Brookdale Senior Living (BKD) 10-K21 Feb 242023 FY Annual reportFinancial data

Company Profile

Cover Page

Cover Page - USD ($) $ in Billions	12 Months Ended
Cover Page - USD ($) $ in Billions	Dec. 31, 2023	Feb. 19, 2024	Jun. 30, 2023
Document Information [Line Items]
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2023
Current Fiscal Year End Date	--12-31
Document Transition Report	false
Entity File Number	001-32641
Entity Registrant Name	BROOKDALE SENIOR LIVING INC.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	20-3068069
Entity Address, Address Line One	111 Westwood Place,
Entity Address, Address Line Two	Suite 400,
Entity Address, City or Town	Brentwood,
Entity Address, State or Province	TN
Entity Address, Postal Zip Code	37027
City Area Code	(615)
Local Phone Number	221-2250
Entity Well-known Seasoned Issuer	Yes
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
ICFR Auditor Attestation Flag	true
Document Financial Statement Error Correction [Flag]	false
Entity Shell Company	false
Entity Public Float			$ 0.8
Entity Common Stock, Shares Outstanding		189,339,428
Documents Incorporated by Reference	Certain sections of the registrant's Definitive Proxy Statement relating to its 2024 Annual Meeting of Stockholders to be filed with the SEC within 120 days of December 31, 2023, are incorporated by reference into Part III of this Annual Report on Form 10-K.
Entity Central Index Key	0001332349
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	FY
Amendment Flag	false
Common Stock
Document Information [Line Items]
Title of 12(b) Security	Common Stock, $0.01 Par Value Per Share
Trading Symbol	BKD
Security Exchange Name	NYSE
Incremental shares issuable under purchase contracts
Document Information [Line Items]
Title of 12(b) Security	7.00% Tangible Equity Units
Trading Symbol	BKDT
Security Exchange Name	NYSE

Audit Information

Audit Information	12 Months Ended
Audit Information	Dec. 31, 2023
Audit Information [Abstract]
Auditor Name	Ernst & Young LLP
Auditor Firm ID	42
Auditor Location	Chicago, Illinois

CONSOLIDATED BALANCE SHEETS

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Current assets
Cash and cash equivalents	$ 277,971	$ 398,850
Marketable securities	29,755	48,680
Restricted cash	41,341	27,735
Accounts receivable, net	48,393	55,761
Prepaid expenses and other current assets, net	80,908	106,067
Total current assets	478,368	637,093
Property, plant and equipment and leasehold intangibles, net	4,330,629	4,535,702
Operating lease right-of-use assets	670,907	597,130
Restricted cash	30,356	47,963
Investment in unconsolidated ventures	1,906	55,333
Goodwill	27,321	27,321
Deferred tax asset	0	1,604
Other assets, net	33,948	34,916
Total assets	5,573,435	5,937,062
Current liabilities
Current portion of long-term debt	41,463	66,043
Current portion of financing lease obligations	1,075	24,059
Current portion of operating lease obligations	192,631	176,758
Trade accounts payable	66,526	71,000
Accrued expenses	242,668	237,148
Refundable fees and deferred revenue	55,753	66,197
Total current liabilities	600,116	641,205
Long-term debt, less current portion	3,655,850	3,784,099
Financing lease obligations, less current portion	150,774	224,801
Operating lease obligations, less current portion	683,876	616,973
Deferred tax liability	5,987	0
Other liabilities	71,679	85,831
Total liabilities	5,168,282	5,352,909
Preferred stock, $0.01 par value, 50,000,000 shares authorized at December 31, 2023 and 2022; no shares issued and outstanding	0	0
Common stock, $0.01 par value, 400,000,000 shares authorized at December 31, 2023 and 2022; 198,780,826 and 197,776,991 shares issued and 188,253,301 and 187,249,466 shares outstanding, respectively	1,988	1,978
Additional paid-in-capital	4,342,362	4,332,302
Treasury stock, at cost; 10,527,525 shares at December 31, 2023 and 2022	(102,774)	(102,774)
Accumulated deficit	(3,837,912)	(3,648,901)
Total Brookdale Senior Living Inc. stockholders' equity	403,664	582,605
Noncontrolling interest	1,489	1,548
Total equity	405,153	584,153
Total liabilities and equity	$ 5,573,435	$ 5,937,062

CONSOLIDATED BALANCE SHEETS (Pa

CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares	Dec. 31, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Preferred stock, par value (in dollars per share)	$ 0.01	$ 0.01
Preferred stock, shares authorized (in shares)	50,000,000	50,000,000
Preferred stock, shares issued (in shares)	0	0
Preferred stock, shares outstanding (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, shares authorized (in shares)	400,000,000	400,000,000
Common stock, shares issued (in shares)	198,780,826	197,776,991
Common stock, shares outstanding (in shares)	188,253,301	187,249,466
Treasury stock, shares (in shares)	10,527,525	10,527,525

CONSOLIDATED STATEMENTS OF OPER

CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Revenue	$ 3,015,829	$ 2,825,379	$ 2,758,259
Cost of Revenue [Abstract]
General and administrative expense (including non-cash stock-based compensation expense of $11,985, $14,466, and $16,270, respectively)	178,894	168,594	184,916
Facility operating lease expense	202,410	165,294	174,358
Depreciation and amortization	342,712	347,444	337,613
Asset impairment	40,572	29,618	23,003
Loss (gain) on sale of communities, net	(36,296)	(73,850)	0
Loss (gain) on facility operating lease termination, net	0	0	(2,003)
Income (loss) from operations	18,412	(42,687)	(216,936)
Interest income	23,146	6,935	1,349
Interest expense:
Debt	(209,772)	(157,869)	(141,409)
Financing lease obligations	(21,950)	(48,061)	(46,282)
Amortization of deferred financing costs	(7,696)	(6,446)	(7,297)
Change in fair value of derivatives	1,144	7,659	(152)
Gain (loss) on debt modification and extinguishment, net	(2,702)	(1,357)	(1,932)
Equity in earnings (loss) of unconsolidated ventures	(3,996)	(10,782)	10,394
Non-operating gain (loss) on sale of assets, net	1,441	595	288,835
Other non-operating income (loss)	21,687	12,114	5,903
Income (loss) before income taxes	(180,286)	(239,899)	(107,527)
Benefit (provision) for income taxes	(8,784)	1,559	8,163
Net income (loss)	(189,070)	(238,340)	(99,364)
Net (income) loss attributable to noncontrolling interest	59	(87)	74
Net income (loss) attributable to Brookdale Senior Living Inc. common stockholders	$ (189,011)	$ (238,427)	$ (99,290)
Basic and diluted net income (loss) per share attributable to Brookdale Senior Living Inc. common stockholders
Basic net income (loss) per share attributable to Brookdale Senior Living Inc. common stockholders (in dollars per share)	$ (0.84)	$ (1.25)	$ (0.54)
Diluted net income (loss) per share attributable to Brookdale Senior Living Inc. common stockholders (in dollars per share)	$ (0.84)	$ (1.25)	$ (0.54)
Weighted average shares used in computing basic and diluted net income (loss) per share
Weighted average shares used in computing basic net income (loss) per share (in shares)	225,209	190,463	184,975
Weighted average shares used in computing diluted net income (loss) per share (in shares)	225,209	190,463	184,975
Resident fees
Revenue	$ 2,857,270	$ 2,585,529	$ 2,543,848
Management fees
Revenue	10,161	12,020	20,598
Reimbursed costs incurred on behalf of managed communities
Revenue	139,325	147,361	181,445
Cost of Revenue [Abstract]
Costs incurred	139,325	147,361	181,445
Other operating income
Revenue	9,073	80,469	12,368
Facility operating expense
Cost of Revenue [Abstract]
Costs incurred	$ 2,129,800	$ 2,083,605	$ 2,075,863

CONSOLIDATED STATEMENTS OF OP_2

CONSOLIDATED STATEMENTS OF OPERATIONS (Parenthetical) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Statement [Abstract]
Facility depreciation and amortization	$ 317,581	$ 324,904	$ 313,830
Non-cash stock-based compensation expense	$ 11,985	$ 14,466	$ 16,270

CONSOLIDATED STATEMENTS OF EQUI

CONSOLIDATED STATEMENTS OF EQUITY - USD ($) $ in Thousands	Total	Common Stock	Additional Paid-In- Capital	Treasury Stock	Accumulated Deficit	Noncontrolling Interest
Balances at beginning of period at Dec. 31, 2020	$ 802,729	$ 1,983	$ 4,212,409	$ (102,774)	$ (3,311,184)	$ 2,295
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Compensation expense related to restricted stock grants			16,270
Issuance of common stock under Associate Stock Purchase Plan			699
Purchase of capped call transactions			(15,916)
Restricted stock and restricted stock units, net		(1)	1
Shares withheld for employee taxes		(7)	(4,813)
Other, net			25
Net income (loss)	(99,290)				(99,290)
Net income (loss) attributable to noncontrolling interest	(99,364)					(74)
Balances at end of period at Dec. 31, 2021	699,623	$ 1,975	4,208,675	(102,774)	(3,410,474)	2,221
Balances at beginning of period (in shares) at Dec. 31, 2020		187,804,000
Equity, Including Portion Attributable to Noncontrolling Interest [Abstract]
Issuance of common stock under Associate Stock Purchase Plan (in shares)		124,000
Restricted stock and restricted stock units, net (in shares)		(159,000)
Shares withheld for employee taxes (in shares)		(811,000)
Balances at end of period (in shares) at Dec. 31, 2021		186,958,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Compensation expense related to restricted stock grants			14,466
Issuance of tangible equity units, net of issuance costs			113,457
Restricted stock and restricted stock units, net		$ 9	(9)
Shares withheld for employee taxes		(6)	(4,287)
Net income (loss)	(238,427)				(238,427)
Net income (loss) attributable to noncontrolling interest	(238,340)					87
Noncontrolling interest distribution						(760)
Balances at end of period at Dec. 31, 2022	$ 584,153	$ 1,978	4,332,302	(102,774)	(3,648,901)	1,548
Equity, Including Portion Attributable to Noncontrolling Interest [Abstract]
Restricted stock and restricted stock units, net (in shares)		911,000
Shares withheld for employee taxes (in shares)		(620,000)
Balances at end of period (in shares) at Dec. 31, 2022	187,249,466	187,249,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Compensation expense related to restricted stock grants			11,985
Restricted stock and restricted stock units, net		$ 16	(16)
Shares withheld for employee taxes		(6)	(1,909)
Net income (loss)	$ (189,011)				(189,011)
Net income (loss) attributable to noncontrolling interest	(189,070)					(59)
Balances at end of period at Dec. 31, 2023	$ 405,153	$ 1,988	$ 4,342,362	$ (102,774)	$ (3,837,912)	$ 1,489
Equity, Including Portion Attributable to Noncontrolling Interest [Abstract]
Restricted stock and restricted stock units, net (in shares)		1,580,000
Shares withheld for employee taxes (in shares)		(576,000)
Balances at end of period (in shares) at Dec. 31, 2023	188,253,301	188,253,000

