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Real Property Acquisitions and Development (Tables)
 12 Months Ended
Dec. 31, 2018
Real Estate Liabilities Associated with Assets Held for Development and Sale [Abstract]  
Schedule of Acquired Assets and Liabilities The following table presents the purchase price calculation and the allocation to assets acquired and liabilities assumed based upon their relative fair value:
(In thousands)
 
 
 
Land and land improvements
 
$
417,983

 
Buildings and improvements
 
2,253,451

 
Acquired lease intangibles
 
12,820

 
Real property held for sale
 
418,297

 
Cash and cash equivalents
 
381,913

 
Restricted cash
 
4,981

 
Receivables and other assets
 
1,354

 
 
Total assets acquired
 
3,490,799

 
Accrued expenses and other liabilities  
 
(13,199
)
 
 
Total liabilities assumed
 
(13,199
)
 
Noncontrolling interests
 
(512,741
)
 
 
Net assets acquired
 
$
2,964,859

 
Estimated Fair Value of Allocated Purchase Price of Asset and Liabilities The following is a summary of our Seniors Housing Operating real property investment activity for the periods presented (in thousands):
 
 
Year Ended December 31,
 
 
2018
 
2017
 
2016
Land and land improvements  
 
$
51,440

 
$
42,525

 
$
164,653

Buildings and improvements  
 
621,731

 
428,777

 
1,518,472

Acquired lease intangibles  
 
69,504

 
63,912

 
115,643

Receivables and other assets  
 
1,492

 
3,959

 
2,462

Total assets acquired(1)
 
744,167

 
539,173

 
1,801,230

Secured debt  
 
(134,752
)
 
—

 
(63,732
)
Accrued expenses and other liabilities
 
(18,463
)
 
(46,301
)
 
(23,681
)
Total liabilities assumed
 
(153,215
)
 
(46,301
)
 
(87,413
)
Noncontrolling interests
 
(14,390
)
 
(4,701
)
 
(6,007
)
Non-cash acquisition related activity(2)
—

 
(67,633
)
 
(47,065
)
 Cash disbursed for acquisitions
 
576,562

 
420,538

 
1,660,745

Construction in progress additions
 
82,621

 
84,874

 
157,845

Capitalized interest
 
(3,190
)
 
(9,106
)
 
(5,793
)
Foreign currency translation
 
3,934

 
(6,830
)
 
(8,500
)
Cash disbursed for construction in progress
 
83,365

 
68,938

 
143,552

Capital improvements to existing properties
 
201,001

 
185,473

 
138,673

Total cash invested in real property, net of cash acquired  
 
$
860,928

 
$
674,949

 
$
1,942,970

(1) Excludes $5,784,000, $6,273,000 and $351,000 of cash and restricted cash acquired during the years ended December 31, 2018, 2017 and 2016, respectively.
(2) For the year ended December 31, 2017, includes $59,665,000 related to the acquisition of assets previously financed as investments in unconsolidated entities and $6,349,000 related to the acquisition of assets previously financed as real estate loans receivable. For the year ended December 31, 2016, includes $43,372,000 related to the acquisition of assets previously financed as investments in unconsolidated entities.

Triple-net Activity 
The following provides our purchase price allocations and other Triple-net real property investment activity for the periods presented (in thousands):
 
 
 
Year Ended December 31,
 
 
 
 
2018
 
2017
 
2016
 
Land and land improvements  
 
$
413,588

 
$
33,416

 
$
104,754

 
Buildings and improvements  
 
2,242,884

 
248,459

 
418,633

 
Acquired lease intangibles  
 
9,690

 
—

 
2,876

 
Real property held for sale
 
396,265

 
—

 
—

 
Receivables and other assets  
 
1,354

 
—

 
551

 
 
Total assets acquired(1)
 
3,063,781


281,875


526,814

 
Accrued expenses and other liabilities
 
(13,199
)
 
(21,236
)
 
(3,384
)
 
 
Total liabilities assumed
 
(13,199
)

(21,236
)

(3,384
)
 
Noncontrolling interests
 
(512,741
)
 
(7,275
)
 
(26,771
)
 
Non-cash acquisition related activity(2)
 
—

 
(54,901
)
 
(51,733
)
 
