments
Real estate investments
Invested in projects	5,053	4,555
ALF | Development | Development and Improvement Commitments
Real estate investments
Invested in projects		105
ALF | Improvements | Development and Improvement Commitments
Real estate investments
Invested in projects	2,418	3,015
SNF | Improvements | Development and Improvement Commitments
Real estate investments
Invested in projects	2,548	981
Other | Improvements | Development and Improvement Commitments
Real estate investments
Invested in projects	$ 87	$ 559

Real Estate Investments - Prope

Real Estate Investments - Properties Sold (Details) $ in Thousands	3 Months Ended			9 Months Ended
	Sep. 30, 2023 USD ($)	Jun. 30, 2023 USD ($)	Sep. 30, 2022 USD ($)	Sep. 30, 2023 USD ($) item property	Sep. 30, 2022 USD ($) property item	Dec. 31, 2022 USD ($)
Disposals and other
Carrying value	$ 1,007,775			$ 1,007,775		$ 1,019,218
Net gain (loss)	4,870		$ (387)	$ 20,545	$ 37,809
Virginia
Disposals and other
Lease termination fee payable			1,181		$ 1,181
Properties sold
Disposals and other
Number of properties sold | property				10	5
Number of beds or units in property sold | item				651	427
Sales price				$ 53,212	$ 74,345
Carrying value	30,865		35,924	30,865	35,924
Net gain (loss)	4,870		(387)	$ 20,545	37,809
Net Gain (Loss)					$ 186
Properties sold | ALF | Florida
Disposals and other
Number of properties sold | property				1
Number of beds or units in property sold | item				70
Sales price		$ 4,850		$ 4,850
Carrying value	4,082			4,082
Net Gain (Loss)				$ 65
Properties sold | ALF | Kentucky
Disposals and other
Number of properties sold | property				1
Number of beds or units in property sold | item				60
Sales price				$ 11,000
Carrying value	10,720			10,720
Net Gain (Loss)				$ 57
Properties sold | ALF | New Jersey
Disposals and other
Number of properties sold | property				1
Number of beds or units in property sold | item				39
Sales price				$ 2,000
Carrying value	1,552			1,552
Net Gain (Loss)				$ 266
Properties sold | ALF | Nebraska
Disposals and other
Number of properties sold | property				3
Number of beds or units in property sold | item				117
Sales price				$ 2,984
Carrying value	2,934			$ 2,934
Properties sold | ALF | Pennsylvania
Disposals and other
Number of properties sold | property				2
Number of beds or units in property sold | item				130
Sales price				$ 11,128
Carrying value	6,054			6,054
Net Gain (Loss)				$ 4,870
Properties sold | ALF | California
Disposals and other
Number of properties sold | property					2
Number of beds or units in property sold | item					232
Sales price					$ 43,715
Carrying value			17,832		17,832
Net Gain (Loss)					$ 25,867
Properties sold | ALF | Virginia
Disposals and other
Number of properties sold | property					1
Number of beds or units in property sold | item					74
Sales price					$ 16,895
Carrying value			15,549		15,549
Net Gain (Loss)					$ 1,344
Properties sold | SNF | New Mexico
Disposals and other
Number of properties sold | property				2
Number of beds or units in property sold | item				235
Sales price				$ 21,250
Carrying value	$ 5,523			5,523
Net Gain (Loss)				$ 15,287
Properties sold | SNF | California
Disposals and other
Number of properties sold | property					1
Number of beds or units in property sold | item					121
Sales price					$ 13,250
Carrying value			1,846		1,846
Net Gain (Loss)					$ 10,846
Properties sold | SNF | Texas
Disposals and other
Number of properties sold | property					1
Sales price					$ 485
Carrying value			$ 697		697
Net Gain (Loss)					$ (434)

Real Estate Investments - Finan

Real Estate Investments - Financing Receivable (Details) $ in Thousands	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2023 USD ($) item	Sep. 30, 2022 USD ($)	Sep. 30, 2023 USD ($) lease item	Sep. 30, 2022 USD ($)	Dec. 31, 2022 USD ($) lease Center
Collaborative Arrangements and Non-collaborative Arrangement Transactions [Line Items]
Interest income from financing receivables	$ 3,832	$ 357	$ 11,413	$ 357
Provision for credit losses	189	$ 795	2,107	$ 1,454
ALF & MC
Collaborative Arrangements and Non-collaborative Arrangement Transactions [Line Items]
Amount of joint venture investment	$ 121,321		121,321
Contribution to JV			$ 117,490
Number of assisted living and memory care communities | item	11		11
Lease term	10 years		10 years
Number of operating lease renewals | lease			2
Lease renewal term	5 years		5 years
Interest income from financing receivables	$ 2,427		$ 7,198
Provision for credit losses			$ 1,213
Percentage of contractual initial cash yield			7.25%
Percentage of contractual initial cash yield in year three			7.50%
Percentage of floor on initial cash yield			2%
Percentage of ceiling on initial cash yield			4%
Maximum percentage of purchase option to buy properties			50%
Percentage of cash return			9%
SNF
Collaborative Arrangements and Non-collaborative Arrangement Transactions [Line Items]
Contribution to JV					$ 61,661
Skilled nursing center purchased | Center					3
Real estate property acquired					$ 75,825
Lease term					10 years
Number of operating lease renewals | lease					2
Lease renewal term					5 years
Interest income from financing receivables	$ 1,405		$ 4,215