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Cash Flows from Operating Activities
Net income (loss)	$ (189,070)	$ (238,340)	$ (99,364)
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:
Loss (gain) on debt modification and extinguishment, net	2,702	1,357	1,932
Depreciation and amortization, net	350,408	353,890	344,910
Asset impairment	40,572	29,618	23,003
Equity in (earnings) loss of unconsolidated ventures	3,996	10,782	(10,394)
Distributions from unconsolidated ventures from cumulative share of net earnings	430	561	6,191
Amortization of entrance fees	(732)	(2,307)	(1,758)
Proceeds from deferred entrance fee revenue	477	4,222	3,562
Deferred income tax (benefit) provision	7,590	(1,324)	(9,837)
Operating lease expense adjustment	(45,739)	(34,896)	(23,280)
Change in fair value of derivatives	(1,144)	(7,659)	152
Loss (gain) on sale of assets, net	(37,737)	(74,445)	(288,835)
Loss (gain) on facility operating lease termination, net	0	0	(2,003)
Non-cash stock-based compensation expense	11,985	14,466	16,270
Property and casualty insurance income	(18,920)	(11,379)	(4,689)
Other non-operating (income) loss	(2,542)	0	0
Changes in operating assets and liabilities:
Accounts receivable, net	7,380	(4,624)	502
Prepaid expenses and other assets, net	21,629	(21,240)	(15,483)
Trade accounts payable and accrued expenses	2,448	(27,185)	(54,032)
Refundable fees and deferred revenue	(654)	(1,934)	(10,066)
Operating lease assets and liabilities for lessor capital expenditure reimbursements	9,844	13,718	30,965
Operating lease assets and liabilities for lease termination	0	0	(2,380)
Net cash provided by (used in) operating activities	162,923	3,281	(94,634)
Cash Flows from Investing Activities
Purchase of marketable securities	(174,476)	(263,669)	(362,257)
Sale and maturities of marketable securities	197,100	398,752	352,988
Capital expenditures, net of related payables	(233,205)	(196,924)	(176,657)
Acquisition of assets, net of cash acquired	(574)	(6,004)	0
Investment in unconsolidated ventures	(7,589)	(218)	(5,436)
Distributions received from unconsolidated ventures	0	966	37,113
Proceeds from sale of assets, net	83,526	4,653	334,006
Property and casualty insurance proceeds	24,704	0	0
Purchase of interest rate cap instruments	(12,454)	(1,632)	0
Proceeds from interest rate cap instruments	9,890	788	0
Other	(286)	(4,141)	1,700
Net cash provided by (used in) investing activities	(113,364)	(67,429)	181,457
Cash Flows from Financing Activities
Proceeds from debt	205,549	254,259	352,962
Repayment of debt and financing lease obligations	(367,242)	(281,185)	(441,571)
Proceeds from issuance of tangible equity units	0	139,438	0
Purchase of capped call transactions	0	0	(15,916)
Payment of financing costs, net of related payables	(10,831)	(7,077)	(3,904)
Payments of employee taxes for withheld shares	(1,915)	(4,293)	(4,820)
Other	0	(760)	(408)
Net cash provided by (used in) financing activities	(174,439)	100,382	(113,657)
Net increase (decrease) in cash, cash equivalents, and restricted cash	(124,880)	36,234	(26,834)
Cash, cash equivalents, and restricted cash at beginning of period	474,548	438,314	465,148
Cash, cash equivalents, and restricted cash at end of period	$ 349,668	$ 474,548	$ 438,314

Description of Business

Description of Business	12 Months Ended
Description of Business	Dec. 31, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Description of Business	1. Description of Business Brookdale Senior Living Inc. together with its consolidated subsidiaries ("Brookdale" or the "Company") is an operator of 652 senior living communities throughout the United States. The Company is committed to its mission of enriching the lives of the people it serves with compassion, respect, excellence, and integrity. The Company operates and manages independent living, assisted living, memory care, and continuing care retirement communities ("CCRCs"). The Company's senior living communities and its comprehensive network help to provide seniors with care, connection, and services in an environment that feels like home. As of December 31, 2023, the Company owned 345 communities, representing a majority of the Company's community portfolio, leased 277 communities, and managed 30 communities.