 
Cash disbursed for acquisitions
 
2,537,841


198,463


444,926

 
Construction in progress additions
 
55,558

 
120,797

 
181,084

 
Capitalized interest
 
(2,238
)
 
(4,713
)
 
(8,729
)
 
Foreign currency translation
 
272

 
(610
)
 
(3,665
)
 
Cash disbursed for construction in progress
 
53,592


115,474


168,690

 
Capital improvements to existing properties
 
10,046

 
19,989

 
32,603

 
 
Total cash invested in real property, net of cash acquired  
 
$
2,601,479


$
333,926


$
646,219

 
(1) Excludes $386,894,000, $318,000 and $682,000 of cash and restricted cash acquired during the years ended December 31, 2018, 2017 and 2016, respectively.
(2) For the year ended December 31, 2017, $54,901,000 is related to the acquisition of assets previously financed as real estate loans receivable.  For the year ended December 31, 2016, primarily relates to $45,044,000 for the acquisition of assets previously financed as real estate loans receivable and $6,630,000 previously financed as equity investments.
Outpatient Medical Activity 
The following is a summary of our Outpatient Medical real property investment activity for the periods presented (in thousands):
 
 
Year Ended December 31,
 
 
2018
 
2017
 
2016
 
Land and land improvements  
 
$
77,239

 
$
40,565

 
$
5,738

 
Buildings and improvements  
 
478,740

 
159,643

 
46,056

 
Acquired lease intangibles  
 
50,813

 
24,014

 
4,592

 
Real property held for sale
 
22,032

 
—

 
—

 
Receivables and other assets  
 
1,185

 
10

 
—

 
Total assets acquired(1)
 
630,009

 
224,232

 
56,386

 
Secured debt  
 
(169,156
)
 
(25,708
)
 
—

 
Accrued expenses and other liabilities
 
(14,896
)
 
(3,181
)
 
(1,670
)
 
Total liabilities assumed
 
(184,052
)
 
(28,889
)
 
(1,670
)
 
Noncontrolling interests
 
—

 
(9,080
)
 
—

 
Non-cash acquisition related activity(2)
 
—

 
—

 
(15,013
)
 
Cash disbursed for acquisitions
 
445,957

 
186,263

 
39,703

 
Construction in progress additions
 
26,565

 
37,094

 
113,933

 
Capitalized interest
 
(2,477
)
 
(2,406
)
 
(3,723
)
 
Accruals(3)
 
(339
)
 
13,615

 
(19,321
)
 
Cash disbursed for construction in progress
 
23,749

 
48,303

 
90,889

 
Capital improvements to existing properties
 
55,136

 
44,814

 
47,870

 
Total cash invested in real property, net of cash acquired  
 
$
524,842

 
$
279,380

 
$
178,462

 
(1) Excludes $2,719,000 of unrestricted and restricted cash acquired during the year ended December 31, 2018.
(2) Relates to the acquisition of assets previously financed as real estate loans. Please refer to Note 6 for additional information.
(3) Represents non-cash accruals for amounts to be paid in future periods for properties that converted, off-set by amounts paid in the current period.
Construction Activity 
The following is a summary of the construction projects that were placed into service and began generating revenues during the periods presented (in thousands):
 
 
Year Ended
 
 
December 31, 2018
 
December 31, 2017
 
December 31, 2016
Development projects:
 
 
 
 
 
 
Seniors Housing Operating
 
$
86,931

 
$
3,634

 
$
18,979

Triple-net
 
90,055

 
283,472

 
46,094

Outpatient Medical
 
11,358

 
63,036

 
108,001

Total development projects
 
188,344

 
350,142

 
173,074

Expansion projects
 
20,029

 
10,336

 
11,363

Total construction in progress conversions
 
$
208,373

 
$
360,478

 
$
184,437
Future minimum lease payments receivable under operating leases At December 31, 2018, future minimum lease payments receivable under operating leases (excluding properties in our Seniors Housing Operating partnerships and excluding any operating expense reimbursements) are as follows (in thousands):
2019
 
$
1,309,186

2020
 
1,275,683

2021
 
1,245,611

2022
 
1,222,519

2023
 
1,171,081

Thereafter
 
9,359,018

Totals
 
$
15,583,098