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Segment Reporting (Tables)
6 Months Ended
Jun. 30, 2021
Segment Reporting [Abstract]  
Summary Information for Reportable Segments
Summary information for the reportable segments (which excludes unconsolidated entities) is as follows (in thousands): 
Three Months Ended June 30, 2021:Seniors Housing OperatingTriple-netOutpatient MedicalNon-segment / CorporateTotal
Resident fees and services$740,891 $— $— $— $740,891 
Rental income— 204,725 149,998 — 354,723 
Interest income856 32,861 4,731 — 38,448 
Other income802 1,355 4,343 430 6,930 
Total revenues742,549 238,941 159,072 430 1,140,992 
Property operating expenses582,361 12,627 45,495 2,174 642,657 
Consolidated net operating income160,188 226,314 113,577 (1,744)498,335 
Depreciation and amortization131,035 54,406 55,444 — 240,885 
Interest expense10,553 1,704 3,907 106,177 122,341 
General and administrative expenses— — — 31,436 31,436 
Loss (gain) on derivatives and financial instruments, net— (359)— — (359)
Loss (gain) on extinguishment of debt, net3,106 — — 52,506 55,612 
Provision for loan losses(181)10,019 (3,641)— 6,197 
Impairment of assets17,713 3,768 2,211 — 23,692 
Other expenses3,709 4,110 1,098 2,770 11,687 
Income (loss) from continuing operations before income taxes and other items(5,747)152,666 54,558 (194,633)6,844 
Income tax (expense) benefit— — — 2,221 2,221 
Income (loss) from unconsolidated entities(12,938)4,877 85 — (7,976)
Gain (loss) on real estate dispositions, net(28)42,709 1,987 — 44,668 
Income (loss) from continuing operations(18,713)200,252 56,630 (192,412)45,757 
Net income (loss)$(18,713)$200,252 $56,630 $(192,412)$45,757 
Total assets$16,129,367 $9,490,724 $6,212,491 $343,534 $32,176,116 
Three Months Ended June 30, 2020:Seniors Housing OperatingTriple-netOutpatient MedicalNon-segment / CorporateTotal
Resident fees and services$769,560 $— $— $— $769,560 
Rental income— 217,492 178,813 — 396,305 
Interest income88 15,520 461 — 16,069 
Other income4,002 607 1,557 375 6,541 
Total revenues773,650 233,619 180,831 375 1,188,475 
Property operating expenses595,513 13,563 51,688 — 660,764 
Consolidated net operating income178,137 220,056 129,143 375 527,711 
Depreciation and amortization139,163 58,138 68,070 — 265,371 
Interest expense14,029 2,746 4,326 105,256 126,357 
General and administrative expenses— — — 34,062 34,062 
Loss (gain) on derivatives and financial instruments, net— 1,434 — — 1,434 
Loss (gain) on extinguishment of debt, net(492)— 741 — 249 
Provision for loan losses— 1,451 (29)— 1,422 
Impairment of assets75,151 — — — 75,151 
Other expenses5,251 3,500 

6,456 4,204 19,411 
Income (loss) from continuing operations before income taxes and other items(54,965)152,787 49,579 (143,147)4,254 
Income tax (expense) benefit— — — (2,233)(2,233)
Income (loss) from unconsolidated entities(6,787)6,403 1,716 — 1,332 
Gain (loss) on real estate dispositions, net14,465 2,148 139,250 — 155,863 
Income (loss) from continuing operations(47,287)161,338 190,545 (145,380)159,216 
Net income (loss)$(47,287)$161,338 $190,545 $(145,380)$159,216 
Six Months Ended June 30, 2021Seniors Housing OperatingTriple-netOutpatient MedicalNon-segment / CorporateTotal
Resident fees and services$1,464,355 $— $— $— $1,464,355 
Rental income— 357,188 300,378 — 657,566 
Interest income1,975 47,783 8,269 — 58,027 
Other income2,621 2,452 6,648 1,385 13,106 
Total revenues1,468,951 407,423 315,295 1,385 2,193,054 