Summary of Significant Accounti

Summary of Significant Accounting Policies	12 Months Ended
Summary of Significant Accounting Policies	Dec. 31, 2023
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	2. Summary of Significant Accounting Policies The consolidated financial statements have been prepared in accordance with U.S. generally accepted accounting principles ("GAAP"). The significant accounting policies are summarized below: Principles of Consolidation The consolidated financial statements include the accounts of Brookdale and its consolidated subsidiaries. The ownership interest of consolidated entities not wholly-owned by the Company are presented as noncontrolling interests in the accompanying consolidated financial statements. Intercompany balances and transactions have been eliminated in consolidation, and net income (loss) is reduced by the portion of net income (loss) attributable to noncontrolling interests. Use of Estimates The preparation of the consolidated financial statements and related disclosures in conformity with GAAP requires management to make estimates and assumptions that affect the amounts reported in the consolidated financial statements and accompanying notes. Estimates are used for, but not limited to, revenue, asset impairments, self-insurance reserves, performance-based compensation, allowance for credit losses, depreciation and amortization, leasing transactions, income taxes, and other contingencies. Although these estimates are based on management's best knowledge of current events and actions that the Company may undertake in the future, actual results may differ from the original estimates. Revenue Recognition Resident Fees Resident fee revenue is reported at the amount that reflects the consideration the Company expects to receive in exchange for the services provided. These amounts are due from residents or third-party payors and include variable consideration for retroactive adjustments from estimated reimbursements, if any, under reimbursement programs. Performance obligations are determined based on the nature of the services provided. Resident fee revenue is recognized as performance obligations are satisfied. Under the Company's senior living residency agreements, which are generally for a contractual term of 30 days to one year, the Company provides senior living services to residents for a stated daily or monthly fee. The Company has elected the lessor practical expedient within ASC 842, Leases ("ASC 842") and recognizes, measures, presents, and discloses the revenue for services under the Company's senior living residency agreements based upon the predominant component, either the lease or nonlease component, of the contracts. The Company has determined that the services included under the Company's independent living, assisted living, and memory care residency agreements have the same timing and pattern of transfer and are performance obligations that are satisfied over time. The Company recognizes revenue under ASC 606, Revenue Recognition from Contracts with Customers ("ASC 606") for its independent living, assisted living, and memory care residency agreements for which it has estimated that the nonlease components of such residency agreements are the predominant component of the contract. The Company receives payment for services under various third-party payor programs which include Medicare, Medicaid, and other third-party payors. Estimates for settlements with third-party payors for retroactive adjustments from estimated reimbursements due to audits, reviews, or investigations are included in the determination of the estimated transaction price for providing services. The Company estimates the transaction price based on the terms of the contract with the payor, correspondence with the payor, and historical payment trends. Changes to these estimates for retroactive adjustments are recognized in the period the change or adjustment becomes known or when final settlements are determined. Billings for services under third-party payor programs are recorded net of estimated retroactive adjustments, if any. Retroactive adjustments are accrued on an estimated basis in the period the related services are rendered and adjusted in future periods or as final settlements are determined. Contractual or cost related adjustments from Medicare or Medicaid are accrued when assessed (without regard to when the assessment is paid or withheld). Subsequent adjustments to these accrued amounts are recorded in net revenues when known. Management Services The Company manages certain communities under contracts which provide periodic management fee payments to the Company and reimbursement for costs and expense related to such communities. Management fees are generally determined by an agreed upon percentage of gross revenues (as defined in the management agreement). Certain management contracts also provide for an annual incentive fee to be paid to the Company upon achievement of certain metrics identified in the contract. The Company has determined that all community management activities are a single performance obligation, which is satisfied over time as the services are rendered. The Company estimates the amount of incentive fee revenue expected to be earned, if any, during the annual contract period and revenue is recognized as services are provided. The Company's estimate of the transaction price for management services also includes the amount of reimbursement due from the owners of the communities for services provided and related costs incurred. Such revenue is included in reimbursed costs incurred on behalf of managed communities on the consolidated statements of operations. The related costs are included in costs incurred on behalf of managed communities on the consolidated statements of operations. Government Grants The Company recognizes income for government grants on a systematic and rational basis over the periods in which the Company recognizes the related expenses or loss of revenue for which the grants are intended to compensate when there is reasonable assurance that the Company will comply with the applicable terms and conditions of the grant and there is reasonable assurance that the grant will be received. Lease Accounting The Company, as lessee, recognizes a right-of-use asset and a lease liability on the Company's consolidated balance sheet for its long-term leases. As of the commencement date of a lease, a lease liability and corresponding right-of-use asset is established on the Company's consolidated balance sheet at the estimated present value of future minimum lease payments. The Company's community leases generally contain fixed annual rent escalators or annual rent escalators based on an index, such as the consumer price index. The future minimum lease payments recognized on the consolidated balance sheet include fixed payments (including in-substance fixed payments) and variable payments estimated utilizing the index or rate on the lease commencement date. The Company recognizes lease expense as incurred for additional variable payments. For the Company's leases for which the rate implicit in the lease is not readily determinable, the Company utilizes its estimated incremental borrowing rate to determine the present value of lease payments based on information available at commencement of the lease. The Company's estimated incremental borrowing rate reflects the fixed rate at which the Company could borrow a similar amount for the same term on a collateralized basis. For accounting purposes, renewal or extension options are included in the lease term at lease inception or modification when it is reasonably certain that the Company will exercise the option. The Company elected the short-term lease exception policy which permits leases with an initial term of 12 months or less to not be recorded on the Company's consolidated balance sheet. The Company, as lessee, makes a determination with respect to each of its leases as to whether each should be accounted for as an operating lease or financing lease. The classification criteria is based on estimates regarding the fair value of the leased asset, minimum lease payments, effective cost of funds, economic life of the asset, and certain other terms in the lease agreements. Lease right-of-use assets are reviewed for impairment whenever changes in circumstances indicate that the carrying amount of an asset group may not be recoverable. Recoverability of right-of-use assets are assessed by a comparison of the carrying amount of the asset group to the estimated future undiscounted net cash flows expected to be generated by the asset group, calculated utilizing the lowest level of identifiable cash flows. If estimated future undiscounted net cash flows are less than the carrying amount of the asset group then the fair value of the asset is estimated. The impairment loss is determined by comparing the estimated fair value of the asset to its carrying amount, with any amount in excess of fair value recognized as an impairment loss in the current period. Undiscounted cash flow projections and estimates of fair value amounts are based on a number of assumptions such as revenue and expense growth rates and estimated lease coverage ratios (Level 3). Operating Leases The Company recognizes operating lease expense for actual rent paid, generally plus or minus a straight-line adjustment for estimated minimum lease escalators if applicable. The right-of-use asset is generally reduced each period by an amount equal to the difference between the operating lease expense and the amount of expense on the lease liability utilizing the effective interest method. Subsequent to the impairment of an operating lease right-of-use asset, the Company recognizes operating lease expense consisting of the reduction of the right-of-use asset on a straight-line basis over the remaining lease term and the amount of expense on the lease liability utilizing the effective interest method. Financing Leases Financing lease right-of-use assets are recognized within property, plant and equipment and leasehold intangibles, net on the Company's consolidated balance sheets. The Company recognizes interest expense on the financing lease liabilities utilizing the effective interest method. The right-of-use asset is generally amortized to depreciation and amortization expense on a straight-line basis over the lease term unless the lease contains an option to purchase the underlying asset that the Company is reasonably certain to exercise. If the Company is reasonably certain to exercise the purchase option, the asset is amortized over the useful life. Sale-Leaseback Transactions For transactions in which an owned community is sold and leased back from the buyer (sale-leaseback transactions), the Company recognizes an asset sale and lease accounting is applied if the Company has transferred control of the community. For such transactions, the Company removes the transferred assets from the consolidated balance sheet and a gain or loss on the sale is recognized for the difference between the carrying amount of the asset and the transaction price for the sale transaction. For sale‑leaseback transactions in which the Company has not transferred control of the underlying asset, the Company does not recognize an asset sale or derecognize the underlying asset until control is transferred. For such transactions, the Company recognizes the underlying assets within assets under financing leases as a component of property, plant and equipment and leasehold intangibles, net on the consolidated balance sheets and continues to depreciate the assets over their useful lives. Additionally, the Company accounts for any amounts received as a financing lease liability and the Company recognizes interest expense on the financing lease liability utilizing the effective interest method with the interest expense limited to an amount that is not greater than the cash payments on the financing lease liability over the term of the lease. The Company reviews for sale accounting whenever events or changes in circumstances indicate that control may have been transferred and the Company recognizes an asset sale and lease accounting is applied if the Company has transferred control of the underlying asset. When an asset sale is recognized for such transactions, the Company removes the transferred assets and financing lease liability from the consolidated balance sheet and a gain or loss on the sale is recognized for the difference between the carrying amount of the asset and the financing lease liability. Gain (Loss) on Sale of Assets The Company regularly enters into real estate transactions which may include the disposition of certain communities, including the associated real estate. The Company recognizes a gain or loss from real estate sales when the transfer of control is complete. The Company recognizes a gain or loss from the sale of equity method investments when the transfer of control is complete and the Company has no continuing involvement with the transferred financial assets. Purchase Accounting For the acquisition of assets that do not meet the definition of a business, the Company accounts for the transaction as an asset acquisition at the purchase price, including acquisition costs, allocated among the acquired assets and assumed liabilities, including identified intangible assets and liabilities, based upon the relative fair values using Level 3 inputs at the date of acquisition. For acquisitions of a business, the Company accounts for the transaction as a business combination pursuant to the acquisition method and assets acquired and liabilities assumed, including identified intangible assets and liabilities, are recorded at fair value. In determining the allocation of the purchase price of companies and communities to net tangible and identified intangible assets acquired and liabilities assumed, the Company makes estimates of fair value using information obtained as a result of pre-acquisition due diligence, marketing, leasing activities, and/or independent appraisals. In connection with a business combination, the excess of the fair value of liabilities assumed and common stock issued and cash paid over the fair value of identifiable assets acquired is allocated to goodwill. Transaction costs associated with business combinations are expensed as incurred. Deferred Financing Costs Costs and fees incurred with third parties that directly relate to obtaining new long-term debt (excluding the Company's line-of-credit) are recorded as a direct adjustment to the carrying amount of long-term debt. The Company presents deferred financing costs related to line-of-credit facilities in other assets, net on the consolidated balance sheet. The Company amortizes deferred financing costs on a straight-line basis, which approximates the effective yield method over the term of the related debt arrangements. Stock-Based Compensation Measurement of the cost of employee services received in exchange for stock-based compensation is based on the grant-date fair value of the employee stock awards, which is based on the quoted price of the Company's common shares on the grant date for the majority of the Company's awards. The Company evaluates if grant-date fair value adjustments are necessary based on whether the Company is in possession of material non-public information at the grant date and the changes in the Company’s stock price subsequent to the release of such information and no adjustments were made. The Company recognizes forfeitures of stock-based awards as they occur and any previously recognized compensation expense is reversed for forfeited awards. Stock-based awards that vest over a requisite service period, other than those with performance or market conditions, generally vest ratably in annual installments over a period of three Certain of the Company's employee stock-based awards vest only upon the achievement of performance conditions. The Company recognizes compensation cost only when achievement of performance conditions is considered probable. Consequently, the Company’s determination of the amount of stock-based compensation expense requires judgment in estimating the probability of achievement of these performance conditions. Performance conditioned awards that vest dependent upon attainment of various levels of performance that equal or exceed threshold levels generally vest based upon performance at the end of a three-year performance period. The number of shares that ultimately vest can range from 0% to 150% of the stock-based awards granted depending on the level of achievement of the performance criteria. Certain of the Company's employee stock-based awards vest only upon the achievement of a market condition where the measurement period is three years and vesting of the awards is based on the Company's level of attainment of a specified total stockholder return relative to the percentage appreciation of a specified index of companies for the respective three-year measurement period. Compensation expense for awards with market conditions is recognized over the service period, which is generally four years, and the actual achievement of the market condition does not impact expense recognition. The Company uses a Monte Carlo valuation model to estimate the grant date fair value of such awards. Depending on the results achieved during the three-year measurement period, the number of shares that ultimately vest may range from 0% to 150% of the stock-based awards granted. The expected volatility of the Company's common stock at the date of grant is estimated based on a historical average volatility rate for the approximate three-year performance period and the estimated expected weighted average volatility was 83.3% and 76.0% for awards granted in 2023 and 2022, respectively. The risk-free interest rate assumption is based on observed interest rates consistent with the approximate three-year measurement period and the estimated weighted average risk free interest rate was 4.4% and 1.8% for awards granted in 2023 and 2022, respectively. For all share-based awards with graded vesting other than performance conditioned awards, the Company records compensation expense for the entire award on a straight-line basis (or, if applicable, on the accelerated method) over the requisite service period. For performance conditioned awards, total compensation expense is recognized over the requisite service period for each separately vesting tranche of the award as if the award is, in substance, multiple awards once the performance condition is deemed probable of achievement. Performance conditions are evaluated quarterly. If such conditions are not ultimately met or it is not probable the conditions will be achieved, no compensation expense for performance conditioned awards is recognized and any previously recognized compensation expense is reversed. Income Taxes The Company accounts for income taxes under the asset and liability approach which requires recognition of deferred tax assets and liabilities for the differences between the financial reporting and tax basis of assets and liabilities using the tax rates in effect for the year in which the differences are expected to affect taxable income. A valuation allowance reduces deferred tax assets when it is more likely than not that some portion or all of the deferred tax assets will not be realized. When it is determined that it is more likely than not that the Company will be able to realize deferred tax assets in the future in excess of the net recorded amount, an adjustment to the deferred tax asset is made and reflected in income. This determination is made by considering various factors, including the reversal and timing of existing temporary differences, tax planning strategies, and estimates of future taxable income exclusive of the reversal of temporary differences. Fair Value of Financial Instruments Fair value measurements are based on a three-level valuation hierarchy for disclosure of fair value measurements. The valuation hierarchy is based upon the transparency of inputs to the valuation of an asset or liability as of the measurement date. Categorization within the valuation hierarchy is based upon the lowest level of input that is significant to the fair value measurement. The three levels are defined as follows. • Level 1 – quoted prices (unadjusted) for identical assets or liabilities in active markets; • Level 2 – quoted prices for similar assets and liabilities in active markets; quoted prices for identical or similar instruments in markets that are not active; and model-derived valuations in which significant inputs and significant value drivers are observable in active markets; and • Level 3 – fair value measurements derived from valuation techniques in which one or more significant inputs or significant value drivers are unobservable. Marketable Securities Marketable securities are investments in commercial paper and short-term corporate bond instruments with maturities of greater than 90 days as of their acquisition date by the Company. Accounts Receivable, Net Accounts receivable are reported net of an allowance for credit losses to represent the Company's estimate of expected losses at the balance sheet date. The adequacy of the Company's allowance for credit losses is reviewed on an ongoing basis, using historical payment trends, write-off experience, analyses of receivable portfolios by payor source and aging of receivables, a review of specific accounts, as well as expected future economic conditions and market trends, and adjustments are made to the allowance as necessary. Property, Plant and Equipment and Leasehold Intangibles, Net Property, plant and equipment and leasehold intangibles, net are recorded at cost. Depreciation and amortization is computed using the straight-line method over the estimated useful lives of the assets, which are as follows. Asset Category Estimated Buildings and improvements 40 Furniture and equipment 3 – 10 Resident in-place lease intangibles 1 – 3 Expenditures for ordinary maintenance and repairs are expensed to operations as incurred. Renovations and improvements, which improve and/or extend the useful life of the asset, are capitalized and depreciated over the estimated useful life of the renovations or improvements. For communities subject to operating or financing leases, leasehold improvements are depreciated over the shorter of the estimated useful life of the assets or the term of the lease. For financing leases that have a purchase option the Company is reasonably certain to exercise, the leasehold improvements are depreciated over their estimated useful life. Facility operating expense excludes facility depreciation and amortization. Long-lived assets are reviewed for impairment whenever events or changes in circumstances indicate the carrying amount of an asset group may not be recoverable. Recoverability of an asset group is assessed by comparing its carrying amount to the estimated future undiscounted net cash flows expected to be generated by the asset group through operation or disposition, calculated utilizing the lowest level of identifiable cash flows. If this comparison indicates that the carrying amount of an asset group is not recoverable, the Company is required to recognize an impairment loss. The impairment loss is measured by the amount by which the carrying amount of the asset exceeds its estimated fair value, with any amount in excess of fair value recognized as an expense in the current period. Undiscounted cash flow projections and estimates of fair value amounts are based on a number of assumptions such as revenue and expense growth rates, estimated holding periods, and estimated capitalization rates (Level 3). Investment in Unconsolidated Ventures The Company reports investments in unconsolidated entities over whose operating and financial policies it has the ability to exercise significant influence under the equity method of accounting. The initial carrying amount of investment in unconsolidated ventures is based on the amount paid to purchase the investment or its fair value in the case of a retained noncontrolling interest upon deconsolidation of a former subsidiary. The Company's reported share of earnings of an unconsolidated venture is adjusted for the impact, if any, of basis differences between its carrying amount of the equity investment and its share of the venture's underlying assets. Distributions received from an investee are recognized as a reduction in the carrying amount of the investment. The Company evaluates realization of its investment in ventures accounted for using the equity method if circumstances indicate that the Company's investment is other than temporarily impaired. A current fair value of an investment that is less than its carrying amount may indicate a loss in value of the investment. If the Company determines that an equity method investment is other than temporarily impaired, it is recorded at its fair value with an impairment charge recognized in asset impairment expense for the difference between its carrying amount and fair value. Goodwill The Company tests goodwill for impairment annually during the fourth quarter or more frequently if indicators of impairment arise. Factors the Company considers important in its analysis of whether an indicator of impairment exists include a significant decline in the Company's stock price or market capitalization for a sustained period since the last testing date, significant underperformance relative to historical or projected future operating results, and significant negative industry or economic trends. The Company first assesses qualitative factors to determine if it is more likely than not that the fair value of a reporting unit is less than its carrying amount. If so, the Company performs a quantitative goodwill impairment test based upon a comparison of the estimated fair value of the reporting unit to which the goodwill has been assigned with the reporting unit's carrying amount. The fair values used in the quantitative goodwill impairment test are estimated using Level 3 inputs based upon discounted future cash flow projections for the reporting unit. These cash flow projections are based upon a number of estimates and assumptions such as revenue and expense growth rates, capitalization rates, and discount rates. The Company also considers market-based measures such as earnings multiples in its analysis of estimated fair values of its reporting units. If the quantitative goodwill impairment test results in a reporting unit's carrying amount exceeding its estimated fair value, an impairment charge will be recorded based on the difference, with the impairment charge limited to the amount of goodwill allocated to the reporting unit. Self-Insurance Liability Accruals The Company is subject to various legal proceedings and claims that arise in the ordinary course of its business. Although the Company maintains general liability and professional liability insurance policies for its owned, leased, and managed communities under a master insurance program, the Company's current policies provide for deductibles for each claim and contain various exclusions from coverage. The Company uses its wholly-owned captive insurance company for the purpose of insuring certain portions of its risk retention under its general and professional liability insurance programs. Accordingly, the Company is, in effect, self-insured for claims that are less than the deductible amounts, for claims that exceed the funding level of the Company’s wholly-owned captive insurance company, and for claims or portions of claims that are not covered by such policies and/or exceed the policy limits. In addition, the Company maintains a high deductible workers' compensation program and a self-insured employee medical program. The Company reviews the adequacy of its accruals related to these liabilities on an ongoing basis using historical claims, actuarial valuations, third-party administrator estimates, consultants, advice from legal counsel, and industry data, and adjusts accruals periodically. Estimated costs related to these self-insurance programs are accrued based on known claims and projected claims incurred but not yet reported. Subsequent changes in actual experience are monitored, and estimates are updated as information becomes available. Treasury Stock The Company accounts for treasury stock under the cost method and includes treasury stock as a component of stockholders' equity. Reclassifications Certain prior period amounts have been reclassified to conform to the current financial statement presentation, with no effect on the Company's consolidated financial position or results of operations.

