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Segment Reporting
 9 Months Ended
Sep. 30, 2025
Segment Reporting [Abstract]  
Segment Reporting Segment Reporting
We invest in seniors housing and healthcare real estate. We evaluate our business and make resource allocations for our three operating segments: Seniors Housing Operating, Triple-net and Outpatient Medical. Our Seniors Housing Operating properties include seniors apartments, assisted living communities, independent living/continuing care retirement communities, independent supportive living communities (Canada), care homes with and without nursing (U.K.) and combinations thereof. Seniors Housing Operating properties that are deemed qualified healthcare properties are owned and 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 healthcare real estate through acquisition of single tenant properties. Properties acquired are generally 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 on 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. The Chief Operating Decision Maker ("CODM"), who is our Vice Chairman & Chief Operating Officer, uses NOI to make decisions about resource allocations and to assess the property-level performance of our properties.
During the year ended December 31, 2024, we adopted ASU 2023-07 (see Note 2 in our Annual Report on Form 10-K for the year ended December 31, 2024 for further details). Additionally, we reclassified loans receivable balances and equity warrants received through lending activities (see Note 12 for further details), the related interest income, provision for loan losses and change in the fair value of the equity warrants from our three operating segments to Non-segment/Corporate to better align with the manner in which the CODM reviews results. Accordingly, the segment information provided in this Note has been updated to conform to the current presentation for all periods presented.
Non-segment revenue consists mainly of interest income on loans receivable balances. Additionally, it includes interest income earned on cash investments recorded in other income. Non-segment assets consist of corporate assets including loans receivable, 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, 2024). 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.
The following table summarizes information for the reportable segments for the three months ended September 30, 2025 (in thousands): 
Three Months Ended September 30, 2025
Seniors Housing OperatingTriple-netOutpatient MedicalNon-segment/CorporateTotal
Resident fees and services$2,061,370 $— $— $— $2,061,370 
Rental income— 286,353 213,122 — 499,475 
Interest income— — — 67,216 67,216 
Other income8,745 284 2,050 46,552 57,631 
Total revenues2,070,115 286,637 215,172 113,768 2,685,692 
Property operating expenses1,499,215 8,227 63,319 6,287 1,577,048 
Consolidated net operating income (loss)$570,900 $278,410 $151,853 $107,481 1,108,644 
Depreciation and amortization509,812 
Interest expense162,052 
General and administrative expenses63,124 
Loss (gain) on derivatives and financial instruments, net31,682 
Provision for loan losses, net1,088 
Impairment of assets3,081 
Other expenses44,699 
Income (loss) from continuing operations before income taxes and other items293,106 
Income tax (expense) benefit(2,335)
Income (loss) from unconsolidated entities(12,610)
Gain (loss) on real estate dispositions and acquisitions of controlling interests, net4,025 
Income (loss) from continuing operations282,186 
Net income (loss)$282,186 
The following table summarizes significant expense categories by segment for the three months ended September 30, 2025 (in thousands):
Seniors Housing OperatingTriple-netOutpatient MedicalNon-segment/CorporateTotal
Compensation$888,672 $28 $14,452 $— $903,152 
Utilities91,065 83 15,248 — 106,396 
Food80,626 — — — 80,626 
Repairs and maintenance60,925 34 10,842 — 71,801 
Property taxes66,160 5,903 16,784 — 88,847 
Other segment expenses(1)
311,767 2,179 5,993 6,287 326,226 
Total property operating expenses$1,499,215 $8,227 $63,319 $6,287 $1,577,048 
(1) Other segment expenses for Seniors Housing Operating include management fees, insurance expense, marketing, supplies, other miscellaneous expenses and right of use asset amortization for properties subject to lease. Triple-net other segment expenses include right of use asset amortization for properties subject to ground leases and other miscellaneous expenses. Outpatient Medical other segment expenses include insurance expense, right of use asset amortization for properties subject to ground leases and other miscellaneous expenses. Non-segment/Corporate other segment expenses primarily represent insurance costs related to our captive insurance program.
