Leases (Tables)

12 Months Ended

Dec. 31, 2021

Leases [Abstract]

Lease Cost

A summary of operating and financing lease expense (including the respective presentation on the consolidated statements of operations) and net cash outflows from leases is as follows.

	Years Ended December 31,
Operating Leases (in thousands)	2021		2020		2019
Facility operating expense	$	12,606	$	19,241	$	18,677
Facility lease expense	174,358		224,033		269,666
Operating lease expense	186,964		243,274		288,343
Operating lease expense adjustment (1)	23,280		136,276		19,453
Changes in operating lease assets and liabilities for lessor capital expenditure reimbursements	(30,965)		(22,242)		(31,305)
Operating net cash outflows from operating leases	$	179,279	$	357,308	$	276,491

(1) Represents the difference between the amount of cash operating lease payments and the amount of operating lease expense. Operating cash flows from operating leases for the year ended December 31, 2020 includes the $119.2 million one-time cash lease payment made to Ventas in connection with the Company's lease restructuring transaction effective July 26, 2020.

	Years Ended December 31,
Financing Leases (in thousands)	2021		2020		2019
Depreciation and amortization	$	30,542	$	32,647	$	46,646
Interest expense: financing lease obligations	46,282		48,534		66,353
Financing lease expense	$	76,824	$	81,181	$	112,999
Operating cash outflows from financing leases	$	46,282	$	48,534	$	66,353
Financing cash outflows from financing leases	19,874		18,867		22,242
Changes in financing lease assets and liabilities for lessor capital expenditure reimbursement	(11,135)		(5,603)		(3,504)
Total net cash outflows from financing leases	$	55,021	$	61,798	$	85,091

Lessee, Operating Lease, Liability, Maturity

The aggregate amounts of future minimum lease payments, including community, office, and equipment leases, recognized on the consolidated balance sheet as of December 31, 2021 are as follows (in thousands).

Year Ending December 31,	Operating Leases		Financing Leases
2022	$	204,702	$	68,101
2023	193,070		68,840
2024	193,796		70,044
2025	191,439		59,413
2026	76,228		60,659
Thereafter	206,388		52,881
Total lease payments	1,065,623		379,938
Purchase option liability and non-cash gain on future sale of property	—		418,542
Imputed interest and variable lease payments	(235,105)		(244,193)
Total lease obligations	$	830,518	$	554,287