Acquisitions, Dispositions, and

Acquisitions, Dispositions, and Other Significant Leasing Transactions	12 Months Ended
	Dec. 31, 2023
Business Combination and Asset Acquisition [Abstract]
Acquisitions, Dispositions, and Other Significant Leasing Transactions	3. Acquisitions, Dispositions, and Other Significant Leasing Transactions Welltower Lease Amendments During the three months ended June 30, 2023, the Company entered into amendments to its existing lease arrangements with Welltower Inc. ("Welltower") pursuant to which the Company continues to lease 74 communities. In connection with the amendments, the Company extended the maturity of one lease involving 39 communities from December 31, 2026 until June 30, 2032. As a result, the Company's amended lease arrangements provide that the current term for 69 of the communities will expire on June 30, 2032 and the current term for five of the communities will expire on December 31, 2024. The amendments did not change the amount of required lease payments over the previous term of the leases or the annual lease escalators. In addition, Welltower agreed to make available a pool in the aggregate amount of up to $17.0 million to fund costs associated with certain capital expenditure projects for 69 of the communities. Upon reimbursement of such expenditures, the annual minimum rent under the lease will prospectively increase by the amount of the reimbursement multiplied by the sum of the then current Secured Overnight Financing Rate ("SOFR") (subject to a floor of 3.0%) and a margin of 4.0%, and such amount will escalate annually consistent with the minimum rent escalation provisions of the 39 community lease. The amended leases for 35 of such communities were prospectively classified as operating leases subsequent to the amendment. For 2023, the classification of such lease costs as operating lease expense resulted in a $19.3 million increase in cash lease payments for operating leases and an offsetting decrease in cash lease payments for financing leases. The amendment to the lease arrangements increased the right-of-use assets and lease obligations recognized on the Company's consolidated balance sheet each by $122.3 million. The amendments replaced the net worth covenant provisions requiring the Company to maintain at least $400.0 million of stockholders' equity with a consolidated tangible net worth covenant requiring the Company to maintain at least $2.0 billion of tangible net worth, generally calculated as stockholders' equity plus accumulated depreciation and amortization less intangible assets and further adjusted for certain other items. Such calculation is generally similar to the tangible net worth covenants within certain of the Company’s long-term debt documents. So long as it maintains tangible net worth as defined in the leases of at least $1.5 billion, the Company will also be able to cure any breach by posting collateral with Welltower. Community Transactions During the year ended December 31, 2023, the Company completed the sale of two owned CCRCs for cash proceeds of $25.6 million, net of $29.6 million in mortgage debt repaid and transaction costs, and recognized a net gain on sale of communities of $36.3 million. During the year ended December 31, 2022, the Company completed the sale of two owned communities for cash proceeds of $4.4 million, net of transaction costs. During the year ended December 31, 2021, the Company completed the sale of three owned communities for cash proceeds of $16.5 million, net of transaction costs. The Company's triple-net lease obligations on 24 communities were terminated from 2021 to 2023 (2 in 2021, 4 in 2022, and 18 in 2023), including through the acquisition of one formerly leased community in 2022. Additionally, the Company acquired the remaining 50% equity interest in one community during 2023. Sale of Health Care Services On July 1, 2021, the Company completed the sale of 80% of its equity in its Health Care Services segment to affiliates of HCA Healthcare, Inc. ("HCA Healthcare") for a purchase price of $400.0 million in cash, subject to certain adjustments set forth in the Securities Purchase Agreement (the "Purchase Agreement") dated February 24, 2021, including a reduction for the remaining outstanding balance as of the closing of Medicare advance payments and deferred payroll tax payments related to the Health Care Services segment (the "HCS Sale"). The Company received net cash proceeds of $312.6 million, including $305.8 million at closing on July 1, 2021 and $6.8 million upon completion of the post-closing net working capital adjustment in October 2021. The Purchase Agreement also contained certain agreed upon indemnities for the benefit of the purchaser. At closing of the transaction, the Company retained a 20% equity interest in the Health Care Services venture (the "HCS Venture"). The accompanying consolidated financial statements include the results of operations and cash flows of the Health Care Services segment through June 30, 2021. The results and financial position of the Health Care Services segment were deconsolidated from its consolidated financial statements as of July 1, 2021 and its 20% equity interest in the HCS Venture was accounted for under the equity method of accounting subsequent to that date. As of July 1, 2021, the Company recognized a $100.0 million asset within investment in unconsolidated ventures on its consolidated balance sheet for the estimated fair value of its retained 20% noncontrolling interest in the HCS Venture. The Company recognized a $286.5 million gain on sale, net of transaction costs, within its consolidated statement of operations for the year ended December 31, 2021 for the HCS Sale. Refer to Note 20 for selected financial data for the Health Care Services segment through June 30, 2021. On November 1, 2021, the HCS Venture sold certain home health, hospice, and outpatient therapy agencies in areas not served by HCA Healthcare to LHC Group Inc. Upon the completion of the sale, the Company received $35.0 million of cash distributions from the HCS Venture from the net sale proceeds, which decreased its investment in unconsolidated ventures. During the three months ended September 30, 2023, the Company contributed $7.5 million to the HCS Venture. During the three months ended December 31, 2023, the Company recognized a non-cash impairment charge of $26.0 million on its investment in the HCS Venture as a result of the Company's decision to sell its equity interest prior to the recovery of its market value. In December 2023, the Company completed the sale of its 20% equity interest in the HCS Venture to HCA Healthcare for cash proceeds of $27.4 million. Master Lease Amendment In the three months ended December 31, 2022, the Company and a lessor entered into an amendment to the Company’s existing master lease pursuant to which the Company continues to lease 24 communities. The amendment removed certain asset repurchase clauses and adjusted the extension option provisions. The amendment did not change the amount of required lease payments or the initial term of the lease. The leases for 16 of these communities were previously accounted for as failed sale-leaseback transactions as the Company had not previously transferred control of the underlying assets for accounting purposes. The Company determined that the adjustment of the extension option provisions and the removal of the asset repurchase clauses in December 2022 resulted in the transfer of control of the assets of the 16 communities for accounting purposes and resulted in qualification as a sale. The Company recognized a $73.9 million non-cash gain on sale of communities for the transaction in the three months ended December 31, 2022. In addition, the amended leases for such communities are prospectively classified as operating leases as of December 31, 2022, the effective date of the amendment. For 2023, the reclassification of such lease costs as operating lease expense resulted in a $22.2 million increase in cash lease payments for operating leases and an offsetting decrease in cash lease payments for financing leases. See Note 18 for more information regarding the impact to the Company’s consolidated balance sheet as a result of this transaction.

Fair Value Measurements

Fair Value Measurements	12 Months Ended
Fair Value Measurements	Dec. 31, 2023
Fair Value Disclosures [Abstract]
Fair Value Measurements	4. Fair Value Measurements Cash, Cash Equivalents, and Restricted Cash Cash, cash equivalents, and restricted cash are reflected in the accompanying consolidated balance sheets at amounts considered by management to reasonably approximate fair value due to their short maturity of 90 days or less. Marketable Securities As of December 31, 2023 and 2022, marketable securities of $29.8 million and $48.7 million, respectively, are stated at fair value based on valuations provided by third-party pricing services and are classified within Level 2 of the valuation hierarchy. Interest Rate Derivatives The Company's derivative assets include interest rate cap and swap instruments that effectively manage the risk above certain interest rates for a portion of the Company's long-term variable rate debt. The Company has not designated the interest rate cap and swap instruments as hedging instruments and as such, changes in the fair value of the instruments are recognized in earnings in the period of the change. The interest rate derivative positions are valued using models developed by the respective counterparty that use as their basis readily available observable market parameters (such as forward yield curves) and are classified within Level 2 of the valuation hierarchy. The Company considers the credit risk of its counterparties when evaluating the fair value of its derivatives. The following table summarizes the Company's SOFR interest rate cap instruments as of December 31, 2023. ($ in thousands) Current notional balance $ 1,231,920 Weighted average fixed cap rate 4.07 % Earliest maturity date 2024 Latest maturity date 2025 Weighted average remaining term 0.8 years Estimated asset fair value (included in other assets, net) at December 31, 2023 $ 13,268 Estimated asset fair value (included in other assets, net) at December 31, 2022 $ 10,599 The following table summarizes the Company's SOFR interest rate swap instrument as of December 31, 2023. ($ in thousands) Current notional balance $ 220,000 Fixed interest rate 3.00 % Remaining term 0.3 years Estimated asset fair value (included in other assets, net) at December 31, 2023 $ 1,611 Estimated asset fair value (included in other assets, net) at December 31, 2022 $ 4,834 Long-Term Debt The Company estimates the fair value of its debt primarily using a discounted cash flow analysis based upon the Company's current borrowing rate for debt with similar maturities and collateral securing the indebtedness. The Company estimates the fair value of its convertible senior notes based on valuations provided by third-party pricing services. The Company had outstanding long-term debt with a carrying amount of approximately $3.7 billion and $3.9 billion as of December 31, 2023 and 2022, respectively. Fair value of the long-term debt is approximately $3.4 billion as of both December 31, 2023 and 2022. The Company's fair value of long-term debt disclosure is classified within Level 2 of the valuation hierarchy. Asset Impairment Expense The following is a summary of asset impairment expense. For the Years Ended December 31, (in millions) 2023 2022 2021 Operating lease right-of-use assets $ 8.3 $ 13.7 $ 16.6 Property, plant and equipment and leasehold intangibles, net 6.3 15.9 6.4 Investment in unconsolidated ventures 26.0 — — Asset impairment $ 40.6 $ 29.6 $ 23.0 Long-lived assets are reviewed for impairment whenever events or changes in circumstances indicate the carrying amount of an asset group may not be recoverable. In estimating the recoverability of asset groups for purposes of the Company’s long-lived asset impairment testing, the Company utilizes future cash flow projections that are developed internally. Any estimates of future cash flow projections necessarily involve predicting unknown future circumstances and events and require significant management judgments and estimates. In arriving at the cash flow projections, the Company considers its historic operating results, approved budgets and business plans, future demographic factors, expected revenue and expense growth rates, estimated asset holding periods, estimated capitalization rates, and other factors. Future events may indicate differences from management's current judgments and estimates which could, in turn, result in future impairments. Operating Lease Right-of-Use Assets During the years ended December 31, 2023, 2022, and 2021, the Company evaluated operating lease right-of-use assets for impairment and identified communities with a carrying amount of the assets in excess of the estimated future undiscounted net cash flows expected to be generated by the assets. The Company compared the estimated fair value of the assets to their carrying amount for these identified communities and recorded an impairment charge for the excess of carrying amount over fair value. During the year ended December 31, 2023, the Company recognized the right-of-use assets for the operating leases for 12 communities on the consolidated balance sheet at the estimated fair value of $16.4 million. During the year ended December 31, 2022, the Company recognized the right-of-use assets for the operating leases for eight communities on the consolidated balance sheet at the estimated fair value of $30.9 million. During the year ended December 31, 2021, the Company recognized the right-of-use assets for the operating leases for 11 communities on the consolidated balance sheet at the estimated fair value of $31.0 million. In the aggregate, the Company recorded a non-cash impairment charge of $8.3 million, $13.7 million, and $16.6 million for the years ended December 31, 2023, 2022, and 2021, respectively, to operating lease right-of-use assets. These impairment charges are primarily due to decreased occupancy and future cash flow estimates at certain leased communities, including as a result of the impacts of the COVID-19 pandemic, and reflect the amount by which the carrying amounts of the assets exceeded their estimated fair value. The fair values of the operating lease right-of-use assets were estimated utilizing a discounted cash flow approach based upon projected community cash flows and market data, including management fees and a market supported lease coverage ratio, all of which are considered Level 3 inputs within the valuation hierarchy. The estimated future cash flows were discounted at a rate that is consistent with a weighted average cost of capital from a market participant perspective. Property, Plant and Equipment and Leasehold Intangibles, Net During the years ended December 31, 2023, 2022, and 2021, the Company evaluated property, plant and equipment and leasehold intangibles for impairment and identified properties with a carrying amount of the assets in excess of the estimated future undiscounted net cash flows expected to be generated by the assets. The Company compared the estimated fair value of the assets to their carrying amount for these identified properties and recorded an impairment charge for the excess of carrying amount over fair value. The Company recorded property, plant and equipment and leasehold intangibles non-cash impairment charges in its operating results of $6.3 million, $15.9 million, and $6.4 million for the years ended December 31, 2023, 2022, and 2021, respectively. These impairment charges are primarily due to property damage sustained at certain communities, decreased occupancy and future cash flow estimates at certain communities, including as a result of the impacts of the COVID-19 pandemic, and/or the completed or potential disposition of underperforming communities and reflect the amount by which the carrying amounts of the assets exceeded their estimated fair value. Investment in Unconsolidated Ventures As of July 1, 2021, the Company recognized a $100.0 million asset within investment in unconsolidated ventures on its consolidated balance sheet for the estimated fair value of its retained 20% noncontrolling interest in the HCS Venture. The initial recognized amount of the Company’s 20% equity interest in the HCS Venture was determined based upon a pro-rata share of the total enterprise value of the HCS Venture considering the $400.0 million purchase price paid by HCA Healthcare, as the Company's 20% interest shared ratably in all of the benefits and losses expected to be generated by the HCS Venture. The fair value measurement is classified within Level 2 of the valuation hierarchy. The Company evaluates realization of its investment in unconsolidated ventures accounted for using the equity method if circumstances indicate the Company's investment is other than temporarily impaired. During the three months ended December 31, 2023, the Company recognized a non-cash impairment charge of $26.0 million on its investment in the HCS Venture as a result of the Company's decision to sell its equity interest prior to the recovery of its market value. The Company determined the $27.4 million fair value of its investment based primarily on the sale agreements with the purchasers. The fair value measurement is classified within Level 2 of the valuation hierarchy.

