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Real Property Acquisitions and Development (Tables)
 12 Months Ended
Dec. 31, 2021
Real Estate [Abstract]  
Summary of Real Property Investment Activity by Segment
The following is a summary of our real property investment activity by segment for the periods presented (in thousands):
Year Ended December 31, 2021
 Seniors Housing OperatingTriple-netOutpatient MedicalTotal
Land and land improvements  $449,335 $88,839 $64,843 $603,017 
Buildings and improvements  2,347,609 809,328 313,864 3,470,801 
Acquired lease intangibles  264,589 — 24,751 289,340 
Right of use assets, net77,455 — — 77,455 
Total net real estate assets3,138,988 898,167 403,458 4,440,613 
Receivables and other assets6,096 411 3,534 10,041 
Total assets acquired(1)
3,145,084 898,578 406,992 4,450,654 
Lease liabilities(138,126)— — (138,126)
Accrued expenses and other liabilities(191,454)(8,703)(266)(200,423)
Total liabilities acquired(329,580)(8,703)(266)(338,549)
Noncontrolling interests(2)
(4,942)(6,449)(16,540)(27,931)
 Cash disbursed for acquisitions2,810,562 883,426 390,186 4,084,174 
Construction in progress additions322,050 77,412 42,464 441,926 
Less: Capitalized interest(13,834)(3,078)(2,440)(19,352)
Accruals(3)
35 — (4,646)(4,611)
Cash disbursed for construction in progress308,251 74,334 35,378 417,963 
Capital improvements to existing properties197,829 37,345 47,414 282,588 
Total cash invested in real property, net of cash acquired  
$3,316,642 $995,105 $472,978 $4,784,725 
(1) Excludes $4,201,000 of unrestricted and restricted cash acquired.
(2) Includes amounts attributable to both redeemable noncontrolling interests and noncontrolling interests.
(3) Represents non-cash accruals for amounts to be paid in future periods for properties that converted, off-set by amounts paid in the current period.
Year Ended December 31, 2020
 Seniors Housing OperatingTriple-netOutpatient MedicalTotal
Land and land improvements  $55,000 $16,876 $45,590 $117,466 
Buildings and improvements  527,189 73,855 179,004 780,048 
Acquired lease intangibles  28,668 — 24,718 53,386 
Total net real estate assets610,857 90,731 249,312 950,900 
Receivables and other assets  746 — 268 1,014 
Total assets acquired(1)
611,603 90,731 249,580 951,914 
Accrued expenses and other liabilities(1,650)— (962)(2,612)
Total liabilities acquired(1,650)— (962)(2,612)
Noncontrolling interests(2)
(45,546)— — (45,546)
Cash disbursed for acquisitions564,407 90,731 248,618 903,756 
Construction in progress additions134,945 45,256 39,833 220,034 
Less: Capitalized interest(10,389)(3,209)(3,874)(17,472)
Accruals (3)
(1,226)— — (1,226)
Cash disbursed for construction in progress123,330 42,047 35,959 201,336 
Capital improvements to existing properties107,379 76,625 60,985 244,989 
Total cash invested in real property, net of cash acquired$795,116 $209,403 $345,562 $1,350,081 
(1) Excludes $580,000 of unrestricted and restricted cash acquired.
(2) Includes amounts attributable to both redeemable noncontrolling interests and noncontrolling interests.
(3) Represents non-cash accruals for amounts to be paid in future periods for properties that converted, off-set by amounts paid in the current period.
Year Ended December 31, 2019
 Seniors Housing OperatingTriple-netOutpatient MedicalTotal
Land and land improvements  $154,470 $24,097 $293,933 $472,500 
Buildings and improvements  1,518,748 203,282 1,954,928 3,676,958 
Acquired lease intangibles  76,009 — 183,921 259,930 
Real property held for sale17,435 — — 17,435 
Construction in progress36,174 — — 36,174 
Right of use assets, net— — 58,377 58,377 
Total net real estate assets1,802,836 227,379 2,491,159 4,521,374 
Receivables and other assets  15,634 — 1,586 17,220 
Total assets acquired(1)
1,818,470 227,379 2,492,745 4,538,594 
Secured debt  (194,408)— (206,754)(401,162)
Lease liabilities— — (47,740)(47,740)
Accrued expenses and other liabilities(12,024)— (32,893)(44,917)
Total liabilities acquired(206,432)— (287,387)(493,819)
Noncontrolling interests(2)
(67,987)(4,015)(1,201)(73,203)
Non-cash acquisition related activity (3)
(11,889)— — (11,889)
Cash disbursed for acquisitions1,532,162 223,364 2,204,157 3,959,683 
Construction in progress additions227,018 61,414 60,884 349,316 
Less: Capitalized interest(8,889)(2,385)(3,998)(15,272)
Accruals(4)
— — (1,035)(1,035)
Cash disbursed for construction in progress218,129 59,029 55,851 333,009 
Capital improvements to existing properties260,413 17,426 50,985 328,824 
Total cash invested in real property, net of cash acquired$2,010,704 $299,819 $2,310,993 $4,621,516 
(1) Excludes $2,090,000 of unrestricted and restricted cash acquired.
(2) Includes amounts attributable to both redeemable noncontrolling interests and noncontrolling interests.
(3) Relates to the acquisition of assets previously recognized as investments in unconsolidated entities.
(4) Represents non-cash accruals for amounts to be paid in future periods for properties that converted, off-set by amounts paid in the current period.
The following is a summary of the construction projects that were placed into service and began generating revenues during the periods presented (in thousands):
 Year Ended
 December 31, 2021December 31, 2020December 31, 2019
Development projects:
Seniors Housing Operating$117,386 $93,188 $28,117 
Triple-net22,990 75,149 — 
Outpatient Medical125,179 43,493 21,006 
Total development projects265,555 211,830 49,123 
Expansion projects5,292 48,600 — 
Total construction in progress conversions$270,847 $260,430 $49,123