Real Estate Investments - Mortg

Real Estate Investments - Mortgage Loan (Details) $ in Thousands	3 Months Ended			9 Months Ended
	Sep. 30, 2023 USD ($) item property state period	Jun. 30, 2023 USD ($) item	Mar. 31, 2023 USD ($) item	Sep. 30, 2023 USD ($) item loan property state period $ / item	Sep. 30, 2022 item property	Dec. 31, 2022 USD ($)
Real Estate [Line Items]
Interest rate (as a percent)					7.25%
Gross Investment | $	$ 1,405,848			$ 1,405,848
Percentage of Investment	100%			100%
Number of properties | property	143			143
Number of beds/units					217
Notes receivable, net of credit loss reserve | $	$ 63,056			$ 63,056		$ 58,383
Loan Term					4 years
Internal Rate of Return					8%
Additional interest income related to the exit IRR | $				$ 1,380
SNF Beds
Real Estate [Line Items]
Number of beds/units	6,231			6,231
ALF Units
Real Estate [Line Items]
Number of beds/units	5,559			5,559
SNF
Real Estate [Line Items]
Gross Investment | $	$ 592,880			$ 592,880
Percentage of Investment	42.10%			42.10%
Number of properties | property	50			50
Average Investment per Bed/Unit | $ / item				93.38
SNF | SNF Beds
Real Estate [Line Items]
Number of beds/units	6,113			6,113
SNF | ALF Units
Real Estate [Line Items]
Number of beds/units	236			236
ALF
Real Estate [Line Items]
Gross Investment | $	$ 800,963			$ 800,963
Percentage of Investment	57%			57%
Number of properties | property	92			92
Average Investment per Bed/Unit | $ / item				150.47
ALF | North Carolina
Real Estate [Line Items]
Number of properties | property					4
ALF | ALF Units
Real Estate [Line Items]
Number of beds/units	5,323			5,323
ILF/ALF/MC | Georgia
Real Estate [Line Items]
Payments to Acquire Real Estate | $				$ 51,111
ALF & MC | North Carolina
Real Estate [Line Items]
Number of beds/units			523
Mezzanine loan
Real Estate [Line Items]
Interest rate (as a percent)					8%
Number of beds/units	136			136	621
Loan Term					5 years
Extension term number of options					2
Additional interest income related to the exit IRR | $			$ 1,380
Mezzanine loan | Georgia
Real Estate [Line Items]
Interest rate (as a percent)	8.75%
Number of beds/units	130			130
Loan Term	5 years
Mezzanine loan | ILF/ALF/MC | Georgia
Real Estate [Line Items]
Gross Investment | $	$ 42,251			$ 42,251
Mortgage loans with 7.5% Interest Maturing 2024 | Mezzanine loan
Real Estate [Line Items]
Notes receivable, net of credit loss reserve | $	7,461			$ 7,461
Mortgage loans with 8.8% Interest Maturing 2028 | SNF
Real Estate [Line Items]
Interest rate (as a percent)				8.75%
Mortgage loans with 8.8% Interest Maturing 2028 | SNF | Illinois
Real Estate [Line Items]
Interest rate (as a percent)		8.75%
Gross Investment | $	$ 16,500	$ 16,500		$ 16,500
Number of beds/units	150	150		150
Mortgage loans with 9.8% Interest Maturing 2045 | SNF
Real Estate [Line Items]
Interest rate (as a percent)				10.10%
Mortgage Loans
Real Estate [Line Items]
Gross Investment | $	$ 478,344			$ 478,344
Percentage of Investment	100%			100%
Number of Loans | loan				13
Number of properties | property	44			44
Average Investment per Bed/Unit | $ / item				116.75
Number of borrowers	7			7
Number of states in which properties are located | state	8			8
Mortgage Loans | SNF Beds
Real Estate [Line Items]
Number of beds/units	3,041			3,041
Mortgage Loans | ALF Units
Real Estate [Line Items]
Number of beds/units	1,056			1,056
Mortgage Loans | SNF
Real Estate [Line Items]
Interest rate (as a percent)				2.25%
Mortgage Loans | ALF
Real Estate [Line Items]
Internal Rate of Return				8%
Mortgage Loans | ILF/ALF/MC | Georgia
Real Estate [Line Items]
Interest rate (as a percent)				7.50%
Gross Investment | $	$ 51,111			$ 51,111
Number of beds/units	203			203
Internal Rate of Return				7.75%
Payments to Acquire Real Estate | $				$ 51,111
Mortgage Loans | Mortgage loans with 7.5% Interest Maturing 2023 | SNF
Real Estate [Line Items]
Number of beds/units	91			91
Mortgage Loans | Mortgage loans with 7.5% Interest Maturing 2024 | SNF
Real Estate [Line Items]
Interest rate (as a percent)				7.50%
Gross Investment | $	$ 29,346			$ 29,346
Percentage of Investment	6.10%			6.10%
Number of Loans | loan				1
Number of properties | property	1			1
Average Investment per Bed/Unit | $ / item				155.27
Mortgage Loans | Mortgage loans with 7.5% Interest Maturing 2024 | SNF | SNF Beds
Real Estate [Line Items]
Number of beds/units	189			189
Mortgage Loans | Mortgage loans with 7.5% Interest Maturing 2024 | OTH
Real Estate [Line Items]
Interest rate (as a percent)				7.50%
Gross Investment | $	$ 1,961			$ 1,961
Percentage of Investment	0.40%			0.40%
Number of Loans | loan				1
Mortgage Loans | Mortgage loans with 7.5% Interest Maturing 2024 | ALF
Real Estate [Line Items]
Interest rate (as a percent)				7.50%
Gross Investment | $	$ 51,111			$ 51,111
Percentage of Investment	10.70%			10.70%
Number of Loans | loan				1
Number of properties | property	1			1
Average Investment per Bed/Unit | $ / item				251.78
Mortgage Loans | Mortgage loans with 7.5% Interest Maturing 2024 | ALF | ALF Units
Real Estate [Line Items]
Number of beds/units	203			203
Mortgage Loans | Mortgage loans with 7.8% Interest Maturing 2025 | ALF
Real Estate [Line Items]
Interest rate (as a percent)				7.80%
Gross Investment | $	$ 16,706			$ 16,706
Percentage of Investment	3.50%			3.50%
Number of Loans | loan				1
Number of properties | property	1			1
Average Investment per Bed/Unit | $ / item				245.68
Mortgage Loans | Mortgage loans with 7.8% Interest Maturing 2025 | ALF | ALF Units
Real Estate [Line Items]
Number of beds/units	68			68
Mortgage Loans | Mortgage loans with 7.3% Interest Maturing 2025, NC | ALF
Real Estate [Line Items]
Interest rate (as a percent)				7.30%
Gross Investment | $	$ 10,750			$ 10,750
Percentage of Investment	2.20%			2.20%
Number of Loans | loan				1
Number of properties | property	1			1
Average Investment per Bed/Unit | $ / item				238.89
Mortgage Loans | Mortgage loans with 7.3% Interest Maturing 2025, NC | ALF | ALF Units
Real Estate [Line Items]
Number of beds/units	45			45
Mortgage Loans | Mortgage loans with 7.3% Interest Maturing 2025, NC | ALF | ALF Units | North Carolina
Real Estate [Line Items]
Interest rate (as a percent)				7.25%
Number of beds/units	45			45
Loan Term				2 years
Internal Rate of Return				9%
Mortgage Loans | Mortgage loans with 7.3% Interest Maturing 2025, NC/SC | ALF
Real Estate [Line Items]
Interest rate (as a percent)				7.30%
Gross Investment | $	$ 58,331			$ 58,331
Percentage of Investment	12.20%			12.20%
Number of Loans | loan				1
Number of properties | property	13			13
Average Investment per Bed/Unit | $ / item				111.53
Mortgage Loans | Mortgage loans with 7.3% Interest Maturing 2025, NC/SC | ALF | ALF Units
Real Estate [Line Items]
Number of beds/units	523			523
Mortgage Loans | Mortgage loans with 7.3% Interest Maturing 2026 | OTH
Real Estate [Line Items]
Interest rate (as a percent)				7.30%
Gross Investment | $	$ 826			$ 826
Percentage of Investment	0.20%			0.20%
Number of Loans | loan				1
Mortgage Loans | Mortgage loans with 7.3% Interest Maturing 2026 | ALF
Real Estate [Line Items]
Interest rate (as a percent)				7.30%
Gross Investment | $	$ 34,043			$ 34,043
Percentage of Investment	7.10%			7.10%
Number of Loans | loan				1
Number of properties | property	4			4
Average Investment per Bed/Unit | $ / item				156.88
Mortgage Loans | Mortgage loans with 7.3% Interest Maturing 2026 | ALF | ALF Units
Real Estate [Line Items]
Number of beds/units	217			217
Mortgage Loans | Mortgage loans with 8.8% Interest Maturing 2028 | SNF
Real Estate [Line Items]
Interest rate (as a percent)				8.80%
Gross Investment | $	$ 16,500			$ 16,500
Percentage of Investment	3.50%			3.50%
Number of Loans | loan				1
Number of properties | property	1			1
Average Investment per Bed/Unit | $ / item				110
Mortgage Loans | Mortgage loans with 8.8% Interest Maturing 2028 | SNF | SNF Beds
Real Estate [Line Items]
Number of beds/units	150			150
Mortgage Loans | Mortgage loans with 10.6% Interest Maturing 2043 | SNF
Real Estate [Line Items]
Interest rate (as a percent)				10.60%
Gross Investment | $	$ 184,220			$ 184,220
Percentage of Investment	38.50%			38.50%
Number of Loans | loan				1
Number of properties | property	15			15
Average Investment per Bed/Unit | $ / item				98.25
Mortgage Loans | Mortgage loans with 10.6% Interest Maturing 2043 | SNF | SNF Beds
Real Estate [Line Items]
Number of beds/units	1,875			1,875
Mortgage Loans | Mortgage loans with 9.6% Interest Maturing 2045 [Member] | SNF
Real Estate [Line Items]
Interest rate (as a percent)				9.70%
Gross Investment | $	$ 40,000			$ 40,000
Percentage of Investment	8.40%			8.40%
Number of Loans | loan				1
Number of properties | property	4			4
Average Investment per Bed/Unit | $ / item				83.33
Mortgage Loans | Mortgage loans with 9.6% Interest Maturing 2045 [Member] | SNF | SNF Beds
Real Estate [Line Items]
Number of beds/units	480			480
Mortgage Loans | Mortgage loans with 9.8% Interest Maturing 2045 | SNF
Real Estate [Line Items]
Interest rate (as a percent)				10.10%
Mortgage Loans | Mortgage Loans with 10.1% Interest Maturing 2045 | SNF
Real Estate [Line Items]
Gross Investment | $	$ 19,700			$ 19,700
Percentage of Investment	4.10%			4.10%
Number of Loans | loan				1
Number of properties | property	2			2
Average Investment per Bed/Unit | $ / item				98.01
Mortgage Loans | Mortgage Loans with 10.1% Interest Maturing 2045 | SNF | SNF Beds
Real Estate [Line Items]
Number of beds/units	201			201
Mortgage Loans | Mortgage loans with 10.3% Interest Maturing 2045 | SNF
Real Estate [Line Items]
Interest rate (as a percent)				10.30%
Gross Investment | $	$ 14,850			$ 14,850
Percentage of Investment	3.10%			3.10%
Number of Loans | loan				1
Number of properties | property	1			1
Average Investment per Bed/Unit | $ / item				101.71
Mortgage Loans | Mortgage loans with 10.3% Interest Maturing 2045 | SNF | SNF Beds
Real Estate [Line Items]
Number of beds/units	146			146
Mortgage Loans | Mortgage Loans With 8.75 Interest | ALF
Real Estate [Line Items]
Interest rate (as a percent)	8.75%			8.75%
Gross Investment | $	$ 19,500			$ 19,500
Number of properties	85			85
Number of beds/units	85			85
Borrower contribution | $	$ 12,100			$ 12,100
Loan Term	3 years			3 years
Extension term number of options | period	2			2
Extension period of mortgage loan on real estate properties	1 year			1 year

