Leases (Tables)

12 Months Ended

Dec. 31, 2022

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)	2022		2021		2020
Facility operating expense	$	6,329	$	12,606	$	19,241
Facility lease expense	165,294		174,358		224,033
Operating lease expense	171,623		186,964		243,274
Operating lease expense adjustment (1)	34,896		23,280		136,276
Changes in operating lease assets and liabilities for lessor capital expenditure reimbursements	(13,718)		(30,965)		(22,242)
Operating net cash outflows from operating leases	$	192,801	$	179,279	$	357,308

(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)	2022		2021		2020
Depreciation and amortization	$	30,065	$	30,542	$	32,647
Interest expense: financing lease obligations	48,061		46,282		48,534
Financing lease expense	$	78,126	$	76,824	$	81,181
Operating cash outflows from financing leases	$	48,061	$	46,282	$	48,534
Financing cash outflows from financing leases	22,221		19,874		18,867
Changes in financing lease assets and liabilities for lessor capital expenditure reimbursement	(11,932)		(11,135)		(5,603)
Total net cash outflows from financing leases	$	58,350	$	55,021	$	61,798

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, 2022 (after giving effect to the change in lease classification for the lease amendment previously described) are as follows (in thousands).

Year Ending December 31,	Operating Leases		Financing Leases
2023	$	233,409	$	48,615
2024	219,311		49,303
2025	217,526		37,184
2026	102,712		37,889
2027	99,566		5,856
Thereafter	135,306		24,172
Total lease payments	1,007,830		203,019
Purchase option liability and non-cash gain on future sale of property	—		135,751
Imputed interest and variable lease payments	(214,099)		(89,910)
Total lease obligations	$	793,731	$	248,860