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Segment Reporting
 9 Months Ended
Sep. 30, 2024
Segment Reporting [Abstract]  
Segment Reporting Segment Reporting
We invest in seniors housing and health care real estate. We evaluate our business and make resource allocations on our three operating segments: Seniors Housing Operating, Triple-net and Outpatient Medical. Our Seniors Housing Operating properties include seniors apartments, assisted living, independent living/continuing care retirement communities, independent supportive living communities (Canada), care homes with and without nursing (U.K.) and combinations thereof that are generally owned and/or operated through RIDEA structures (see Note 19). Our Triple-net properties include the property types described above as well as long-term/post-acute care facilities. Under the Triple-net segment, we invest in seniors housing and health care real estate through acquisition and financing of primarily single tenant properties. Properties acquired are primarily leased under triple-net leases and we are not involved in the management of the property. Our Outpatient Medical properties are typically leased to multiple tenants and generally require a certain level of property management by us.
We evaluate performance based upon consolidated NOI of each segment. We define NOI as total revenues, including tenant reimbursements, less property operating expenses. We believe NOI provides investors relevant and useful information as it measures the operating performance of our properties at the property level on an unleveraged basis. We use NOI to make decisions about resource allocations and to assess the property level performance of our properties.
Non-segment revenue consists mainly of interest income on cash investments recorded in other income. Non-segment assets consist of corporate assets including cash, deferred loan expenses and corporate offices and equipment among others. Non-property specific revenues and expenses are not allocated to individual segments in determining NOI.
The accounting policies of the segments are the same as those described in the summary of significant accounting policies (see Note 2 to the financial statements included in our Annual Report on Form 10-K for the year ended December 31, 2023). The results of operations for all acquisitions described in Note 3 are included in our consolidated results of operations from the acquisition dates and are components of the appropriate segments. All inter-segment transactions are eliminated.
Summary information for the reportable segments is as follows (in thousands): 
Three Months Ended September 30, 2024Seniors Housing OperatingTriple-netOutpatient MedicalNon-segment/CorporateTotal
Resident fees and services$1,511,524 $— $— $— $1,511,524 
Rental income— 227,531 202,955 — 430,486 
Interest income16,328 51,866 852 — 69,046 
Other income2,498 1,118 2,040 38,951 44,607 
Total revenues1,530,350 280,515 205,847 38,951 2,055,663 
Property operating expenses1,135,887 9,345 62,778 4,691 1,212,701 
Consolidated net operating income (loss)394,463 271,170 143,069 34,260 842,962 
Depreciation and amortization279,693 57,583 66,503 — 403,779 
Interest expense8,742 90 (573)130,791 139,050 
General and administrative expenses— — — 77,901 77,901 
Loss (gain) on derivatives and financial instruments, net— (9,906)— — (9,906)
Loss (gain) on extinguishment of debt, net— — — 419 419 
Provision for loan losses, net5,543 (1,345)(5)— 4,193 
Impairment of assets20,887 2,534 — — 23,421 
Other expenses17,914 2,445 (500)380 20,239 
Income (loss) from continuing operations before income taxes and other items61,684 219,769 77,644 (175,231)183,866 
Income tax (expense) benefit— — — 4,706 4,706 
Income (loss) from unconsolidated entities4,247 (8,680)395 — (4,038)
Gain (loss) on real estate dispositions and acquisitions of controlling interests, net63 272,334 (131)— 272,266 
Income (loss) from continuing operations65,994 483,423 77,908 (170,525)456,800 
Net income (loss)$65,994 $483,423 $77,908 $(170,525)$456,800 
Total assets$28,900,249 $9,845,405 $7,553,112 $2,654,932 $48,953,698 
Three Months Ended September 30, 2023Seniors Housing OperatingTriple-netOutpatient MedicalNon-segment/CorporateTotal
Resident fees and services$1,199,808 $— $— $— $1,199,808 
Rental income— 194,912 189,595 — 384,507 
Interest income2,194 39,928 98 — 42,220 
Other income1,897 1,482 2,265 29,834 35,478 
Total revenues1,203,899 236,322 191,958 29,834 1,662,013 
Property operating expenses918,990 10,044 62,204 4,035 995,273 
Consolidated net operating income (loss)284,909 226,278 129,754 25,799 666,740 
Depreciation and amortization215,195 58,196 65,923 — 339,314 
Interest expense14,358 374 2,313 139,487 156,532 
General and administrative expenses— — — 46,106 46,106 
Loss (gain) on derivatives and financial instruments, net— 2,885 — — 2,885 
Loss (gain) on extinguishment of debt, net— — 1 — 1 
Provision for loan losses, net384 3,675 — — 4,059 