Real Estate Investments - Mor_2

Real Estate Investments - Mortgage Loans Activity (Details) $ in Thousands	3 Months Ended			9 Months Ended
	Sep. 30, 2023 USD ($) item property	Jun. 30, 2023 USD ($) item	Mar. 31, 2023 USD ($)	Sep. 30, 2023 USD ($) item property	Sep. 30, 2022 USD ($) a item property loan	Dec. 31, 2022 USD ($) item
Mortgage Loans
Originations and funding under mortgage loans receivable				$ 83,383	$ 35,234
Application of interest reserve				1,609	4,348
Scheduled principal payments received				(301)	(625)
Mortgage loan premium amortization				(5)	(4)
Provision for loan loss reserve				(847)	(389)
Net increase in mortgage loans receivable				83,839	$ 38,564
Number of senior mortgage loans | loan					2
Area of land | a					7.6
Loan Term					4 years
Gross Investment	$ 1,405,848			$ 1,405,848
Interest rate (as a percent)					7.25%
Internal Rate of Return					8%
Number of properties | property	143			143
Number of beds/units | item					217
Percentage of Investment	100%			100%
Notes receivable, net of credit loss reserve	$ 63,056			$ 63,056		$ 58,383
Additional interest income related to the exit IRR				1,380
Maximum
Mortgage Loans
Loan Term					4 years
Mortgage Loans
Mortgage Loans
Gross Investment	$ 478,344			$ 478,344
Number of properties | property	44			44
Percentage of Investment	100%			100%
Other Mortgage Loans
Mortgage Loans
Additions to mortgage loans				$ 5,022
Mezzanine loan
Mortgage Loans
Loan Term					5 years
Interest rate (as a percent)					8%
Number of beds/units | item	136			136	621
Additional interest income related to the exit IRR			$ 1,380
Extension term number of options | item					2
Extension term					1 year
Mortgage loans with 7.5% Interest Maturing 2024 | Mezzanine loan
Mortgage Loans
Notes receivable, net of credit loss reserve	$ 7,461			$ 7,461
SNF
Mortgage Loans
Gross Investment	$ 592,880			$ 592,880
Number of properties | property	50			50
Percentage of Investment	42.10%			42.10%
SNF | Mortgage Loans
Mortgage Loans
Interest rate (as a percent)				2.25%
SNF | Mortgage loans with 7.5% Interest Maturing 2024 | Mortgage Loans
Mortgage Loans
Gross Investment	$ 29,346			$ 29,346
Interest rate (as a percent)				7.50%
Number of properties | property	1			1
Percentage of Investment	6.10%			6.10%
SNF | Mortgage loans with 8.8% Interest Maturing 2028
Mortgage Loans
Interest rate (as a percent)				8.75%
SNF | Mortgage loans with 8.8% Interest Maturing 2028 | Mortgage Loans
Mortgage Loans
Gross Investment	$ 16,500			$ 16,500
Interest rate (as a percent)				8.80%
Number of properties | property	1			1
Percentage of Investment	3.50%			3.50%
ALF
Mortgage Loans
Gross Investment	$ 800,963			$ 800,963
Number of properties | property	92			92
Percentage of Investment	57%			57%
ALF | Mortgage Loans
Mortgage Loans
Internal Rate of Return				8%
ALF | Mortgage loans with 7.3% Interest Maturing 2025, NC | Mortgage Loans
Mortgage Loans
Gross Investment	$ 10,750			$ 10,750
Interest rate (as a percent)				7.30%
Number of properties | property	1			1
Percentage of Investment	2.20%			2.20%
ALF | Mortgage loans with 7.5% Interest Maturing 2024 | Mortgage Loans
Mortgage Loans
Gross Investment	$ 51,111			$ 51,111
Interest rate (as a percent)				7.50%
Number of properties | property	1			1
Percentage of Investment	10.70%			10.70%
Florida | SNF
Mortgage Loans
Number of beds/units | item						299
North Carolina | ALF
Mortgage Loans
Number of properties | property					4
Georgia | Mezzanine loan
Mortgage Loans
Loan Term	5 years
Interest rate (as a percent)	8.75%
Number of beds/units | item	130			130
Georgia | ILF/ALF/MC
Mortgage Loans
Payments to Acquire Real Estate				$ 51,111
Georgia | ILF/ALF/MC | Mortgage Loans
Mortgage Loans
Payments to Acquire Real Estate				51,111
Gross Investment	$ 51,111			$ 51,111
Interest rate (as a percent)				7.50%
Internal Rate of Return				7.75%
Number of beds/units | item	203			203
Georgia | ILF/ALF/MC | Mezzanine loan
Mortgage Loans
Gross Investment	$ 42,251			$ 42,251
Illinois | SNF | Mortgage loans with 8.8% Interest Maturing 2028
Mortgage Loans
Gross Investment	$ 16,500	$ 16,500		$ 16,500
Interest rate (as a percent)		8.75%
Number of beds/units | item	150	150		150
SNF Beds
Mortgage Loans
Number of beds/units | item	6,231			6,231
SNF Beds | Mortgage Loans
Mortgage Loans
Number of beds/units | item	3,041			3,041
SNF Beds | SNF
Mortgage Loans
Number of beds/units | item	6,113			6,113
SNF Beds | SNF | Mortgage loans with 7.5% Interest Maturing 2024 | Mortgage Loans
Mortgage Loans
Number of beds/units | item	189			189
SNF Beds | SNF | Mortgage loans with 8.8% Interest Maturing 2028 | Mortgage Loans
Mortgage Loans
Number of beds/units | item	150			150
ALF Units
Mortgage Loans
Number of beds/units | item	5,559			5,559
ALF Units | Mortgage Loans
Mortgage Loans
Number of beds/units | item	1,056			1,056
ALF Units | SNF
Mortgage Loans
Number of beds/units | item	236			236
ALF Units | ALF
Mortgage Loans
Number of beds/units | item	5,323			5,323
ALF Units | ALF | Mortgage loans with 7.3% Interest Maturing 2025, NC | Mortgage Loans
Mortgage Loans
Number of beds/units | item	45			45
ALF Units | ALF | Mortgage loans with 7.5% Interest Maturing 2024 | Mortgage Loans
Mortgage Loans
Number of beds/units | item	203			203
ALF Units | North Carolina | ALF | Mortgage loans with 7.3% Interest Maturing 2025, NC | Mortgage Loans
Mortgage Loans
Loan Term				2 years
Interest rate (as a percent)				7.25%
Internal Rate of Return				9%
Number of beds/units | item	45			45