Revenue

Revenue	12 Months Ended
Revenue	Dec. 31, 2023
Revenue from Contract with Customer [Abstract]
Revenue	5. Revenue Resident fee revenue by payor source is as follows. For the Years Ended December 31, 2023 2022 2021 Private pay 93.7 % 93.5 % 86.8 % Government reimbursement 4.8 % 5.1 % 10.3 % Other third-party payor programs 1.5 % 1.4 % 2.9 % The sale of 80% of the Company's equity in its Health Care Services segment on July 1, 2021 reduced its revenue from government reimbursement programs. Government reimbursements represented 16.9%, 18.0%, and 18.8% of resident fee revenue for the CCRCs segment for the years ended December 31, 2023, 2022, and 2021, respectively. Refer to Note 20 for disaggregation of revenue by reportable segment. The payment terms and conditions within the Company's revenue-generating contracts vary by contract type and payor source, although terms generally include payment to be made within 30 days. Resident fee revenue for recurring and routine monthly services is generally billed monthly in advance under the Company's independent living, assisted living, and memory care residency agreements. Resident fee revenue for standalone or certain healthcare services is generally billed monthly in arrears. Additionally, certain of the Company's revenue-generating contracts include non-refundable fees that are generally billed and collected in advance or upon move-in of a resident under the Company's independent living, assisted living, and memory care residency agreements. Amounts of revenue that are collected from residents in advance are recognized as deferred revenue until the performance obligations are satisfied. The Company had total deferred revenue (included within refundable fees and deferred revenue, and other liabilities within the consolidated balance sheets) of $48.3 million and $67.3 million, including $24.1 million and $25.2 million of monthly resident fees billed and received in advance, as of December 31, 2023 and 2022, respectively. For the years ended December 31, 2023, 2022, and 2021 the Company recognized $50.2 million, $54.5 million, and $60.2 million respectively, of revenue that was included in the deferred revenue balance as of January 1, 2023, 2022, and 2021, respectively. The Company applies the practical expedient in ASC 606-10-50-14 and does not disclose amounts for remaining performance obligations that have original expected durations of one year or less. The following table presents the changes in allowance for credit losses on accounts receivable for the periods indicated. For the Years Ended December 31, (in millions) 2023 2022 2021 Balance at beginning of period $ 12.8 $ 13.3 $ 9.8 Provision within facility operating expense 22.6 20.0 21.6 Write-offs (22.5) (22.2) (19.2) Recoveries and other 1.2 1.7 1.1 Balance at end of period $ 14.1 $ 12.8 $ 13.3

Property, Plant and Equipment a

Property, Plant and Equipment and Leasehold Intangibles, Net	12 Months Ended
	Dec. 31, 2023
Property, Plant and Equipment [Abstract]
Property, Plant and Equipment and Leasehold Intangibles, Net	6. Property, Plant and Equipment and Leasehold Intangibles, Net As of December 31, 2023 and 2022, net property, plant and equipment and leasehold intangibles, which include assets under financing leases, consisted of the following. As of December 31, (in thousands) 2023 2022 Land $ 500,649 $ 506,968 Buildings and improvements 5,348,133 5,323,736 Furniture and equipment 1,111,408 1,055,304 Resident in-place lease intangibles 282,411 286,122 Construction in progress 33,905 41,778 Assets under financing leases and leasehold improvements 1,070,900 1,375,521 Property, plant and equipment and leasehold intangibles 8,347,406 8,589,429 Accumulated depreciation and amortization (4,016,777) (4,053,727) Property, plant and equipment and leasehold intangibles, net $ 4,330,629 $ 4,535,702 Long-lived assets with definite useful lives are depreciated or amortized on a straight-line basis over their estimated useful lives (or, in certain cases, the shorter of their estimated useful lives or the lease term) and are tested for impairment whenever indicators of impairment arise. Refer to Note 4 for information on impairment expense for property, plant and equipment and leasehold intangibles. For the years ended December 31, 2023, 2022, and 2021, the Company recognized depreciation and amortization expense on its property, plant and equipment and leasehold intangibles of $342.7 million, $347.4 million, and $337.6 million, respectively.

Debt

Debt	12 Months Ended
Debt	Dec. 31, 2023
Debt Disclosure [Abstract]
Debt	7. Debt Long-term debt consists of the following. December 31, (in thousands) 2023 2022 Fixed mortgage notes payable due 2025 through 2047; weighted average interest rate of 4.26% and 4.14%, as of December 31, 2023 and 2022, respectively. $ 1,953,414 $ 2,055,867 Variable mortgage notes payable due 2025 through 2030; weighted average interest rate of 7.74% and 6.68% as of December 31, 2023 and 2022, respectively. 1,524,907 1,568,555 Convertible notes payable due October 2026; interest rate of 2.00% as of both December 31, 2023 and 2022. 230,000 230,000 Tangible equity units senior amortizing notes due November 2025; interest rate of 10.25% as of both December 31, 2023 and 2022. 17,990 25,586 Deferred financing costs, net (28,998) (29,866) Total long-term debt 3,697,313 3,850,142 Current portion 41,463 66,043 Total long-term debt, less current portion $ 3,655,850 $ 3,784,099 As of December 31, 2023, 91.9%, or $3.4 billion of the Company's total debt obligations represented non-recourse property-level mortgage financings. The annual aggregate scheduled maturities (including recurring principal payments) of long-term debt outstanding as of December 31, 2023 are as follows (in thousands). Year Ending December 31, Long-term Weighted Rate 2024 $ 49,485 6.46 % 2025 (1) 573,035 7.30 % 2026 305,614 2.71 % 2027 960,971 6.00 % 2028 563,548 5.79 % Thereafter 1,273,658 5.03 % Total obligations 3,726,311 5.58 % Less amount representing deferred financing costs, net (28,998) Total $ 3,697,313 (1) Includes the initial maturity of $320.0 million of mortgage debt for which the Company has the option to extend the maturity for two additional terms of one year each subject to the satisfaction of certain conditions. The Company's remaining variable rate mortgage notes payable arrangements indexed to London Interbank Offered Rate ("LIBOR") were modified to reference SOFR rather than LIBOR prospectively after the discontinuance of LIBOR in July 2023. The Company applied the optional expedient provided by Accounting Standards Codification 848, Reference Rate Reform , for debt contract modifications related to the discontinuation of reference rates to ease the potential burden in accounting for reference rate reform. Convertible Debt Offering On October 1, 2021, the Company issued $230.0 million principal amount of 2.00% convertible senior notes due 2026 (the "Notes"). The Company received net proceeds of $224.3 million at closing after the deduction of the initial purchasers' discount. The Company used $15.9 million of the net proceeds to pay the Company’s cost of the capped call transactions described below. Additionally, the Company used the remaining net proceeds together with cash on hand to repay $284.4 million of mortgage debt and a $45.0 million note payable. The Notes were issued pursuant to, and are governed by, the Indenture dated as of October 1, 2021 by and between the Company and American Stock Transfer & Trust Company, LLC, as trustee. The Notes are the Company’s senior unsecured obligations and rank senior in right of payment to any of the Company’s indebtedness that is expressly subordinated in right of payment to the Notes, and equal in right of payment to any of the Company’s indebtedness that is not so subordinated. The Notes are effectively junior in right of payment to any of the Company’s secured indebtedness to the extent of the value of the assets securing such indebtedness; and structurally junior to all indebtedness and other liabilities (including trade payables) and any preferred equity of current or future subsidiaries of the Company. The Notes bear interest at 2.00% per year, payable semi-annually in arrears in cash on April 15 and October 15 of each year. The Notes will mature on October 15, 2026, unless earlier converted, redeemed, or repurchased in accordance with their terms. Holders of the Notes may convert all or any portion of their Notes at their option at any time prior to the close of business on the business day immediately preceding July 15, 2026, only under the following circumstances: (1) during any calendar quarter commencing after the calendar quarter ending on December 31, 2021 (and only during such calendar quarter), if the last reported sale price of the common stock of the Company for at least 20 trading days (whether or not consecutive) during a period of 30 consecutive trading days ending on, and including, the last trading day of the immediately preceding calendar quarter is greater than or equal to 130% of the conversion price on each applicable trading day; (2) during the five business day period after any ten consecutive trading day period (the "measurement period") in which the trading price per $1,000 principal amount of Notes for each trading day of the measurement period was less than 98% of the product of the last reported sale price of the common stock of the Company and the conversion rate for the Notes on each such trading day; (3) if the Company calls any or all of the Notes for redemption, at any time prior to the close of business on the second scheduled trading day immediately preceding the redemption date, but only with respect to the Notes called (or deemed called) for redemption; or (4) upon the occurrence of specified corporate events. On or after July 15, 2026, holders may convert all or any portion of their Notes at any time prior to the close of business on the second scheduled trading day immediately preceding the maturity date regardless of the foregoing conditions. Upon conversion, the Company will satisfy its conversion obligation by paying or delivering, as the case may be, cash, shares of the Company’s common stock or a combination of cash and shares of the Company’s common stock at the Company’s election. The conversion rate for the Notes is initially 123.4568 shares of the Company’s common stock per $1,000 principal amount of Notes (equivalent to an initial conversion price of approximately $8.10 per share of common stock). The conversion rate will be subject to adjustment in some events but will not be adjusted for any accrued and unpaid interest. In addition, following certain corporate events that occur prior to the maturity date or following the issuance of a notice of redemption, the Company will increase the conversion rate for a holder who elects to convert its Notes in connection with such a corporate event or who elects to convert any Notes called (or deemed called) for redemption during the related redemption period in certain circumstances. The Company may not redeem the Notes prior to October 21, 2024. The Company may redeem for cash all or (subject to certain limitations) any portion of the Notes, at the Company's option, on or after October 21, 2024 and prior to the 51st scheduled trading day immediately preceding the maturity date if the last reported sale price of the Company's common stock has been at least 130% of the conversion price then in effect for at least 20 trading days (whether or not consecutive) during any 30 consecutive trading day period (including the last trading day of such period) ending on, and including, the trading day immediately preceding the date on which the Company provides notice of redemption at a redemption price equal to 100% of the principal amount of the Notes to be redeemed, plus accrued and unpaid interest to, but excluding, the redemption date. No sinking fund is provided for the Notes. The Company has recognized the Notes in their entirety as a liability on the consolidated balance sheet and no portion of the proceeds from the issuance of the convertible debt instrument was accounted for separately as an embedded conversion feature within stockholders’ equity. The Notes were initially recognized at $223.3 million, which reflects $230.0 million principal amount less the $5.7 million initial purchasers' discount and $1.0 million of debt issuance costs. Capped Call Transactions In connection with the offering of the Notes, the Company entered into privately negotiated capped call transactions ("Capped Call Transactions") with each of Bank of America, N.A., Royal Bank of Canada, Wells Fargo Bank, National Association or their respective affiliates (the "Capped Call Counterparties"). The Capped Call Transactions initially cover, subject to customary anti-dilution adjustments, the number of shares of the Company’s common stock that initially underlie the Notes and initially have an exercise price of $8.10 per share of common stock. The cap price of the Capped Call Transactions is initially approximately $9.90 per share of the Company’s common stock, representing a premium of 65% above the last reported sale price of $6.00 per share of the Company’s common stock on September 28, 2021, and is subject to certain adjustments under the terms of the Capped Call Transactions. The Capped Call Transactions are expected generally to reduce or offset potential dilution to holders of the Company’s common stock upon conversion of the Notes and/or offset the potential cash payments that the Company could be required to make in excess of the principal amount of any converted Notes upon conversion thereof, with such reduction and/or offset subject to a cap based on the cap price. The Capped Call Transactions are separate transactions entered into by the Company with the Capped Call Counterparties and are not part of the terms of the Notes. The Capped Call Transactions had a cost of $15.9 million, which was paid on October 1, 2021 from the proceeds of the Notes. The Company accounted for the Capped Call Transactions separately from the Notes and recognized the $15.9 million cost as a reduction of additional paid-in capital in the year ended December 31, 2021 as the Capped Call Transactions are indexed to the Company’s common stock. Credit Facilities In December 2023, the Company amended its revolving credit agreement with Capital One, National Association, as administrative agent and lender and the other lenders from time to time parties thereto. The amended agreement provides an expanded commitment amount of up to $100.0 million which can be drawn in cash or as letters of credit. The credit facility matures in January 2027, and the Company has the option to extend the facility for two additional terms of approximately one year each subject to the satisfaction of certain conditions. Amounts drawn under the facility will bear interest at SOFR plus an applicable margin which was 3.00% as of December 31, 2023. Additionally, a quarterly commitment fee of 0.25% per annum was applicable on the unused portion of the facility as of December 31, 2023. The revolving credit facility is currently secured by first priority mortgages and negative pledges on certain of the Company’s communities. Available capacity under the facility will vary from time to time based upon certain calculations related to the appraised value and performance of the communities securing the credit facility and the variable interest rate of the credit facility. As of December 31, 2023, $63.6 million of letters of credit and no cash borrowings were outstanding under the Company's $100.0 million secured credit facility. The Company also had a separate secured letter of credit facility providing up to $15.0 million of letters of credit as of December 31, 2023 under which $14.5 million had been issued as of that date. 2024 Financing On February 9, 2024, the Company obtained $50.0 million of debt secured by first priority mortgages on 11 communities. The loan bears interest at a variable rate equal to SOFR plus a margin of 350 basis points. The debt matures in February 2027 with two one-year renewal options, exercisable subject to certain performance criteria. 2023 Financing In December 2023, the Company obtained $179.5 million of debt secured by non-recourse first mortgages on 47 communities, which also continue to secure $580.4 million of additional outstanding mortgages with a later maturity. The $179.5 million loan bears interest at a fixed rate of 5.97%, and matures in January 2031. The mortgage facility includes certain provisions allowing for the Company to obtain additional funding based on the performance of the underlying communities. At the closing, the Company repaid $260.1 million of debt under the mortgage facility, which was scheduled to mature in 2024, using proceeds from the $179.5 million loan and cash on hand. 2022 Financing In October 2022, the Company obtained $220.0 million of debt secured by first priority mortgages on 24 communities. The loan bears interest at a variable rate equal to SOFR plus a margin of 245 basis points and is interest only for the first three years. The debt matures in October 2025 with two one-year renewal options, exercisable by the Company subject to the satisfaction of certain conditions. The debt documents contain a requirement for the Company to maintain liquidity of at least $130.0 million and 25% of the loan amount is subject to a guaranty by the Company. The proceeds from the financing were primarily utilized to repay $199.6 million of outstanding mortgage debt previously scheduled to mature in 2023 and to purchase a SOFR interest rate swap instrument for $6.1 million. The interest rate swap instrument has a $220.0 million notional amount, a fixed interest rate of 3.0%, and a term of eighteen months. Financial Covenants Certain of the Company's debt documents contain restrictions and financial covenants, such as those requiring the Company to maintain prescribed minimum liquidity, net worth, and stockholders' equity levels and debt service ratios, and requiring the Company not to exceed prescribed leverage ratios, in each case on a consolidated, portfolio-wide, multi-community, single-community, and/or entity basis. In addition, the Company's debt documents generally contain non-financial covenants, such as those requiring the Company to comply with Medicare or Medicaid provider requirements and maintain insurance coverage. The Company's failure to comply with applicable covenants could constitute an event of default under the applicable debt documents. Many of the Company's debt documents contain cross-default provisions so that a default under one of these instruments could cause a default under other debt and lease documents (including documents with other lenders and lessors). Furthermore, the Company's mortgage debt is secured by its communities and, in certain cases, a guaranty by the Company and/or one or more of its subsidiaries. As of December 31, 2023, the Company is in compliance with the financial covenants of its debt agreements.

