Real Property Acquisitions and Development (Details 1) - USD ($) $ in Thousands		9 Months Ended
		Sep. 30, 2017	Sep. 30, 2016
Triple Net [Member]
Estimated Fair Value of Allocated Purchase Price of Asset and Liabilities
Land and land improvements		$ 31,948	$ 21,713
Buildings and improvements		206,910	220,274
Acquired lease intangibles		0	2,876
Total assets acquired		238,858	244,863
Accrued expenses and other liabilities		(21,236)	(2,145)
Total liabilities assumed		(21,236)	(2,145)
Noncontrolling interests		(7,275)	(3,162)
Non-cash acquisition related activity	[1]	(54,901)	(51,733)
Cash disbursed for acquisitions		155,446	187,823
Construction in progress additions		106,186	133,611
Less: Capitalized Interest		(3,886)	(6,263)
Less: Foreign currency translation		(656)	(3,179)
Cash disbursed for construction in progress		101,644	124,169
Capital improvements to existing properties		17,873	21,447
Total cash invested in real property		274,963	333,439
Non Cash Acquisition Financed As Real Estate Loan Receivable		54,901	45,044
Non cash acquisition financed as equity investments			6,689
Senior housing - operating [Member]
Estimated Fair Value of Allocated Purchase Price of Asset and Liabilities
Land and land improvements		31,006	122,649
Buildings and improvements		384,522	1,108,195
Acquired lease intangibles		48,197	90,771
Restricted cash		1,692	137
Receivables and other assets		3,164	2,179
Total assets acquired	[2]	468,581	1,323,931
Secured debt		0	(49,381)
Accrued expenses and other liabilities		(43,364)	(12,328)
Total liabilities assumed		(43,364)	(61,709)
Noncontrolling interests		(4,701)	(1,089)
Non-cash acquisition related activity	[3]	(59,065)	(17,477)
Cash disbursed for acquisitions		361,451	1,243,656
Construction in progress additions		65,282	139,160
Less: Capitalized Interest		(5,996)	(3,923)
Less: Foreign currency translation		(6,218)	(5,953)
Cash disbursed for construction in progress		53,068	129,284
Capital improvements to existing properties		110,372	84,444
Total cash invested in real property		524,891	1,457,384
Cash Acquired from Acquisition		4,581	135
Non Cash Acquisition Financed As Real Estate Loan Receivable		6,349
Non cash acquisition financed as equity investments		51,097	17,477
Outpatient Medical [Member]
Estimated Fair Value of Allocated Purchase Price of Asset and Liabilities
Land and land improvements		25,060	1,466
Buildings and improvements		62,336	27,272
Acquired lease intangibles		8,397	4,592
Receivables and other assets		3	0
Total assets acquired		95,796	33,330
Secured debt		(25,709)	0
Accrued expenses and other liabilities		(2,210)	(1,670)
Total liabilities assumed		(27,919)	(1,670)
Noncontrolling interests		(9,080)	0
Non-cash acquisition related activity	[4]	0	(15,013)
Cash disbursed for acquisitions		58,797	16,647
Construction in progress additions		33,495	81,843
Less: Capitalized Interest		(1,847)	(2,588)
Less: Accruals	[5]	11,708	(7,336)
Cash disbursed for construction in progress		43,356	71,919
Capital improvements to existing properties		30,897	35,309
Total cash invested in real property		$ 133,050	$ 123,875

[1] For the nine months ended September 30, 2017, $54,901,000 is related to the acquisition of assets previously financed as real estate loans receivable. For the nine months ended September 30, 2016, $45,044,000 is related to the acquisition of assets previously financed as real estate loans receivable and $6,689,000 is related to the acquisition of assets previously financed as an investment in an unconsolidated entity.

[2] Excludes $4,581,000 and $135,000 of cash acquired during the nine months ended September 30, 2017 and 2016, respectively.

[3] Includes $6,349,000 related to the acquisition of assets previously financed as real estate loans receivable during the nine months ended September 30, 2017. Includes $51,097,000 and $17,477,000 for the nine months ended September 30, 2017 and 2016, respectively, related to the acquisition of assets previously financed as an investments in an unconsolidated entity.

[4] Represents the acquisition of assets previously financed as real estate loans receivable.

[5] Represents the change in non-cash consideration accruals for amounts to be paid in periods other than the period in which the construction projects converted to operations.