Real Estate Investments - Accru

Real Estate Investments - Accrued Interest Receivable (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022
Real Estate Investments
Interest Receivable	$ 54,605		$ 46,000
Write-off of accrued interest receivable	$ 0	$ 0

Investment in Unconsolidated _3

Investment in Unconsolidated Joint Ventures - Investment (Details) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023 USD ($) item	Sep. 30, 2022 USD ($) item	Sep. 30, 2023 USD ($) item	Sep. 30, 2022 USD ($) item	Dec. 31, 2022 USD ($)
Investment in Unconsolidated Joint Ventures
Number of beds/units | item		217		217
Carrying Value	$ 19,340		$ 19,340		$ 19,340
Percentage of Investment	100%		100%
Application of Interest Reserve			$ 1,788	$ 4,348
Income from unconsolidated joint ventures	$ 375	$ 376	$ 1,127	1,127
Joint Venture | Not primary beneficiary
Investment in Unconsolidated Joint Ventures
Number of beds/units | item	95		95
Carrying Value	$ 19,340		$ 19,340
Income Recognized			1,127	1,127
Cash Interest Earned				351
Application of Interest Reserve			1,127	776
UDP | Joint Venture | Not primary beneficiary
Investment in Unconsolidated Joint Ventures
Income Recognized			790	790
Cash Interest Earned				351
Application of Interest Reserve			$ 790	439
UDP | Joint Venture | Not primary beneficiary | Washington
Investment in Unconsolidated Joint Ventures
Preferred return percentage			14%
Contractual cash portion			8%
Number of beds/units | item	267		267
Carrying Value	$ 13,000		$ 13,000
Percentage of Investment	11%		11%
Percentage of cash return			8%
Percentage of internal rate of return			14%
Combination ALF/MC | Joint Venture | Not primary beneficiary
Investment in Unconsolidated Joint Ventures
Income Recognized			$ 337	337
Application of Interest Reserve			$ 337	$ 337
Combination ALF/MC | Joint Venture | Not primary beneficiary | Internal Rate of Return is Until Eight Percent
Investment in Unconsolidated Joint Ventures
Percentage of internal rate of return			8%
Combination ALF/MC | Joint Venture | Not primary beneficiary | The Internal Rate of Return is Between Twelve and Fourteen Percent | Minimum
Investment in Unconsolidated Joint Ventures
Percentage of internal rate of return			12%
Combination ALF/MC | Joint Venture | Not primary beneficiary | The Internal Rate of Return is Between Twelve and Fourteen Percent | Maximum
Investment in Unconsolidated Joint Ventures
Percentage of internal rate of return			14%
Combination ALF/MC | Joint Venture | Not primary beneficiary | Washington
Investment in Unconsolidated Joint Ventures
Preferred return percentage			12%
Contractual cash portion			7%
Number of beds/units | item	95		95
Carrying Value	$ 6,340		$ 6,340
Percentage of Investment	15.50%		15.50%
Combination ALF/MC | Joint Venture | Not primary beneficiary | Washington | Internal Rate of Return is Until Eight Percent | Minimum
Investment in Unconsolidated Joint Ventures
Percentage of cash return			7%
Combination ALF/MC | Joint Venture | Not primary beneficiary | Washington | Internal Rate of Return is Until Eight Percent | Maximum
Investment in Unconsolidated Joint Ventures
Percentage of cash return			9%