Leases

Leases	12 Months Ended
Leases	Dec. 31, 2023
Leases [Abstract]
Leases	8. Leases As of December 31, 2023, the Company operated 277 communities under long-term leases (263 operating leases and 14 financing leases). The substantial majority of the Company's lease arrangements are structured as master leases. Under a master lease, numerous communities are leased through an indivisible lease. In certain cases, the Company guarantees the performance and lease payment obligations of its subsidiary lessees under the master leases. An event of default related to an individual property or limited number of properties within a master lease portfolio may result in a default on the entire master lease portfolio. The leases relating to these communities are generally fixed rate leases with annual escalators that are either fixed or based upon changes in the consumer price index or the leased property revenue. The Company is responsible for all operating costs, including repairs, property taxes, and insurance. As of December 31, 2023, the weighted average remaining lease term of the Company's operating and financing leases was 5.7 and 2.3 years, respectively. The leases generally provide for renewal or extension options from 5 to 20 years and in some instances, purchase options. As of December 31, 2023, none of the Company's renewal or extension option periods are included in the lease term for accounting purposes. The community leases contain other customary terms, which may include assignment and change of control restrictions, maintenance and capital expenditure obligations, termination provisions, and financial covenants, such as those requiring the Company to maintain prescribed minimum liquidity, net worth, and stockholders' equity levels and lease coverage ratios, in each case on a consolidated, portfolio-wide, multi-community, single-community and/or entity basis. In addition, the Company's lease documents generally contain non-financial covenants, such as those requiring the Company to comply with Medicare or Medicaid provider requirements and maintain insurance coverage. The Company's failure to comply with applicable covenants could constitute an event of default under the applicable lease documents. Many of the Company's debt and lease documents contain cross-default provisions so that a default under one of these instruments could cause a default under other debt and lease documents (including documents with other lenders and lessors). Certain leases contain cure provisions, which generally allow the Company to post an additional lease security deposit if the required covenant is not met. Furthermore, the Company's leases are secured by its communities and, in certain cases, a guaranty by the Company and/or one or more of its subsidiaries. As of December 31, 2023, the Company is in compliance with the financial covenants of its long-term leases. A summary of operating and financing lease expense (including the respective presentation on the consolidated statements of operations) and net cash outflows from leases is as follows. Years Ended December 31, Operating Leases (in thousands) 2023 2022 2021 Facility operating expense $ 7,105 $ 6,329 $ 12,606 Facility lease expense 202,410 165,294 174,358 Operating lease expense 209,515 171,623 186,964 Operating lease expense adjustment (1) 45,739 34,896 23,280 Changes in operating lease assets and liabilities for lessor capital expenditure reimbursements (9,844) (13,718) (30,965) Operating net cash outflows from operating leases $ 245,410 $ 192,801 $ 179,279 (1) Represents the difference between the amount of cash operating lease payments and the amount of operating lease expense. Years Ended December 31, Financing Leases (in thousands) 2023 2022 2021 Depreciation and amortization $ 16,444 $ 38,126 $ 37,921 Interest expense: financing lease obligations 21,950 48,061 46,282 Financing lease expense $ 38,394 $ 86,187 $ 84,203 Operating cash outflows from financing leases $ 21,950 $ 48,061 $ 46,282 Financing cash outflows from financing leases 8,473 22,221 19,874 Changes in financing lease assets and liabilities for lessor capital expenditure reimbursement (475) (11,932) (11,135) Total net cash outflows from financing leases $ 29,948 $ 58,350 $ 55,021 As of December 31, 2023, the weighted average discount rate of the Company's operating and financing leases was 8.4% and 10.3%, respectively. The aggregate amounts of future minimum lease payments, including community, office, and equipment leases, recognized on the consolidated balance sheet as of December 31, 2023 are as follows (in thousands). Year Ending December 31, Operating Leases Financing Leases 2024 $ 260,694 $ 20,266 2025 260,501 6,849 2026 145,832 6,833 2027 147,660 6,082 2028 84,767 5,917 Thereafter 251,579 20,625 Total lease payments 1,151,033 66,572 Purchase option liability and non-cash gain on future sale of property — 145,136 Imputed interest and variable lease payments (274,526) (59,859) Total lease obligations $ 876,507 $ 151,849
Leases	8. Leases As of December 31, 2023, the Company operated 277 communities under long-term leases (263 operating leases and 14 financing leases). The substantial majority of the Company's lease arrangements are structured as master leases. Under a master lease, numerous communities are leased through an indivisible lease. In certain cases, the Company guarantees the performance and lease payment obligations of its subsidiary lessees under the master leases. An event of default related to an individual property or limited number of properties within a master lease portfolio may result in a default on the entire master lease portfolio. The leases relating to these communities are generally fixed rate leases with annual escalators that are either fixed or based upon changes in the consumer price index or the leased property revenue. The Company is responsible for all operating costs, including repairs, property taxes, and insurance. As of December 31, 2023, the weighted average remaining lease term of the Company's operating and financing leases was 5.7 and 2.3 years, respectively. The leases generally provide for renewal or extension options from 5 to 20 years and in some instances, purchase options. As of December 31, 2023, none of the Company's renewal or extension option periods are included in the lease term for accounting purposes. The community leases contain other customary terms, which may include assignment and change of control restrictions, maintenance and capital expenditure obligations, termination provisions, and financial covenants, such as those requiring the Company to maintain prescribed minimum liquidity, net worth, and stockholders' equity levels and lease coverage ratios, in each case on a consolidated, portfolio-wide, multi-community, single-community and/or entity basis. In addition, the Company's lease documents generally contain non-financial covenants, such as those requiring the Company to comply with Medicare or Medicaid provider requirements and maintain insurance coverage. The Company's failure to comply with applicable covenants could constitute an event of default under the applicable lease documents. Many of the Company's debt and lease documents contain cross-default provisions so that a default under one of these instruments could cause a default under other debt and lease documents (including documents with other lenders and lessors). Certain leases contain cure provisions, which generally allow the Company to post an additional lease security deposit if the required covenant is not met. Furthermore, the Company's leases are secured by its communities and, in certain cases, a guaranty by the Company and/or one or more of its subsidiaries. As of December 31, 2023, the Company is in compliance with the financial covenants of its long-term leases. A summary of operating and financing lease expense (including the respective presentation on the consolidated statements of operations) and net cash outflows from leases is as follows. Years Ended December 31, Operating Leases (in thousands) 2023 2022 2021 Facility operating expense $ 7,105 $ 6,329 $ 12,606 Facility lease expense 202,410 165,294 174,358 Operating lease expense 209,515 171,623 186,964 Operating lease expense adjustment (1) 45,739 34,896 23,280 Changes in operating lease assets and liabilities for lessor capital expenditure reimbursements (9,844) (13,718) (30,965) Operating net cash outflows from operating leases $ 245,410 $ 192,801 $ 179,279 (1) Represents the difference between the amount of cash operating lease payments and the amount of operating lease expense. Years Ended December 31, Financing Leases (in thousands) 2023 2022 2021 Depreciation and amortization $ 16,444 $ 38,126 $ 37,921 Interest expense: financing lease obligations 21,950 48,061 46,282 Financing lease expense $ 38,394 $ 86,187 $ 84,203 Operating cash outflows from financing leases $ 21,950 $ 48,061 $ 46,282 Financing cash outflows from financing leases 8,473 22,221 19,874 Changes in financing lease assets and liabilities for lessor capital expenditure reimbursement (475) (11,932) (11,135) Total net cash outflows from financing leases $ 29,948 $ 58,350 $ 55,021 As of December 31, 2023, the weighted average discount rate of the Company's operating and financing leases was 8.4% and 10.3%, respectively. The aggregate amounts of future minimum lease payments, including community, office, and equipment leases, recognized on the consolidated balance sheet as of December 31, 2023 are as follows (in thousands). Year Ending December 31, Operating Leases Financing Leases 2024 $ 260,694 $ 20,266 2025 260,501 6,849 2026 145,832 6,833 2027 147,660 6,082 2028 84,767 5,917 Thereafter 251,579 20,625 Total lease payments 1,151,033 66,572 Purchase option liability and non-cash gain on future sale of property — 145,136 Imputed interest and variable lease payments (274,526) (59,859) Total lease obligations $ 876,507 $ 151,849

