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Real Property Acquisitions and Development (Tables)
 9 Months Ended
Sep. 30, 2019
Real Estate [Abstract]  
Estimated Fair Value of Allocated Purchase Price of Asset and Liabilities
The following is a summary of our real property investment activity by segment for the periods presented (in thousands):
 
Nine Months Ended
 
September 30, 2019
 
September 30, 2018
 
Seniors Housing Operating
 
Triple-net
 
Outpatient
Medical
 
Totals
 
Seniors Housing Operating
 
Triple-net
 
Outpatient
Medical
 
Totals
Land and land improvements
$
107,945

 
$
14,172

 
$
187,301

 
$
309,418

 
$
47,865

 
$
413,588

 
$
18,496

 
$
479,949

Buildings and improvements
1,138,484

 
125,763

 
1,324,371

 
2,588,618

 
535,436

 
2,239,422

 
79,205

 
2,854,063

Acquired lease intangibles
61,163

 
—

 
104,309

 
165,472

 
68,084

 
12,383

 
11,271

 
91,738

Construction in progress
36,174

 
—

 
—

 
36,174

 
—

 
—

 
—

 
—

Real property held for sale
17,435

 
—

 
—

 
17,435

 
—

 
396,265

 
22,032

 
418,297

Right of use assets, net
—

 
—

 
58,377

 
58,377

 
—

 
—

 
—

 
—

Receivables and other assets
6,742

 
—

 
419

 
7,161

 
1,255

 
1,322

 
6

 
2,583

Total assets acquired(1)
1,367,943

 
139,935

 
1,674,777

 
3,182,655

 
652,640

 
3,062,980

 
131,010

 
3,846,630

Secured debt
(43,209
)
 
—

 
—

 
(43,209
)
 
(89,973
)
 
—

 
(14,769
)
 
(104,742
)
Lease liabilities
—

 
—

 
(47,740
)
 
(47,740
)
 
—

 
—

 
—

 
—

Accrued expenses and other liabilities  
(9,639
)
 
(100
)
 
(23,483
)
 
(33,222
)
 
(14,686
)
 
(13,199
)
 
(910
)
 
(28,795
)
Total liabilities acquired
(52,848
)
 
(100
)
 
(71,223
)
 
(124,171
)
 
(104,659
)
 
(13,199
)
 
(15,679
)
 
(133,537
)
Noncontrolling interests(2)
(39,570
)
 
(1,056
)
 
(1,201
)
 
(41,827
)
 
(9,818
)
 
(512,741
)
 
—

 
(522,559
)
Non-cash acquisition related activity(3)
(11,889
)
 
—

 
—

 
(11,889
)
 
—

 
—

 
—

 
—

Cash disbursed for acquisitions
1,263,636

 
138,779

 
1,602,353

 
3,004,768

 
538,163

 
2,537,040

 
115,331

 
3,190,534

Construction in progress additions
184,581

 
37,649

 
42,316

 
264,546

 
28,222

 
49,619

 
16,733

 
94,574

Less: Capitalized interest
(5,972
)
 
(1,565
)
 
(2,867
)
 
(10,404
)
 
(2,608
)
 
(1,932
)
 
(1,817
)
 
(6,357
)
Foreign currency translation
3,597

 
329

 
—

 
3,926

 
2,151

 
180

 
—

 
2,331

Accruals(4)
—

 
—

 
45

 
45

 
—

 
—

 
(2,402
)
 
(2,402
)
Cash disbursed for construction in progress
182,206

 
36,413

 
39,494

 
258,113

 
27,765

 
47,867

 
12,514

 
88,146

Capital improvements to existing properties
160,260

 
10,337

 
35,816

 
206,413

 
127,274

 
6,766

 
39,595

 
173,635

Total cash invested in real property, net of cash acquired
$
1,606,102

 
$
185,529

 
$
1,677,663

 
$
3,469,294

 
$
693,202

 
$
2,591,673

 
$
167,440

 
$
3,452,315

(1) Excludes $1,910,000 and $391,580,000 of unrestricted and restricted cash acquired during the nine months ended September 30, 2019 and 2018, respectively.
(2) Includes amounts attributable to both redeemable noncontrolling interests and noncontrolling interests.
(3) Relates to the acquisition of assets previously recognized as investments in unconsolidated entities.
(4) 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.
The following is a summary of the construction projects that were placed into service and began generating revenues during the periods presented (in thousands):
 
 
Nine Months Ended
 
 
September 30, 2019
 
September 30, 2018
Development projects:
 
 
 
 
Seniors Housing Operating
 
$
28,117

 
$
86,931

Triple-net
 
—

 
90,055

Outpatient Medical
 
—

 
11,358

Total development projects
 
28,117

 
188,344

Expansion projects
 
—

 
8,879

Total construction in progress conversions
 
$
28,117

 
$
197,223