Notes Receivable - Investment i

Notes Receivable - Investment in Notes Receivable (Details) $ in Thousands	3 Months Ended	9 Months Ended
	Sep. 30, 2023 USD ($) item	Sep. 30, 2023 USD ($) item loan	Sep. 30, 2022 item
Notes Receivable
Internal Rate of Return			8%
Gross Investment	$ 1,405,848	$ 1,405,848
Number of units | item			217
Loan Term			4 years
Interest rate (as a percent)			7.25%
ALF
Notes Receivable
Gross Investment	800,963	800,963
SNF
Notes Receivable
Gross Investment	592,880	592,880
Notes Receivable
Notes Receivable
Gross Investment	63,693	$ 63,693
Number of Loans | loan		10
Working capital loans | Working capital loan 5% interest rate, 2024 maturity | ALF
Notes Receivable
Gross Investment	2,442	$ 2,442
Number of Loans | loan		1
Interest rate (as a percent)		5%
Working capital loans | Working capital loan 4% interest rate, 2024 maturity | SNF
Notes Receivable
Gross Investment	13,531	$ 13,531
Number of Loans | loan		1
Interest rate (as a percent)		4%
Working capital loans | Working capital loan 5% interest rate, 2025 maturity | ALF
Notes Receivable
Gross Investment	732	$ 732
Number of Loans | loan		1
Interest rate (as a percent)		5%
Working capital loans | Working capital loan 7.5% interest rate, 2027 maturity | ALF
Notes Receivable
Gross Investment	550	$ 550
Number of Loans | loan		1
Interest rate (as a percent)		7.50%
Working capital loans | Working capital loan 6.5% interest rate, 2030 maturity | SNF
Notes Receivable
Gross Investment	138	$ 138
Number of Loans | loan		1
Interest rate (as a percent)		6.50%
Working capital loans | Working capital loan 7.1% interest rate, 2030 maturity | ALF
Notes Receivable
Gross Investment	500	$ 500
Number of Loans | loan		1
Interest rate (as a percent)		7.30%
Working capital loans | Working capital loan 7.3% interest rate, 2030 maturity | ALF
Notes Receivable
Gross Investment	1,107	$ 1,107
Number of Loans | loan		1
Interest rate (as a percent)		7.30%
Working capital loans | Working capital loan 7% interest rate, 2031 maturity | ALF
Notes Receivable
Gross Investment	$ 2,693	$ 2,693
Number of Loans | loan		1
Interest rate (as a percent)		7%
Mezzanine loan
Notes Receivable
Number of units | item	136	136	621
Loan Term			5 years
IRR on mortgage loan on real estate property			11%
Interest rate (as a percent)			8%
Mezzanine loan | Georgia
Notes Receivable
Number of units | item	130	130
Loan Term	5 years
IRR on mortgage loan on real estate property	12%
Number of additional units under construction | item	89	89
Interest rate (as a percent)	8.75%
Mezzanine loan | Mezzanine loan loan 8% interest rate, 2027 maturity | ALF
Notes Receivable
Internal Rate of Return		11%
Gross Investment	$ 25,000	$ 25,000
Number of Loans | loan		1
Interest rate (as a percent)		8%
Mezzanine loan | Mezzanine loan loan 8.8% interest rate, 2028 maturity | ALF
Notes Receivable
Internal Rate of Return		12%
Gross Investment	$ 17,000	$ 17,000
Number of Loans | loan		1
Interest rate (as a percent)		8.80%

Notes Receivable - Components (

Notes Receivable - Components (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Notes receivable activities
Notes receivable loan loss reserve	$ (637)	$ (589)
Total	63,056	58,383
Mezzanine loan
Notes receivable activities
Mezzanine loan	42,000	36,815
Working capital loans
Notes receivable activities
Mezzanine loan	$ 21,693	$ 22,157

Notes Receivable - Notes Receiv

Notes Receivable - Notes Receivable Activity (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Notes receivable activities
Advances under notes receivable	$ 19,258	$ 37,008
Principal payments received under notes receivable	(14,537)
Principal payments received under notes receivable	(7,077)	(6,618)
Provision for credit losses	(48)	(303)
Net increase in notes receivable	$ 4,673	$ 30,087

Notes Receivable - New Loan Com

Notes Receivable - New Loan Commitment (Details) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023 USD ($) item	Mar. 31, 2023 USD ($)	Sep. 30, 2023 USD ($) item	Sep. 30, 2022 USD ($) item property
Notes receivable activities
Gross Investment	$ 1,405,848		$ 1,405,848
Principal payments received on notes receivable			7,077	$ 6,618
Additional interest income related to the exit IRR			1,380
Amounts funded			19,258	$ 37,008
Loan Term				4 years
Interest rate (as a percent)				7.25%
Number of units | item				217
Mortgage Loans
Notes receivable activities
Gross Investment	478,344		478,344
Mortgage Loans | ILF/ALF/MC | Georgia
Notes receivable activities
Gross Investment	$ 51,111		$ 51,111
Interest rate (as a percent)			7.50%
Number of units | item	203		203
Loan principal amount	$ 7,461		$ 7,461
Maximum
Notes receivable activities
Loan Term				4 years
Mezzanine loan
Notes receivable activities
Principal payments received on notes receivable			4,545
Additional interest income related to the exit IRR		$ 1,380
Exit IRR			$ 190
Amounts funded				$ 25,000
Number of property | property				5
Loan Term				5 years
Extension term number of options | item				2
Extension term				1 year
Interest rate (as a percent)				8%
IRR on mortgage loan on real estate property				11%
Number of real estate property communities | property				5
Number of units | item	136		136	621
Mezzanine loan | Georgia
Notes receivable activities
Number of additional units under construction | item	89		89
Loan Term	5 years
Interest rate (as a percent)	8.75%
IRR on mortgage loan on real estate property	12%
Number of units | item	130		130
Mezzanine loan | ILF/ALF/MC | Georgia
Notes receivable activities
Gross Investment	$ 42,251		$ 42,251
Notes Receivable
Notes receivable activities
Gross Investment	$ 63,693		$ 63,693

Lease Incentives - Activity (De

Lease Incentives - Activity (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2023 USD ($) property	Sep. 30, 2022 USD ($)	Dec. 31, 2022 USD ($)
Collaborative Arrangements and Non-collaborative Arrangement Transactions [Line Items]
Non-contingent lease incentives	$ 2,193		$ 1,789
Lease incentives funded	1,023	$ 418
Amortization of lease incentives	(584)	(665)
Adjustment for collectability of lease incentives		(256)
Other adjustments	(35)	(174)
Net decrease in non-contingent lease incentives	$ 404	$ (677)
Number of properties with lease incentives write-offs | property	2
ALF
Collaborative Arrangements and Non-collaborative Arrangement Transactions [Line Items]
Amount of joint venture investment	$ 54,134
Amount committed to fund	2,100
Amount funded under lease incentives	$ 1,004
Number of properties with lease incentives write-offs | property	12

Debt Obligations - Bank Borrowi

Debt Obligations - Bank Borrowings (Details)	3 Months Ended	9 Months Ended
	Dec. 31, 2022	Sep. 30, 2023 USD ($) loan
Debt Obligations
Basis spread over base rate (as a percent)	0.10%
Number of term loans | loan		2
Revolving line of credit
Debt Obligations
Unused commitment fee (as a percent)		0.20%
Revolving line of credit | SOFR
Debt Obligations
Basis spread over base rate (as a percent)		1.20%
Credit Agreement
Debt Obligations
Maximum available under facility		$ 500,000,000
Contingent increase in maximum borrowing capacity		$ 1,000,000,000
Additional extension period option		1 year
Revolving Credit Facility
Debt Obligations
Maximum available under facility		$ 400,000,000
Term loans
Debt Obligations
Maximum available under facility		$ 50,000,000
Term loans | SOFR
Debt Obligations
Basis spread over base rate (as a percent)		1.40%