The following table summarizes information for the reportable segments for the three months ended September 30, 2024 (in thousands):
Three Months Ended September 30, 2024
Seniors 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 income— — — 69,046 69,046 
Other income2,498 1,118 2,040 38,951 44,607 
Total revenues1,514,022 228,649 204,995 107,997 2,055,663 
Property operating expenses1,135,887 9,345 62,778 4,691 1,212,701 
Consolidated net operating income (loss)$378,135 $219,304 $142,217 $103,306 842,962 
Depreciation and amortization403,779 
Interest expense139,050 
General and administrative expenses77,901 
Loss (gain) on derivatives and financial instruments, net(9,906)
Loss (gain) on extinguishment of debt, net419 
Provision for loan losses, net4,193 
Impairment of assets23,421 
Other expenses20,239 
Income (loss) from continuing operations before income taxes and other items183,866 
Income tax (expense) benefit4,706 
Income (loss) from unconsolidated entities(4,038)
Gain (loss) on real estate dispositions and acquisitions of controlling interests, net272,266 
Income (loss) from continuing operations456,800 
Net income (loss)$456,800 
The following table summarizes significant expense categories by segment for the three months ended September 30, 2024 (in thousands):
Seniors Housing OperatingTriple-netOutpatient MedicalNon-segment/CorporateTotal
Compensation$659,650 $13 $13,519 $— $673,182 
Utilities72,153 52 15,432 — 87,637 
Food62,130 — — — 62,130 
Repairs and maintenance42,015 13 10,093 — 52,121 
Property taxes54,008 6,716 18,011 — 78,735 
Other segment expenses(1)
245,931 2,551 5,723 4,691 258,896 
Total property operating expenses$1,135,887 $9,345 $62,778 $4,691 $1,212,701 
(1) Other segment expenses for Seniors Housing Operating include management fees, insurance expense, marketing, supplies, other miscellaneous expenses and right of use asset amortization for properties subject to lease. Triple-net other segment expenses include right of use asset amortization for properties subject to ground leases and other miscellaneous expenses. Outpatient Medical other segment expenses include insurance expense, right of use asset amortization for properties subject to ground leases and other miscellaneous expenses. Non-segment/Corporate other segment expenses primarily represent insurance costs related to our captive insurance program.
The following table summarizes our total assets by segment for the periods presented (in thousands):
As of
September 30, 2025December 31, 2024
Assets:Amount%Amount%
Seniors Housing Operating$33,567,442 56.4 %$30,094,016 59.0 %
Triple-net9,434,879 15.9 %7,934,415 15.5 %
Outpatient Medical7,496,841 12.6 %7,530,815 14.8 %
Non-segment/Corporate9,005,640 15.1 %5,485,062 10.7 %
Total$59,504,802 100.0 %$51,044,308 100.0 %
The following table summarizes information for the reportable segments for the nine months ended September 30, 2025 (in thousands): 
Nine Months Ended September 30, 2025
Seniors Housing OperatingTriple-netOutpatient MedicalNon-segment / CorporateTotal
Resident fees and services$5,896,944 $— $— $— $5,896,944 
Rental income— 812,435 631,647 — 1,444,082 
Interest income— 2,111 — 189,652 191,763 
Other income16,774 875 6,352 100,233 124,234 
Total revenues5,913,718 815,421 637,999 289,885 7,657,023 
Property operating expenses4,322,176 25,697 190,759 15,517 4,554,149 
Consolidated net operating income (loss)$1,591,542 $789,724 $447,240 $274,368 3,102,874 
Depreciation and amortization1,490,717 
Interest expense448,171 
General and administrative expenses191,057 
Loss (gain) on derivatives and financial instruments, net28,063 
Loss (gain) on extinguishment of debt, net6,156 
Provision for loan losses, net(2,032)
Impairment of assets75,359 
Other expenses75,357 
Income (loss) from continuing operations before income taxes and other items790,026 
Income tax (expense) benefit2,131 
Income (loss) from unconsolidated entities(18,739)
Gain (loss) on real estate dispositions and acquisitions of controlling interests, net70,652 
Income (loss) from continuing operations844,070 
Net income (loss)$844,070 
The following table summarizes significant expense categories by segment for the nine months ended September 30, 2025 (in thousands):
Seniors Housing OperatingTriple-netOutpatient MedicalNon-segment/CorporateTotal
Compensation$2,565,808 $60 $42,992 $— $2,608,860 
Utilities259,279 292 41,742 — 301,313 
Food229,818 — — — 229,818 
Repairs and maintenance168,715 80 33,220 — 202,015 
Property taxes192,705 17,869 53,008 — 263,582 
Other segment expenses(1)
905,851 7,396 19,797 15,517 948,561 
Total property operating expenses$4,322,176 $25,697 $190,759 $15,517 $4,554,149 
(1) Other segment expenses for Seniors Housing Operating include management fees, insurance expense, marketing, supplies, other miscellaneous expenses and right of use asset amortization for properties subject to lease. Triple-net other segment expenses include right of use asset amortization for properties subject to ground leases and other miscellaneous expenses. Outpatient Medical other segment expenses include insurance expense, right of use asset amortization for properties subject to ground leases and other miscellaneous expenses. Non-segment/Corporate other segment expenses primarily represent insurance costs related to our captive insurance program.