Tangible Equity Units

Tangible Equity Units	12 Months Ended
Tangible Equity Units	Dec. 31, 2023
Equity [Abstract]
Tangible Equity Units	9. Tangible Equity Units During 2022, the Company issued 2,875,000 of its 7.00% tangible equity units (the “Units”) at a public offering price of $50.00 per Unit for an aggregate offering of $143.8 million. The Company received proceeds of $139.4 million after the deduction of the underwriters’ discount. Each Unit is comprised of a prepaid stock purchase contract and a senior amortizing note with an initial principal amount of $8.8996. Under each purchase contract, the Company is obligated to deliver to the holder on November 15, 2025 a minimum of 12.9341, and a maximum of 15.1976, shares of the Company’s common stock depending on the daily volume-weighted average price ("VWAPs") of its common stock for the 20 trading days preceding the settlement date. Each amortizing note bears interest at the rate of 10.25% per annum, requires quarterly installment payments of principal and interest, and has a final installment payment date of November 15, 2025. The cash installment payments will be equivalent to 7.00% per year with respect to each $50.00 stated amount of Unit. The Units, purchase contracts, and amortizing notes are subject to the terms and conditions set forth in the Purchase Contract Agreement dated November 21, 2022 between the Company and American Stock Transfer & Trust Company, LLC ("AST") as purchase contract agent, and the Indenture and First Supplemental Indenture, each dated November 21, 2022, between the Company and AST as trustee, including certain early settlement, repurchase, and adjustment events as set forth therein. Subsequent to issuance, each Unit may be legally separated into the two components, both of which are freestanding instruments and separate units of account. The Company allocated the proceeds from the issuance of the Units to the purchase contracts and amortizing notes based on the relative fair values of the respective components, determined as of the date of issuance of the Units. The Company recognized the issuance of the purchase contract portion of the Units, net of issuance costs, as additional paid-in-capital on the consolidated balance sheet. The Company separately recognized the amortizing notes portion of the Units, net of issuance costs, as long-term debt on the consolidated balance sheet. The proceeds from the issuance of the Units were allocated to equity and debt based on the relative fair value of the respective components of each Unit as follows: (in thousands, except value per unit) Equity Component Debt Component Total Value per unit $ 41.10 $ 8.90 $ 50.00 Gross proceeds $ 118,164 $ 25,586 $ 143,750 Less: underwriters' discount (3,544) (768) (4,312) Proceeds from issuance of Units $ 114,620 $ 24,818 $ 139,438 Less: issuance costs (1,163) (252) (1,415) Net proceeds $ 113,457 $ 24,566 $ 138,023 Unless settled early in accordance with the terms of the instruments, each prepaid stock purchase contract will automatically settle on November 15, 2025 (the mandatory settlement date) for a number of shares of the Company’s common stock based on the arithmetic average of the VWAPs of the Company’s common stock on each of the 20 consecutive trading days beginning on, and including, the 21st scheduled trading day immediately preceding November 15, 2025 (applicable market value) with reference to the following settlement rates: Applicable Market Value Common Stock Issued Equal to or greater than the threshold appreciation price 12.9341 shares (minimum settlement rate) Less than the threshold appreciation price, but greater than the reference price $50 divided by applicable market value Less than or equal to the reference price 15.1976 shares (maximum settlement rate)

Accrued Expenses

Accrued Expenses	12 Months Ended
Accrued Expenses	Dec. 31, 2023
Accounts Payable and Accrued Liabilities, Current [Abstract]
Accrued Expenses	10. Accrued Expenses Accrued expenses reflected within current liabilities on the Company’s consolidated balance sheets consist of the following. As of December 31, (in thousands) 2023 2022 Employee compensation $ 104,322 $ 85,610 Insurance reserves 54,834 65,757 Real estate taxes 26,988 26,661 Interest 17,838 17,569 Utilities 8,444 8,533 Income taxes payable 2,071 2,081 Other 28,171 30,937 Total $ 242,668 $ 237,148

Commitments and Contingencies

Commitments and Contingencies	12 Months Ended
Commitments and Contingencies	Dec. 31, 2023
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	11. Commitments and Contingencies Litigation The Company has been and is currently involved in litigation and claims incidental to the conduct of its business, which it believes are generally comparable to other companies in the senior living and healthcare industries, including, but not limited to, putative class action claims from time to time regarding staffing at the Company’s communities and compliance with consumer protection laws and the Americans with Disabilities Act. Certain claims and lawsuits allege large damage amounts and may require significant costs to defend and resolve. As a result, the Company maintains general liability, professional liability, and other insurance policies in amounts and with coverage and deductibles the Company believes are appropriate, based on the nature and risks of its business, historical experience, availability, and industry standards. The Company's current policies provide for deductibles for each claim and contain various exclusions from coverage. The Company uses its wholly-owned captive insurance company for the purpose of insuring certain portions of its risk retention under its general and professional liability insurance programs. Accordingly, the Company is, in effect, self-insured for claims that are less than the deductible amounts, for claims that exceed the funding level of the Company's wholly-owned captive insurance company, and for claims or portions of claims that are not covered by such policies and/or exceed the policy limits. The senior living and healthcare industries are continuously subject to scrutiny by governmental regulators, which could result in reviews, audits, investigations, enforcement actions, or litigation related to regulatory compliance matters. In addition, the Company is subject to various government reviews, audits, and investigations to verify compliance with Medicare and Medicaid programs and other applicable laws and regulations. The Centers for Medicare & Medicaid Services ("CMS") has engaged third-party firms to review claims data to evaluate appropriateness of billings. In addition to identifying overpayments, audit contractors can refer suspected violations to government authorities. In addition, states' Attorneys General vigorously enforce consumer protection laws as those laws relate to the senior living industry. An adverse outcome of government scrutiny may result in citations, sanctions, other criminal or civil fines and penalties, the refund of overpayments, payment suspensions, termination of participation in Medicare and Medicaid programs, and damage to the Company’s business reputation. The Company’s costs to respond to and defend any such audits, reviews, and investigations may be significant. In June 2020, the Company and several current and former executive officers were named as defendants in a putative class action lawsuit alleging violations of the federal securities laws filed in the federal court for the Middle District of Tennessee. The lawsuit asserted that the defendants made material misstatements and omissions concerning the Company's business, operational and compliance policies, compliance with applicable regulations and statutes, and staffing practices that caused the Company's stock price to be artificially inflated between August 2016 and April 2020. The district court dismissed the lawsuit and entered judgment in favor of the defendants in September 2021, and the plaintiffs did not file an appeal. Between October 2020 and June 2021, alleged stockholders of the Company filed several stockholder derivative lawsuits in the federal courts for the Middle District of Tennessee and the District of Delaware, which were subsequently transferred to the Middle District of Tennessee and consolidated into two lawsuits. In January 2024, the court dismissed one of the two derivative lawsuits. Plaintiffs have appealed the dismissal to the United States Court of Appeals for the Sixth Circuit. The other derivative lawsuit remains pending with the Middle District of Tennessee and asserts claims on behalf of the Company against certain current and former officers and directors for alleged breaches of duties owed to the Company. The complaint incorporates substantively similar allegations to the securities lawsuit previously described. Other

Self-Insurance

Self-Insurance	12 Months Ended
Self-Insurance	Dec. 31, 2023
Self Insurance Reserves [Abstract]
Self-Insurance	12. Self-Insurance The Company obtains various insurance coverages, including general and professional liability and workers' compensation programs, from commercial carriers at stated amounts as defined in the applicable policy. The Company's current general and professional liability policies provide for deductibles for each claim and contain various exclusions from coverage. The Company uses its wholly-owned captive insurance company for the purpose of insuring certain portions of its risk retention under its general and professional liability insurance programs. Accordingly, the Company is, in effect, self-insured for claims that are less than the deductible amounts, for claims that exceed the funding level of the Company’s wholly-owned captive insurance company, and for claims or portions of claims that are not covered by such policies and/or exceed the policy limits. Losses related to self-insured amounts are accrued based on the Company's estimate of expected losses for known claims and projected claims incurred but not yet reported. As of December 31, 2023 and 2022, the Company accrued reserves of $122.6 million and $135.9 million, respectively, under the Company's insurance programs, of which $67.8 million and $70.2 million is classified as other liabilities as of December 31, 2023 and 2022, respectively. As of December 31, 2023 and 2022, the Company accrued $4.3 million and $9.9 million, respectively, of estimated amounts receivable from the insurance companies under these insurance programs.

Stock-Based Compensation

Stock-Based Compensation	12 Months Ended
Stock-Based Compensation	Dec. 31, 2023
Share-Based Payment Arrangement [Abstract]
Stock-Based Compensation	13. Stock-Based Compensation The following table sets forth information about the Company's restricted stock units and stock awards. (in thousands, except for weighted average amounts) Number of Restricted Stock Units and Stock Awards Weighted Outstanding on January 1, 2021 8,505 $ 7.68 Granted 1,998 5.12 Vested (2,641) 8.40 Cancelled/forfeited (2,851) 6.77 Outstanding on December 31, 2021 5,011 6.80 Granted 2,921 5.58 Vested (2,039) 7.15 Cancelled/forfeited (520) 6.88 Outstanding on December 31, 2022 5,373 6.00 Granted 3,992 2.98 Vested (2,001) 5.87 Cancelled/forfeited (961) 5.90 Outstanding on December 31, 2023 6,403 4.17 As of December 31, 2023, there was $15.8 million of total unrecognized compensation cost related to outstanding, unvested share-based compensation. That cost is expected to be recognized over a weighted average period of 2.3 years and is based on grant date fair value. As of December 31, 2022, the Company's outstanding shares included 422,542 unvested restricted shares. The Company did not have any unvested restricted shares as of December 31, 2023. During 2023, grants of restricted stock units and stock awards under the Company's 2014 Omnibus Incentive Plan were as follows. (in thousands, except for weighted average amounts) Restricted Stock Unit and Stock Award Grants Weighted Average Grant Date Fair Value Total Grant Date Fair Value Three months ended March 31, 2023 3,959 $ 2.97 $ 11,778 Three months ended June 30, 2023 10 $ 2.95 $ 29 Three months ended September 30, 2023 16 $ 4.01 $ 65 Three months ended December 31, 2023 7 $ 4.14 $ 29