Debt Obligations - Interest Rat

Debt Obligations - Interest Rate Swap Agreement (Details) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023 USD ($) item	Sep. 30, 2022 USD ($)	Sep. 30, 2023 USD ($) item	Sep. 30, 2022 USD ($)	Dec. 31, 2022 USD ($)
Debt Obligations
Notional Amount	$ 100,000		$ 100,000
Fair Value	$ 8,596		$ 8,596		$ 8,719
Interest Rate Swap
Debt Obligations
Number of interest rate swaps | item	2		2
Interest Rate Swap | Minimum
Debt Obligations
Debt instrument term			4 years
Interest Rate Swap | Maximum
Debt Obligations
Debt instrument term			5 years
Interest Rate Swap | Cash Flow Hedging
Debt Obligations
Increase (decrease) in fair value	$ 28,000	$ 3,306,000	$ (123,000)	$ 9,617,000
Interest Rate Swap | Cash Flow Hedging | Maturing on November 19, 2025
Debt Obligations
Notional Amount	50,000		50,000
Fair Value	3,776		3,776		4,003
Interest Rate Swap | Cash Flow Hedging | Maturing on November 19, 2026
Debt Obligations
Notional Amount	50,000		50,000
Fair Value	$ 4,820		$ 4,820		$ 4,716
Interest Rate Swap | Cash Flow Hedging | SOFR | Maturing on November 19, 2025
Debt Obligations
Swap rate (in percentage)	2.62%		2.62%
Interest Rate Swap | Cash Flow Hedging | SOFR | Maturing on November 19, 2026
Debt Obligations
Swap rate (in percentage)	2.76%		2.76%

Debt Obligations - Senior Unsec

Debt Obligations - Senior Unsecured Notes (Details)	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Debt Obligations
Interest rate (as a percent)		7.25%
Senior Unsecured Notes | Minimum
Debt Obligations
Interest rate (as a percent)	3.66%
Senior Unsecured Notes | Maximum
Debt Obligations
Interest rate (as a percent)	5.03%
Revolving line of credit
Financial covenants
Maximum ratio of total indebtedness to total asset value	0.6
Maximum ratio of secured debt to total asset value	0.35
Maximum ratio of unsecured debt to the value of the unencumbered asset pool	0.6
Minimum ratio of EBITDA to fixed charges	1.50

Debt Obligations - Component (D

Debt Obligations - Component (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Debt Obligations
Applicable Interest Rate (as a percent)	4.97%
Outstanding Balance	$ 956,223	$ 767,854
Available for borrowing	$ 37,750	270,000
Revolving line of credit
Debt Obligations
Applicable Interest Rate (as a percent)	6.63%
Outstanding Balance	$ 362,250	130,000
Available for borrowing	$ 37,750	270,000
Term loans
Debt Obligations
Applicable Interest Rate (as a percent)	2.74%
Outstanding Balance	$ 99,620	99,511
Senior Unsecured Notes
Debt Obligations
Applicable Interest Rate (as a percent)	4.20%
Outstanding Balance	$ 494,353	$ 538,343

Debt Obligations - Borrowings a

Debt Obligations - Borrowings and Repayments (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Borrowings
Borrowings from revolving line of credit	$ 274,450	$ 194,000
Total	274,450	269,000
Repayments
Revolving line of credit	(42,200)	(153,900)
Senior unsecured notes	(44,160)	(43,160)
Total	(86,360)	(197,060)
Revolving line of credit
Borrowings
Borrowings from revolving line of credit	274,450	194,000
Repayments
Revolving line of credit	(42,200)	(153,900)
Senior Unsecured Notes
Borrowings
Senior unsecured notes		75,000
Repayments
Senior unsecured notes	$ (44,160)	$ (43,160)

Equity - Noncontrolling Interes

Equity - Noncontrolling Interest (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2022 USD ($) Center item	Sep. 30, 2023 USD ($) item	Jun. 30, 2023 item	Mar. 31, 2023 item	Sep. 30, 2022 item
Noncontrolling interest
Gross Consolidated Assets	$ 1,656,103	$ 1,867,863
Non-controlling interests	$ 21,940	$ 34,974
Number of units | item					217
ALF & MC
Noncontrolling interest
Number of Assisted Living and Memory Care Communities | item		11
SNF
Noncontrolling interest
Skilled nursing center purchased | Center	3
Partnership
Noncontrolling interest
Gross Consolidated Assets		$ 319,536
Non-controlling interests		34,973
Ohio | ILF/ALF/MC
Noncontrolling interest
Number of units | item			242
Ohio | 2023 Acquisitions | Partnership | ILF/ALF/MC
Noncontrolling interest
Gross Consolidated Assets		54,714
Non-controlling interests		9,134
North Carolina | ALF & MC
Noncontrolling interest
Number of Assisted Living and Memory Care Communities | item				11
Number of units | item				523
North Carolina | 2023 Acquisitions | Partnership | ALF & MC
Noncontrolling interest
Gross Consolidated Assets		121,321
Non-controlling interests		3,831
Florida | SNF
Noncontrolling interest
Skilled nursing center purchased | item	3
Number of units | item	299
Florida | 2022 Acquisitions | Partnership | SNF
Noncontrolling interest
Gross Consolidated Assets		76,712
Non-controlling interests		14,325
Oregon | 2018 Acquisitions | Partnership | ALF & MC
Noncontrolling interest
Gross Consolidated Assets		18,452
Non-controlling interests		1,231
Oregon | 2018 Acquisitions | Partnership | ILF
Noncontrolling interest
Gross Consolidated Assets		14,650
Non-controlling interests		2,907
Wisconsin | 2017 Acquisitions | Partnership | ILF/ALF/MC
Noncontrolling interest
Gross Consolidated Assets		22,007
Non-controlling interests		2,305
South Carolina | 2017 Acquisitions | Partnership | ALF & MC
Noncontrolling interest
Gross Consolidated Assets		11,680
Non-controlling interests		$ 1,240

Equity - Common Stock (Details)

Equity - Common Stock (Details) - USD ($)	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Equity
Proceeds from common stock issued, net of issuance costs	$ 1,777,000	$ 38,957,000
Equity Distribution Agreements
Equity
Amount available under effective shelf registration statement	$ 128,822,000
Common Stock
Equity
Number of shares repurchased	43,933	39,463
Common Stock | Equity Distribution Agreements
Equity
Maximum offering capacity under shelf registration statement	$ 200,000,000
Shares common stock sold	48,500
Proceeds from common stock issued, net of issuance costs	$ 1,777,000
Reclassification of accumulated costs to additional paid in capital	$ 80,000

Equity - Distributions (Details

Equity - Distributions (Details) - USD ($) $ / shares in Units, $ in Thousands	1 Months Ended			3 Months Ended						9 Months Ended
	Dec. 31, 2023	Nov. 30, 2023	Oct. 31, 2023	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2022	Jun. 30, 2022	Mar. 31, 2022	Sep. 30, 2023	Sep. 30, 2022
Dividend Distributions
Paid										$ 70,767	$ 68,202
Common Stock cash distributions				$ 0.57	$ 0.57	$ 0.57	$ 0.57	$ 0.57	$ 0.57	$ 1.71	$ 1.71
Subsequent Event | Dividend Payable, October 31, 2023
Dividend Distributions
Dividends declared and paid per common share			$ 0.19
Subsequent Event | Dividend Payable, November 30, 2023
Dividend Distributions
Dividends declared and paid per common share		$ 0.19
Subsequent Event | Dividend Payable, December 29, 2023
Dividend Distributions
Dividends declared and paid per common share	$ 0.19
Common Stock
Dividend Distributions
Declared				$ 70,767			$ 68,202			$ 70,767	$ 68,202
Paid										$ 70,767	$ 68,202
Common Stock cash distributions										$ 0.19	$ 0.19
Common Stock | Subsequent Event | Dividend Payable, October 31, 2023
Dividend Distributions
Dividends declared and paid per common share			$ 0.19
Common Stock | Subsequent Event | Dividend Payable, November 30, 2023
Dividend Distributions
Dividends declared and paid per common share		$ 0.19
Common Stock | Subsequent Event | Dividend Payable, December 29, 2023
Dividend Distributions
Dividends declared and paid per common share	$ 0.19

