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Real Property Acquisitions and Development (Tables)
 12 Months Ended
Dec. 31, 2020
Real Estate Liabilities Associated with Assets Held for Development and Sale [Abstract]  
Summary of Real Property Investment Activity by Segment
The following is a summary of our real property investment activity by segment for the periods presented (in thousands):
Year Ended December 31, 2020
 Seniors Housing OperatingTriple-netOutpatient MedicalTotal
Land and land improvements  $55,000 $16,876 $45,590 $117,466 
Buildings and improvements  527,189 73,855 179,004 780,048 
Acquired lease intangibles  28,668 — 24,718 53,386 
Total net real estate assets610,857 90,731 249,312 950,900 
Receivables and other assets746 — 268 1,014 
Total assets acquired(1)
611,603 90,731 249,580 951,914 
Accrued expenses and other liabilities(1,650)— (962)(2,612)
Total liabilities assumed(1,650)— (962)(2,612)
Noncontrolling interests(2)
(45,546)— — (45,546)
 Cash disbursed for acquisitions564,407 90,731 248,618 903,756 
Construction in progress additions134,945 45,256 39,833 220,034 
Less: Capitalized interest(10,389)(3,209)(3,874)(17,472)
Accruals(3)
(1,226)— — (1,226)
Cash disbursed for construction in progress123,330 42,047 35,959 201,336 
Capital improvements to existing properties107,379 76,625 60,985 244,989 
Total cash invested in real property, net of cash acquired  
$795,116 $209,403 $345,562 $1,350,081 
(1) Excludes $580,000 of unrestricted and restricted cash acquired.
(2) Includes amounts attributable to both redeemable noncontrolling interests and noncontrolling interests.
(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.
Year Ended December 31, 2019
 Seniors Housing OperatingTriple-netOutpatient MedicalTotal
Land and land improvements  $154,470 $24,097 $293,933 $472,500 
Buildings and improvements  1,518,748 203,282 1,954,928 3,676,958 
Acquired lease intangibles  76,009 — 183,921 259,930 
Real property held for sale17,435 — — 17,435 
Construction in progress36,174 — — 36,174 
Right of use assets, net— — 58,377 58,377 
Total net real estate assets1,802,836 227,379 2,491,159 4,521,374 
Receivables and other assets  15,634 — 1,586 17,220 
Total assets acquired(1)
1,818,470 227,379 2,492,745 4,538,594 
Secured debt  (194,408)— (206,754)(401,162)
Lease liabilities— — (47,740)(47,740)
Accrued expenses and other liabilities(12,024)— (32,893)(44,917)
Total liabilities assumed(206,432)— (287,387)(493,819)
Noncontrolling interests(2)
(67,987)(4,015)(1,201)(73,203)
Non-cash acquisition related activity(3)
(11,889)— — (11,889)
Cash disbursed for acquisitions1,532,162 223,364 2,204,157 3,959,683 
Construction in progress additions227,018 61,414 60,884 349,316 
Less: Capitalized interest(8,889)(2,385)(3,998)(15,272)
Accruals(4)
— — (1,035)(1,035)
Cash disbursed for construction in progress218,129 59,029 55,851 333,009 
Capital improvements to existing properties260,413 17,426 50,985 328,824 
Total cash invested in real property, net of cash acquired$2,010,704 $299,819 $2,310,993 $4,621,516 
(1) Excludes $2,090,000 of unrestricted and restricted cash acquired.
(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.
Year Ended December 31, 2018
 Seniors Housing OperatingTriple-netOutpatient MedicalTotal
Land and land improvements  $51,440 $413,588 $77,239 $542,267 
Buildings and improvements  621,731 2,242,884 478,740 3,343,355 
Acquired lease intangibles  69,504 9,690 50,813 130,007 
Real property held for sale— 396,265 22,032 418,297 
Total net real estate assets742,675 3,062,427 628,824 4,433,926 
Receivables and other assets  1,492 1,354 1,185 4,031 
Total assets acquired(1)
744,167 3,063,781 630,009 4,437,957 
Secured debt  (134,752)— (169,156)(303,908)
Accrued expenses and other liabilities(18,463)(13,199)(14,896)(46,558)
Total liabilities assumed(153,215)(13,199)(184,052)(350,466)
Noncontrolling interests(2)
(14,390)(512,741)— (527,131)
Cash disbursed for acquisitions576,562 2,537,841 445,957 3,560,360 
Construction in progress additions82,621 55,558 26,565 164,744 
Less: Capitalized interest(3,190)(2,238)(2,477)(7,905)
Accruals(3)
— — (339)(339)
Cash disbursed for construction in progress79,431 53,320 23,749 156,500 
Capital improvements to existing properties201,001 10,046 55,136 266,183 
Total cash invested in real property, net of cash acquired$856,994 $2,601,207 $524,842 $3,983,043 
(1) Excludes $395,397,000 of unrestricted and restricted cash acquired.
(2) Includes amounts attributable to both redeemable noncontrolling interests and noncontrolling interests.
(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.
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, 2020December 31, 2019December 31, 2018
Development projects:
Seniors Housing Operating$93,188 $28,117 $86,931 
Triple-net75,149 — 90,055 
Outpatient Medical43,493 21,006 11,358 
Total development projects211,830 49,123 188,344 
Expansion projects48,600 — 20,029 
Total construction in progress conversions$260,430 $49,123 $208,373 
Schedule of Purchase Price Calculation and Allocation to Assets Acquired and Liabilities Assumed 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 improvements2,253,451 
Acquired lease intangibles12,820 
Real property held for sale418,297 
Cash and cash equivalents381,913 
Restricted cash4,981 
Receivables and other assets1,354 
Total assets acquired3,490,799 
Accrued expenses and other liabilities  (13,199)
Total liabilities assumed(13,199)
Noncontrolling interests(512,741)
Net assets acquired$2,964,859