CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019
Cash flows from operating activities:
Net (loss) income	$ (119,387)	$ (32,258)
Adjustments to reconcile net loss to cash provided by operating activities:
Depreciation and amortization	204,466	219,522
Amortization of debt issuance costs and debt discounts and premiums	5,574	4,592
Straight line rental income	(3,029)	(3,550)
Amortization of acquired real estate leases and other intangible assets	(5,559)	(4,922)
Loss on early extinguishment of debt	51	17
Gain on lease termination	(22,896)	0
Impairment of assets	106,611	41,518
Gain on sale of properties	(2,403)	(21,893)
Gains and losses on equity securities, net	(14,541)	41,476
Other non-cash adjustments, net	(1,662)	(2,828)
Equity in earnings of an investee	0	(617)
Change in assets and liabilities:
Other assets	(39,358)	(6,139)
Accrued interest	29,604	4,126
Other liabilities	21,508	(43,374)
Net cash provided by operating activities	158,979	195,670
Cash flows from investing activities:
Real estate acquisitions and deposits	(2,526)	0
Real estate improvements	(118,141)	(175,146)
Proceeds from sale of properties, net	78,244	50,355
Proceeds from sale of RMR Inc. common shares, net	0	98,557
Distributions in excess of earnings from Affiliates Insurance Company	287	0
Net cash used in investing activities	(42,136)	(26,234)
Cash flows from financing activities:
Proceeds from issuance of senior unsecured notes, net	985,000	0
Proceeds from borrowings on revolving credit facility	430,500	803,000
Repayments of borrowings on revolving credit facility	(968,000)	(353,000)
Repayment of senior unsecured notes	(200,000)	(400,000)
Repayment of unsecured term loan	(250,000)	0
Repayment of other debt	(5,189)	(45,438)
Loss on early extinguishment of debt settled in cash	(376)	0
Payment of debt issuance costs	(5,306)	0
Repurchase of common shares	(171)	(292)
Distributions to noncontrolling interest	(16,707)	(16,294)
Distributions to shareholders	(40,443)	(164,034)
Net cash used in financing activities	(70,692)	(176,058)
Increase (decrease) in cash and cash equivalents and restricted cash	46,151	(6,622)
Cash and cash equivalents and restricted cash at beginning of period	52,224	70,071
Cash and cash equivalents and restricted cash at end of period	98,375	63,449
Supplemental cash flow information:
Interest paid	109,689	129,010
Income taxes paid	381	452
Non-cash investing activities:
Capitalized interest	1,152	$ 888
Five Star
Non-cash investing activities:
Transaction Agreement additional consideration	(75,000)
Five Star
Non-cash investing activities:
Five Star Senior Living Inc. common stock	97,896
Shareholders | Five Star
Non-cash financing activities:
Distribution to common shareholders of the right to receive Five Star Senior Living Inc. common stock	$ (59,801)