Equity - Stock-Based Compensati

Equity - Stock-Based Compensation plans (Details)	9 Months Ended
	Sep. 30, 2023 shares	Sep. 30, 2022 shares
Stock Based Compensation Plans
Options outstanding (in shares)	5,000
Options exercisable (in shares)	5,000
Options expired and cancelled (in shares)	5,000	5,000
Stock options granted (in shares)	0	0
2015 Plan
Stock Based Compensation Plans
Ratio of shares subject to award granted	1
2021 Plan
Stock Based Compensation Plans
Total shares reserved for issuance of common stock related to the conversion of preferred stock	1,900,000

Equity - Restricted Stock and P

Equity - Restricted Stock and Performance-based Stock Units (Details) - USD ($) $ / shares in Units, $ in Thousands	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Stock Based Compensation Plans
Stock options granted (in shares)	0	0
Restricted stock and performance-based stock units
Restricted stock and performance based stock units activity
Granted (in shares)	232,887	221,542
Compensation expense
Compensation expense related to share-based award	$ 6,349	$ 5,951
Remaining compensation expense	11,752
Restricted stock and performance-based stock units | October - December 2023
Compensation expense
Remaining compensation expense	2,132
Restricted stock and performance-based stock units | 2024
Compensation expense
Remaining compensation expense	6,026
Restricted stock and performance-based stock units | 2025
Compensation expense
Remaining compensation expense	3,238
Restricted stock and performance-based stock units | 2026
Compensation expense
Remaining compensation expense	$ 356
Restricted stock and performance-based stock units | Grant Date Price $37.16 | Three year vesting
Restricted stock and performance based stock units activity
Granted (in shares)	127,960
Granted (in dollars per share)	$ 37.16
Vesting period	3 years
Restricted stock and performance-based stock units | Grant Date Price $37.16 | TSR Targets
Restricted stock and performance based stock units activity
Granted (in shares)	86,867
Granted (in dollars per share)	$ 37.16
Vesting period	4 years
Restricted stock and performance-based stock units | Grant Date Price $37.16 | Accelerated TSR Targets
Restricted stock and performance based stock units activity
Vesting period	3 years
Restricted stock and performance-based stock units | Grant Date Price $31.54 | Vesting Date May 24,2024
Restricted stock and performance based stock units activity
Granted (in shares)	15,060
Granted (in dollars per share)	$ 31.54
Restricted stock and performance-based stock units | Grant Date Price 35.45 | Vesting Date July 25, 2024
Restricted stock and performance based stock units activity
Granted (in shares)	3,000
Granted (in dollars per share)	$ 35.45
Restricted stock and performance-based stock units | Grant Date Price $33.94 | Three year vesting
Restricted stock and performance based stock units activity
Granted (in shares)		122,865
Granted (in dollars per share)		$ 33.94
Vesting period		3 years
Restricted stock and performance-based stock units | Grant Date Price $33.94 | TSR Targets
Restricted stock and performance based stock units activity
Granted (in shares)		86,332
Granted (in dollars per share)		$ 33.94
Restricted stock and performance-based stock units | Grant Date Price $38.48 | Vesting Date, May 25, 2023
Restricted stock and performance based stock units activity
Granted (in shares)		12,345
Granted (in dollars per share)		$ 38.48
Restricted stock
Restricted stock and performance based stock units activity
Outstanding at the beginning of the period (in shares)	229,236	197,422
Granted (in shares)	146,020	135,210
Vested (in shares)	(115,551)	(103,396)
Canceled (in shares)	(1,085)
Outstanding at the end of the period (in shares)	258,620	229,236

Commitments and Contingencies -

Commitments and Contingencies - Summary of Commitments (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2023 USD ($) property
Commitments and Contingencies
Investment Commitment	$ 103,890
2023 Funding	6,670
Total Commitment funded	26,805
Remaining commitment	77,085
Skilled Nursing Centers
Commitments and Contingencies
Fair value of earn-out liability	3,000
Earn-out liability, Write off	$ 3,000
Number of properties acquired | property	4
Real estate properties
Commitments and Contingencies
Investment Commitment	$ 10,242
2023 Funding	1,932
Total Commitment funded	2,650
Remaining commitment	7,592
Accrued incentives and earn-out liabilities
Commitments and Contingencies
Investment Commitment	21,100
2023 Funding	1,004
Total Commitment funded	1,004
Remaining commitment	20,096
Mortgage loans
Commitments and Contingencies
Investment Commitment	43,598
2023 Funding	1,476
Total Commitment funded	7,178
Remaining commitment	36,420
Commitments To Expand and Renovate Properties
Commitments and Contingencies
Investment Commitment	6,098
Contingent Funding Commitments
Commitments and Contingencies
Investment Commitment	18,000
Notes receivable
Commitments and Contingencies
Investment Commitment	28,950
2023 Funding	2,258
Total Commitment funded	15,973
Remaining commitment	12,977
Construction loans
Commitments and Contingencies
Investment Commitment	$ 19,500

Major Operators (Details)

Major Operators (Details) $ in Thousands	1 Months Ended			9 Months Ended
	Dec. 31, 2023 USD ($)	Nov. 30, 2023 USD ($)	Oct. 31, 2023 USD ($)	Sep. 30, 2023 USD ($) property item	Sep. 30, 2022 item	Jun. 30, 2023 USD ($)
Major Operators
Number of major operators | item				1
Number of beds/units | item					217
Interest payment receivable on mortgage loan deferred				$ 900		$ 600
Interest rate (as a percent)					7.25%
Prestige Healthcare Mortgage Loan [Member]
Major Operators
Interest receivable on mortgage loan deferral monthly cap amount				300
Prestige Healthcare Mortgage Loan [Member] | Subsequent Event
Major Operators
Amount of letter of credit drawn down for the repayment of deferred interest outstanding	$ 334	$ 334	$ 2,767
Amount of letter of credit owned as collateral for mortgage loans			4,945
Amount of interest payment receivable on mortgage loan			$ 19,539
Interest rate (as a percent)			8.50%
Prestige Healthcare Mortgage Loan [Member] | Maximum
Major Operators
Interest payment receivable on mortgage loan deferred				$ 1,500
SNF | Prestige Healthcare Mortgage Loan [Member]
Major Operators
Number of beds/units | item				15
Prestige Healthcare | SNF
Major Operators
Number of beds | property				24
Number of beds/units | item				2,820
Prestige Healthcare | ALF
Major Operators
Number of beds/units | item				93
Total Revenues | Operator Concentration Risk | Prestige Healthcare
Major Operators
Concentration risk (as a percent)				16.60%
Total Assets | Credit Concentration Risk | Prestige Healthcare
Major Operators
Concentration risk (as a percent)				14.20%