Impairment of assets2,400 4,988 — — 7,388 
Other expenses34,865 1,627 

1,117 611 38,220 
Income (loss) from continuing operations before income taxes and other items17,707 154,533 60,400 (160,405)72,235 
Income tax (expense) benefit— — — (4,584)(4,584)
Income (loss) from unconsolidated entities(6,021)2,056 (66)— (4,031)
Gain (loss) on real estate dispositions and acquisitions of controlling interests, net71,173 (12)(59)— 71,102 
Income (loss) from continuing operations82,859 156,577 60,275 (164,989)134,722 
Net income (loss)$82,859 $156,577 $60,275 $(164,989)$134,722 
Nine Months Ended September 30, 2024Seniors Housing OperatingTriple-netOutpatient MedicalNon-segment / CorporateTotal
Resident fees and services$4,265,271 $— $— $— $4,265,271 
Rental income— 590,426 593,523 — 1,183,949 
Interest income37,428 145,183 2,552 — 185,163 
Other income5,861 3,248 7,019 89,777 105,905 
Total revenues4,308,560 738,857 603,094 89,777 5,740,288 
Property operating expenses3,190,140 30,657 186,426 13,688 3,420,911 
Consolidated net operating income (loss)1,118,420 708,200 416,668 76,089 2,319,377 
Depreciation and amortization770,020 181,884 199,783 — 1,151,687 
Interest expense27,254 800 2,455 389,283 419,792 
General and administrative expenses— — — 186,784 186,784 
Loss (gain) on derivatives and financial instruments, net— (18,785)— — (18,785)
Loss (gain) on extinguishment of debt, net1,711 — — 419 2,130 
Provision for loan losses, net13,253 (2,874)(9)— 10,370 
Impairment of assets65,996 3,150 — — 69,146 
Other expenses64,395 12,070 440 6,149 83,054 
Income (loss) from continuing operations before income taxes and other items175,791 531,955 213,999 (506,546)415,199 
Income tax (expense) benefit— — — (2,586)(2,586)
Income (loss) from unconsolidated entities(2,546)(9,219)4,840 — (6,925)
Gain (loss) on real estate dispositions and acquisitions of controlling interests, net141,726 293,628 8,062 — 443,416 
Income (loss) from continuing operations314,971 816,364 226,901 (509,132)849,104 
Net income (loss)$314,971 $816,364 $226,901 $(509,132)$849,104 

Nine Months Ended September 30, 2023Seniors Housing OperatingTriple-netOutpatient MedicalNon-segment / CorporateTotal
Resident fees and services$3,490,942 $— $— $— $3,490,942 
Rental income— 596,247 555,758 — 1,152,005 
Interest income6,840 110,211 284 — 117,335 
Other income7,237 70,057 6,939 43,705 127,938 
Total revenues3,505,019 776,515 562,981 43,705 4,888,220 
Property operating expenses2,687,961 32,365 179,266 12,106 2,911,698 
Consolidated net operating income (loss)817,058 744,150 383,715 31,599 1,976,522 
Depreciation and amortization656,030 167,958 196,383 — 1,020,371 
Interest expense41,981 (436)9,569 402,158 453,272 
General and administrative expenses— — — 134,764 134,764 
Loss (gain) on derivatives and financial
instruments, net		— 5,095 — — 5,095 
Loss (gain) on extinguishment of debt, net— — 7 — 7 
Provision for loan losses, net2,178 5,116 (2)— 7,292 
Impairment of assets15,029 6,074 — — 21,103 
Other expenses60,504 4,912 2,311 4,307 72,034 
Income (loss) from continuing operations before income taxes and other items41,336 555,431 175,447 (509,630)262,584 
Income tax (expense) benefit— — — (11,132)(11,132)
Income (loss) from unconsolidated entities(61,055)9,858 (237)— (51,434)
Gain (loss) on real estate dispositions and acquisitions of controlling interests, net69,910 436 (665)— 69,681 
Income (loss) from continuing operations50,191 565,725 174,545 (520,762)269,699 
Net income (loss)$50,191 $565,725 $174,545 $(520,762)$269,699 
Our portfolio of properties and other investments are located in the United States, the United Kingdom and Canada. Revenues and assets are attributed to the country in which the property is physically located. The following is a summary of geographic information for the periods presented (dollars in thousands): 
 Three Months EndedNine Months Ended
 September 30, 2024September 30, 2023September 30, 2024September 30, 2023
Revenues:Amount%Amount%
Amount(1)
%Amount%
United States$1,745,893 84.9 %$1,384,381 83.2 %$4,822,963 84.0 %$4,072,915 83.3 %
United Kingdom174,337 8.5 %153,765 9.3 %499,109 8.7 %455,669 9.3 %
Canada135,433 6.6 %123,867 7.5 %418,216 7.3 %359,636 7.4 %
Total$2,055,663 100.0 %$1,662,013 100.0 %$5,740,288 100.0 %$4,888,220 100.0 %
Three Months EndedNine Months Ended
September 30, 2024September 30, 2023September 30, 2024September 30, 2023
Resident Fees and Services:Amount%Amount%
Amount(1)
%Amount%
United States$1,255,020 83.0 %$967,360 80.7 %$3,501,168 82.1 %$2,806,301 80.4 %
United Kingdom125,581 8.3 %111,947 9.3 %360,254 8.4 %334,544 9.6 %
Canada130,923 8.7 %120,501 10.0 %403,849 9.5 %350,097 10.0 %
Total$1,511,524 100.0 %$1,199,808 100.0 %$4,265,271 100.0 %$3,490,942 100.0 %
 As of
 September 30, 2024December 31, 2023
Assets:Amount%Amount%
United States$40,861,259 83.4 %$36,929,186 83.9 %
United Kingdom4,930,587 10.1 %3,587,230 8.2 %
Canada3,161,852 6.5 %3,495,750 7.9 %
Total$48,953,698 100.0 %$44,012,166 100.0 %