The following table summarizes information for the reportable segments for the nine months ended September 30, 2024 (in thousands): 
Nine Months Ended September 30, 2024
Seniors 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 income— — — 185,163 185,163 
Other income5,861 3,248 7,019 89,777 105,905 
Total revenues4,271,132 593,674 600,542 274,940 5,740,288 
Property operating expenses3,190,140 30,657 186,426 13,688 3,420,911 
Consolidated net operating income (loss)$1,080,992 $563,017 $414,116 $261,252 2,319,377 
Depreciation and amortization1,151,687 
Interest expense419,792 
General and administrative expenses186,784 
Loss (gain) on derivatives and financial
instruments, net		(18,785)
Loss (gain) on extinguishment of debt, net2,130 
Provision for loan losses, net10,370 
Impairment of assets69,146 
Other expenses83,054 
Income (loss) from continuing operations before income taxes and other items415,199 
Income tax (expense) benefit(2,586)
Income (loss) from unconsolidated entities(6,925)
Gain (loss) on real estate dispositions and acquisitions of controlling interests, net443,416 
Income (loss) from continuing operations849,104 
Net income (loss)$849,104 

The following table summarizes significant expense categories by segment for the nine months ended September 30, 2024 (in thousands):
Seniors Housing OperatingTriple-netOutpatient MedicalNon-segment/CorporateTotal
Compensation$1,864,383 $54 $41,582 $— $1,906,019 
Utilities199,683 239 40,084 — 240,006 
Food173,887 — — — 173,887 
Repairs and maintenance120,983 61 30,581 — 151,625 
Property taxes156,949 22,686 54,923 — 234,558 
Other segment expenses(1)
674,255 7,617 19,256 13,688 714,816 
Total property operating expenses$3,190,140 $30,657 $186,426 $13,688 $3,420,911 
(1) Other segment expenses for Seniors Housing Operating include management fees, insurance expense, marketing, supplies, other miscellaneous expenses and right of use asset amortization for properties subject to lease. Triple-net other segment expenses include right of use asset amortization for properties subject to ground leases and other miscellaneous expenses. Outpatient Medical other segment expenses include insurance expense, right of use asset amortization for properties subject to ground leases and other miscellaneous expenses. Non-segment/Corporate other segment expenses primarily represent insurance costs related to our captive insurance program.
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, 2025September 30, 2024September 30, 2025September 30, 2024
Revenues:Amount%Amount%Amount%Amount%
United States$2,044,666 76.1 %$1,745,893 84.9 %$5,878,406 76.8 %$4,822,963 84.0 %
United Kingdom448,018 16.7 %174,337 8.5 %1,240,334 16.2 %499,109 8.7 %
Canada193,008 7.2 %135,433 6.6 %538,283 7.0 %418,216 7.3 %
Total$2,685,692 100.0 %$2,055,663 100.0 %$7,657,023 100.0 %$5,740,288 100.0 %
Three Months EndedNine Months Ended
September 30, 2025September 30, 2024September 30, 2025September 30, 2024
Resident Fees and Services:Amount%Amount%Amount%Amount%
United States$1,499,789 72.8 %$1,255,020 83.0 %$4,340,445 73.6 %$3,501,168 82.1 %
United Kingdom388,021 18.8 %125,581 8.3 %1,066,789 18.1 %360,254 8.4 %
Canada173,560 8.4 %130,923 8.7 %489,710 8.3 %403,849 9.5 %
Total$2,061,370 100.0 %$1,511,524 100.0 %$5,896,944 100.0 %$4,265,271 100.0 %
 As of
 September 30, 2025December 31, 2024
Assets:Amount%Amount%
United States$46,803,623 78.7 %$41,966,871 82.2 %
United Kingdom7,214,380 12.1 %5,892,598 11.5 %
Canada5,486,799 9.2 %3,184,839 6.3 %
Total$59,504,802 100.0 %$51,044,308 100.0 %