Property operating expenses1,138,329 25,468 92,358 3,828 1,259,983 
Consolidated net operating income330,622 381,955 222,937 (2,443)933,071 
Depreciation and amortization263,621 111,073 110,617 — 485,311 
Interest expense21,971 3,586 7,922 212,004 245,483 
General and administrative expenses— — — 61,362 61,362 
Loss (gain) on derivatives and financial instruments, net— 1,575 — — 1,575 
Loss (gain) on extinguishment of debt, net(1,537)— — 52,506 50,969 
Provision for loan losses70 10,872 (3,362)— 7,580 
Impairment of assets22,317 22,732 2,211 — 47,260 
Other expenses7,168 9,093 1,810 4,610 22,681 
Income (loss) from continuing operations before income taxes and other items17,012 223,024 103,739 (332,925)10,850 
Income tax (expense) benefit— — — (1,722)(1,722)
Income (loss) from unconsolidated entities(7,704)9,784 2,993 — 5,073 
Gain (loss) on real estate dispositions, net5,167 44,751 53,830 — 103,748 
Income (loss) from continuing operations14,475 277,559 160,562 (334,647)117,949 
Net income (loss)$14,475 $277,559 $160,562 $(334,647)$117,949 

Six Months Ended June 30, 2020Seniors Housing OperatingTriple-netOutpatient MedicalNon-segment / CorporateTotal
Resident fees and services$1,619,532 $— $— $— $1,619,532 
Rental income— 408,877 377,388 — 786,265 
Interest income192 30,191 927 — 31,310 
Other income5,054 2,280 1,845 791 9,970 
Total revenues1,624,778 441,348 380,160 791 2,447,077 
Property operating expenses1,203,384 26,865 112,296 — 1,342,545 
Consolidated net operating income421,394 414,483 267,864 791 1,104,532 
Depreciation and amortization285,937 115,832 138,403 — 540,172 
Interest expense30,463 5,598 9,134 223,169 268,364 
General and administrative expenses— — — 69,543 69,543 
Loss (gain) on derivatives and financial
instruments, net
— 9,085 — — 9,085 
Loss (gain) on extinguishment of debt, net(492)— 741 — 249 
Provision for loan losses— 18.69 8,523 — (29)18.69 — 8,494 
Impairment of assets78,646 24,332 — — 102,978 
Other expenses8,240 4,013 7,463 5,987 25,703 
Income (loss) from continuing operations before income taxes and other items18,600 247,100 112,152 (297,908)79,944 
Income tax (expense) benefit— — — (7,675)(7,675)
Income (loss) from unconsolidated entities(17,811)12,199 3,252 — (2,360)
Gain (loss) on real estate dispositions, net14,316 51,785 352,586 — 418,687 
Income (loss) from continuing operations15,105 311,084 467,990 (305,583)488,596 
Net income (loss)$15,105 $311,084 $467,990 $(305,583)$488,596 
Summary of Geographic Information The following is a summary of geographic information for the periods presented (dollars in thousands): 
 Three Months EndedSix Months Ended
 June 30, 2021June 30, 2020June 30, 2021June 30, 2020
Revenues:
Amount(1)
%Amount%
Amount(1)
%Amount%
United States$893,672 78.4 %$973,772 81.9 %$1,719,320 78.4 %$2,001,553 81.8 %
United Kingdom140,756 12.3 %109,437 9.2 %259,630 11.8 %227,319 9.3 %
Canada106,564 9.3 %105,266 8.9 %214,104 9.8 %218,205 8.9 %
Total$1,140,992 100.0 %$1,188,475 100.0 %$2,193,054 100.0 %$2,447,077 100.0 %
 As of
 June 30, 2021December 31, 2020
Assets:Amount%Amount%
United States$25,673,854 79.8 %$26,658,659 82.1 %
United Kingdom4,075,693 12.7 %3,352,549 10.3 %
Canada2,426,569 7.5 %2,472,434 7.6 %
Total$32,176,116 100.0 %$32,483,642 100.0 %
(1) The United States, United Kingdom and Canada represent 73%, 13% and 14% of our resident fees and services revenue for the three and six month periods ended June 30, 2021, respectively.