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Real Estate Loans Receivable (Tables)
12 Months Ended
Dec. 31, 2017
Real Estate Loans Receivable (Tables) [Abstract]  
Summary of real estate loans receivable

6. Real Estate Loans Receivable

     The following is a summary of our real estate loans receivable (in thousands):

December 31,
20172016
Mortgage loans$374,492$485,735
Other real estate loans121,379136,893
Totals$495,871$622,628
Summary of real estate loan activity

The following is a summary of our real estate loan activity for the periods presented (in thousands):

Year Ended
December 31, 2017December 31, 2016December 31, 2015
OutpatientOutpatientOutpatient
Triple-netMedicalTotalsTriple-netMedicalTotalsTriple-netMedicalTotals
Advances on real estate loans receivable:
Investments in new loans$12,091$-$12,091$8,445$-$8,445$530,497$-$530,497
Draws on existing loans71,647-71,647118,7882,651121,43965,6142,61168,225
Net cash advances on real estate loans83,738-83,738127,2332,651129,884596,1112,611598,722
Receipts on real estate loans receivable:
Loan payoffs157,91260,500218,412275,43927,303302,742121,778-121,778
Principal payments on loans1,219-1,2196,867-6,86733,340-33,340
Sub-total159,13160,500219,631282,30627,303309,609155,118-155,118
Less: Non-cash activity(1)(63,108)(60,500)(123,608)(45,044)(15,013)(60,057)(23,288)-(23,288)
Net cash receipts on real estate loans96,023-96,023237,26212,290249,552131,830-131,830
Net cash advances (receipts) on real estate loans(12,285)-(12,285)(110,029)(9,639)(119,668)464,2812,611466,892
Change in balance due to foreign currency translation9,136-9,136(14,086)-(14,086)(4,281)-(4,281)
Loan impairments(2)----(3,053)(3,053)---
Net change in real estate loans receivable$(66,257)$(60,500)$(126,757)$(169,159)$(27,705)$(196,864)$436,712$2,611$439,323
(1) Primarily represents aquisitions of assets previously financed as a real estate loans. Please see Note 3 for additional information.
(2) Represents a direct write down of an impaired loan receivable.
Summary of allowance for losses on loans receivable

The following is a summary of the allowance for losses on loans receivable for the periods presented (in thousands):

Year Ended December 31,
201720162015
Balance at beginning of year$6,563$-$-
Provision for loan losses(1)62,9666,935-
Change in present value (1,157) (372) -
Balance at end of year$68,372$6,563$-
(1) Excludes direct write down of an impaired loan receivable in 2016.
Summary of loan impairments

The following is a summary of our loan impairments (in thousands):

Year Ended December 31,
201720162015
Balance of impaired loans at end of year$282,882$377,549$-
Allowance for loan losses68,3726,563-
Balance of impaired loans not reserved$214,510$370,986$-
Average impaired loans for the year$330,216$188,775$10,500
Interest recognized on impaired loans(1)27,7938,707-
(1) Represents cash interest recognized in the period since loans were identified as impaired.