Earnings per Share (Details)

Earnings per Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2022	Jun. 30, 2022	Mar. 31, 2022	Sep. 30, 2023	Sep. 30, 2022
Net income	$ 22,627	$ 6,604	$ 33,561	$ 13,389	$ 54,490	$ 14,507	$ 62,792	$ 82,386
Less income allocated to non-controlling interests	(430)			(99)			(1,287)	(301)
Less income allocated to participating securities:
Non-forfeitable dividends on participating securities	(147)			(131)			(440)	(401)
Income allocated to participating securities								(80)
Total net income allocated to participating securities	(147)			(131)			(440)	(481)
Net income available to common stockholders	22,050			13,159			61,065	81,604
Net income for diluted net income per share	$ 22,050			$ 13,159			$ 61,065	$ 81,604
Reconciliation of shares
Shares for basic net income per share	41,153			40,270			41,127	39,658
Effect of dilutive securities:
Total effect of dilutive securities (in shares)	58			282			58	281
Shares for diluted net income per share	41,211			40,552			41,185	39,939
Basic net income per share (in dollars per share)	$ 0.54			$ 0.33			$ 1.48	$ 2.06
Diluted net income per share (in dollars per share)	$ 0.54			$ 0.32			$ 1.48	$ 2.04
Employee Stock Option [Member]
Effect of dilutive securities:
Stock options and performance-based stock units (in shares)				1
Performance-based stock units
Effect of dilutive securities:
Stock options and performance-based stock units (in shares)	58			281			58	281

Fair Value Measurements (Detail

Fair Value Measurements (Details) $ in Thousands	Sep. 30, 2023 USD ($) item	Dec. 31, 2022 USD ($) item
Fair value measurements
Mortgage loans receivable, net of credit loss reserve	$ 473,567	$ 389,728
Notes receivable, net of credit loss reserve	63,056	58,383
Outstanding Balance	956,223	767,854
Senior unsecured notes, net of debt issue costs	$ 494,353	$ 538,343
Level 3 | Senior Unsecured Notes maturing before 2030 | Discount Rate
Fair value measurements
Future cash outflows discount rate (as a percent) | item	0.0725	0.0650
Level 3 | Senior Unsecured Notes maturing 2030 and after | Discount Rate
Fair value measurements
Future cash outflows discount rate (as a percent) | item	0.0750	0.0700
Level 3 | Financing Receivable | Discount Rate
Fair value measurements
Future cash inflows discount rate (as a percent)	0.076	0.076
Level 3 | Mortgage Loans Receivable | Discount Rate
Fair value measurements
Future cash inflows discount rate (as a percent)	0.091	0.093
Level 3 | Notes Receivable | Discount Rate
Fair value measurements
Future cash inflows discount rate (as a percent) | item	0.068	0.071
Carrying Value
Fair value measurements
Mortgage loans receivable, net of credit loss reserve	$ 473,567	$ 389,728
Revolving line of credit	362,250	130,000
Outstanding Balance	99,620	99,511
Senior unsecured notes, net of debt issue costs	494,353	538,343
Carrying Value | Financing Receivable
Fair value measurements
Notes receivable, net of credit loss reserve	196,053	75,999
Carrying Value | Notes Receivable
Fair value measurements
Notes receivable, net of credit loss reserve	63,056	58,383
Fair Value
Fair value measurements
Revolving line of credit	362,250	130,000
Outstanding Balance	100,000	100,000
Fair Value | Financing Receivable
Fair value measurements
Notes receivable, net of credit loss reserve	199,050	76,033
Fair Value | Level 3
Fair value measurements
Mortgage loans receivable, net of credit loss reserve	560,808	461,276
Senior unsecured notes, net of debt issue costs	429,534	477,653
Fair Value | Level 3 | Notes Receivable
Fair value measurements
Notes receivable, net of credit loss reserve	$ 70,482	$ 61,858

Subsequent Events (Details)

Subsequent Events (Details) $ / shares in Units, $ in Thousands	1 Months Ended			9 Months Ended
	Dec. 31, 2023 USD ($) $ / shares	Nov. 30, 2023 USD ($) $ / shares	Oct. 31, 2023 USD ($) property item $ / shares	Sep. 30, 2023 USD ($) property	Sep. 30, 2022 item
Equity
Number of properties | property				143
Number of beds/units | item					217
Interest rate (as a percent)					7.25%
Brookdale Senior Living | Master lease agreement
Equity
Number of properties | property				35
Lease term				6 years
Rental income to be received in first year				$ 8,000
Fund for capital expenditures				$ 4,500
ALF
Equity
Number of properties | property				92
Subsequent Event | Prestige Healthcare Mortgage Loan [Member]
Equity
Amount of letter of credit drawn down for the repayment of deferred interest outstanding	$ 334	$ 334	$ 2,767
Amount of letter of credit owned as collateral for mortgage loans			4,945
Amount of interest payment receivable on mortgage loan			$ 19,539
Interest rate (as a percent)			8.50%
Subsequent Event | Brookdale Senior Living | Master lease agreement
Equity
Number of properties | property			7
Lease term			3 years
Lease renewal term			4 years
Rental income to be received in first year			$ 960
Rental income to be received in second year			984
Rental income to be received in third year			$ 1,150
Subsequent Event | Brookdale Senior Living | New master lease agreement
Equity
Number of properties | property			17
Rental income to be received in first year			$ 9,325
Fund for capital expenditures			$ 7,150
Subsequent Event | Dividend Payable, October 31, 2023
Equity
Dividends declared and paid per common share | $ / shares			$ 0.19
Subsequent Event | Dividend Payable, November 30, 2023
Equity
Dividends declared and paid per common share | $ / shares		$ 0.19
Subsequent Event | Dividend Payable, December 29, 2023
Equity
Dividends declared and paid per common share | $ / shares	$ 0.19
Subsequent Event | Common Stock | Dividend Payable, October 31, 2023
Equity
Dividends declared and paid per common share | $ / shares			$ 0.19
Subsequent Event | Common Stock | Dividend Payable, November 30, 2023
Equity
Dividends declared and paid per common share | $ / shares		$ 0.19
Subsequent Event | Common Stock | Dividend Payable, December 29, 2023
Equity
Dividends declared and paid per common share | $ / shares	$ 0.19
Subsequent Event | Ohio | Brookdale Senior Living | Master lease agreement
Equity
Number of properties | property			1
Subsequent Event | Texas | Brookdale Senior Living | Master lease agreement
Equity
Number of properties | property			6
Subsequent Event | Oklahoma | Brookdale Senior Living | Master lease agreement
Equity
Number of properties | property			6
Subsequent Event | ALF | Ohio | Brookdale Senior Living | Master lease agreement
Equity
Number of beds/units | item			42
Subsequent Event | ALF | Texas | Brookdale Senior Living | Master lease agreement
Equity
Number of beds/units | item			235
Subsequent Event | ALF | Oklahoma | Brookdale Senior Living | Master lease agreement
Equity
Number of beds/units | item			219

Pay vs Performance Disclosure

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Pay vs Performance Disclosure
Net Income (Loss)	$ 22,197	$ 13,290	$ 61,505	$ 82,085

Insider Trading Arrangements

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