Earnings Per Share

Earnings Per Share	12 Months Ended
Earnings Per Share	Dec. 31, 2023
Earnings Per Share [Abstract]
Earnings Per Share	14. Earnings Per Share Potentially dilutive common stock equivalents for the Company include convertible senior notes, warrants, unvested restricted stock, restricted stock units, and prepaid stock purchase contracts. As of December 31, 2023, the maximum number of shares issuable upon settlement of the Notes is 38.3 million (after giving effect to additional shares that would be issuable upon conversion in connection with the occurrence of certain corporate or other events). On July 26, 2020, the Company issued to Ventas, Inc. ("Ventas") a warrant (the "Warrant") to purchase 16.3 million shares of the Company’s common stock, $0.01 par value per share, at a price per share of $3.00. The Warrant is exercisable at Ventas' option at any time and from time to time, in whole or in part, until December 31, 2025. The exercise price and the number of shares issuable on exercise of the Warrant are subject to certain anti-dilution adjustments, including for cash dividends, stock dividends, stock splits, reclassifications, non-cash distributions, certain repurchases of common stock, and business combination transactions. As of December 31, 2023, the maximum number of shares issuable upon settlement of the Units' prepaid stock purchase contracts is 43.7 million. Basic earnings per share ("EPS") is calculated by dividing net income (loss) by the weighted average number of shares of common stock outstanding, after giving effect to the minimum number of shares issuable upon settlement of the prepaid stock purchase contract component of the Units. For both the years ended December 31, 2023 and 2022, 37.2 million shares are included in weighted average basic shares outstanding for the minimum number of shares issuable upon settlement of the Units' prepaid stock purchase contracts. Years Ended December 31, (in thousands) 2023 2022 2021 Weighted average common shares outstanding 188,023 186,574 184,975 Weighted average minimum shares issuable under purchase contracts 37,186 3,889 — Weighted average shares outstanding - basic 225,209 190,463 184,975 Diluted EPS includes the components of basic EPS and also gives effect to dilutive common stock equivalents. Diluted EPS reflects the potential dilution that could occur if securities or other instruments that are convertible into common stock were exercised or could result in the issuance of common stock. For the purposes of computing diluted EPS, weighted average shares outstanding do not include potentially dilutive securities that are anti-dilutive under the treasury stock method or if-converted method, and performance-based equity awards are included based on the attainment of the applicable performance metrics as of the end of the reporting period. The Company has the following potentially outstanding shares of common stock, which were excluded from the computation of diluted net income (loss) per share attributable to common stockholders in all periods as a result of the net loss. As of December 31, (in millions) 2023 2022 2021 Convertible senior notes 38.3 38.3 38.3 Warrants 16.3 16.3 16.3 Restricted stock and restricted stock units 6.4 5.4 5.0 Incremental shares issuable under purchase contracts 6.5 6.5 — Total 67.5 66.5 59.6 Refer to Notes 7 and 9 for more information on the Notes and the Units, respectively.

Share Repurchase Program

Share Repurchase Program	12 Months Ended
Share Repurchase Program	Dec. 31, 2023
Equity [Abstract]
Share Repurchase Program	15. Share Repurchase Program In 2016, the Company's Board of Directors approved a share repurchase program that authorizes the Company to purchase up to $100.0 million in the aggregate of the Company's common stock. The share repurchase program is intended to be implemented through purchases made from time to time using a variety of methods, which may include open market purchases, privately negotiated transactions, or block trades, or by any combination of these methods, in accordance with applicable insider trading and other securities laws and regulations. The size, scope, and timing of any purchases will be based on business, market, and other conditions and factors, including price, regulatory, and contractual requirements or consents, and capital availability. The repurchase program does not obligate the Company to acquire any particular amount of common stock and the program may be suspended, modified, or discontinued at any time at the Company's discretion without prior notice. Shares of stock repurchased under the program will be held as treasury shares. The Company temporarily suspended purchases under the share repurchase plan in March 2020.

Retirement Plans

Retirement Plans	12 Months Ended
Retirement Plans	Dec. 31, 2023
Retirement Benefits [Abstract]
Retirement Plans	16. Retirement Plans

Income Taxes

Income Taxes	12 Months Ended
Income Taxes	Dec. 31, 2023
Income Tax Disclosure [Abstract]
Income Taxes	17. Income Taxes The benefit (provision) for income taxes is comprised of the following. For the Years Ended December 31, (in thousands) 2023 2022 2021 Federal: Current $ (183) $ (17) $ 161 Deferred (7,590) 1,325 9,837 Total federal (7,773) 1,308 9,998 State: Current (1,011) 251 (1,835) Deferred (included in federal above) — — — Total state (1,011) 251 (1,835) Total $ (8,784) $ 1,559 $ 8,163 A reconciliation of the benefit (provision) for income taxes to the amount computed at the U.S. Federal statutory rate of 21% is as follows. For the Years Ended December 31, (in thousands) 2023 2022 2021 Tax benefit (provision) at U.S. statutory rate $ 37,848 $ 50,397 $ 22,565 State taxes, net of federal income tax 5,766 10,811 7,673 Valuation allowance (49,109) (57,080) 13,027 Goodwill derecognition — — (31,829) Stock compensation (1,312) (181) (1,856) Other (1,977) (2,388) (1,417) Total $ (8,784) $ 1,559 $ 8,163 Significant components of the Company's deferred tax assets and liabilities are as follows. As of December 31, (in thousands) 2023 2022 Deferred income tax assets: Operating loss carryforwards $ 392,577 $ 361,160 Operating lease obligations 220,003 199,226 Tax credits 50,415 50,415 Accrued expenses 46,814 42,828 Intangible assets 26,816 39,360 Financing lease obligations — 12,749 Capital loss carryforward 2,102 2,140 Other 3,268 3,091 Total gross deferred income tax asset 741,995 710,969 Valuation allowance (474,152) (425,043) Net deferred income tax assets 267,843 285,926 Deferred income tax liabilities: Operating lease right-of-use assets (168,398) (149,881) Property, plant and equipment (92,580) (122,377) Investment in unconsolidated ventures — (12,064) Financing lease obligations (10,273) — Other (2,579) — Total gross deferred income tax liability (273,830) (284,322) Net deferred tax asset (liability) $ (5,987) $ 1,604 A reconciliation of the beginning and ending amounts of the deferred tax valuation allowance is as follows: Year Ended Balance at beginning of period Charged to deferred income tax (benefit) provision Balance at end of period December 31, 2021 $ 380,990 $ (13,027) (1) $ 367,963 December 31, 2022 $ 367,963 $ 57,080 (2) $ 425,043 December 31, 2023 $ 425,043 $ 49,109 (2) $ 474,152 (1) Reduction of valuation allowance for federal and state net operating losses and credits. (2) Increase to valuation allowance for federal and state net operating losses and credits. As of December 31, 2023 and 2022, the Company had federal net operating loss carryforwards generated in 2017 and prior of approximately $790.8 million and $802.2 million, respectively, which are available to offset future taxable income from 2024 through 2034. Additionally, as of December 31, 2023 and 2022, the Company had federal net operating loss carryforwards generated after 2017 of $799.3 million and $659.7 million, respectively, which have an indefinite life, but with usage limited to 80% of taxable income in any given year. The Company had state capital loss carryforwards of $2.1 million as of both December 31, 2023 and 2022, which are available to offset future capital gains through 2024, and are fully offset by a valuation allowance. The Company determined that a valuation allowance was required after consideration of the Company's estimated future reversal of existing timing differences as of December 31, 2023 and 2022. The Company does not consider estimates of future taxable income in its determination due to the existence of cumulative historical operating losses. The Company's valuation allowance as of December 31, 2023 and 2022 was $474.2 million and $425.0 million, respectively. The Company has recorded valuation allowances of $421.6 million and $372.5 million against its federal and state net operating losses as of December 31, 2023 and 2022, respectively. The Company has recorded a valuation allowance against its state capital loss carryforward of $2.1 million as of both December 31, 2023 and 2022. The Company also recorded a valuation allowance against federal and state credits of $50.4 million as of both December 31, 2023 and 2022. As of December 31, 2023 and 2022, the Company had gross tax affected unrecognized tax benefits of $18.2 million and $18.1 million, respectively, which, if recognized, would result in an income tax benefit recorded in the consolidated statement of operations. Interest and penalties related to these tax positions are classified as tax expense in the Company's consolidated financial statements. Total interest and penalties reserved is $0.2 million and $0.1 million as of December 31, 2023 and 2022, respectively. As of December 31, 2023, the Company's tax returns for years 2019 through 2022 are subject to future examination by tax authorities. In addition, the net operating losses from prior years are subject to adjustment under examination. The Company does not expect that unrecognized tax benefits for tax positions taken with respect to 2023 and prior years will significantly change in 2024. A reconciliation of the unrecognized tax benefits is as follows. For the Years Ended December 31, (in thousands) 2023 2022 Balance at beginning of period $ 18,088 $ 18,089 Additions for tax positions related to prior years 173 — Reductions for tax positions related to prior years (56) (1) Balance at end of period $ 18,205 $ 18,088

Supplemental Disclosure of Cash

Supplemental Disclosure of Cash Flow Information	12 Months Ended
Supplemental Disclosure of Cash Flow Information	Dec. 31, 2023
Supplemental Cash Flow Elements [Abstract]
Supplemental Disclosure of Cash Flow Information	18. Supplemental Disclosure of Cash Flow Information (in thousands) For the Years Ended December 31, Supplemental Disclosure of Cash Flow Information: 2023 2022 2021 Interest paid $ 231,786 $ 200,308 $ 188,791 Income taxes paid, net of (refunds) $ (1,429) $ (330) $ 5,923 Capital expenditures, net of related payables: Capital expenditures - non-development, net $ 216,511 $ 168,166 $ 137,410 Capital expenditures - development, net 1,762 6,193 3,208 Capital expenditures - non-development - reimbursable from lessor 10,319 25,650 42,100 Trade accounts payable 4,613 (3,085) (6,061) Net cash paid $ 233,205 $ 196,924 $ 176,657 For the Years Ended December 31, (in thousands) 2023 2022 2021 Acquisition of assets, net of cash acquired: Prepaid expenses and other assets, net $ 23 $ — $ — Property, plant and equipment and leasehold intangibles, net 6,872 4 — Investment in unconsolidated ventures (3,395) — — Financing lease obligations — 6,000 — Other liabilities (384) — — Other non-operating loss (income) (2,542) — — Net cash paid $ 574 $ 6,004 $ — Proceeds from HCS Sale, net: Accounts receivable, net $ — $ — $ (57,582) Property, plant and equipment and leasehold intangibles, net — — (1,806) Operating lease right-of-use assets — — (8,145) Investment in unconsolidated ventures — — 100,000 Goodwill — — (126,810) Prepaid expenses and other assets, net — — (32,963) Trade accounts payable — — 1,387 Accrued expenses — — 25,226 Refundable fees and deferred revenue — — 57,314 Operating lease obligations — — 8,145 Other liabilities — — 9,165 Non-operating loss (gain) on sale of assets, net — — (286,489) Net cash received $ — $ — $ (312,558) Proceeds from sale of other assets, net: Prepaid expenses and other assets, net $ (1,889) $ (1,308) $ (1,983) Assets held for sale — (3,668) (16,166) Property, plant and equipment and leasehold intangibles, net (36,545) (107) (878) Investment in unconsolidated ventures (27,392) — — Refundable fees and deferred revenue 9,347 — — Other liabilities 10,690 1,025 (75) Non-operating loss (gain) on sale of assets, net (1,441) (595) (2,346) Loss (gain) on sale of communities, net (36,296) — — Net cash received $ (83,526) $ (4,653) $ (21,448) Supplemental Schedule of Non-cash Operating, Investing and Financing Activities: For the Years Ended December 31, (in thousands) 2023 2022 2021 Gain on sale for master lease amendment: Property, plant and equipment and leasehold intangibles, net $ — $ (220,477) $ — Operating lease right-of-use assets — 91,641 — Financing lease obligations — 294,327 — Operating lease obligations — (91,641) — Loss (gain) on sale of communities, net — (73,850) — Net $ — $ — $ — Other non-cash lease transactions, net: Property, plant and equipment and leasehold intangibles, net $ (51,518) $ 11,098 $ 4,056 Operating lease right-of-use assets 223,309 11,419 17,197 Operating lease obligations (260,611) (16,179) (17,197) Financing lease obligations 88,820 (6,338) (4,056) Net $ — $ — $ — Restricted cash consists principally of escrow deposits for interest rate caps, real estate taxes, property insurance, capital expenditures, and debt service reserves required by certain lenders under mortgage debt agreements, deposits as security for self-insured retention risk under workers' compensation programs and property insurance programs, and regulatory reserves for certain CCRCs. The components of restricted cash are as follows. December 31, (in thousands) 2023 2022 Current: Interest rate cap escrows $ 17,843 $ 3,797 Real estate tax and property insurance escrows 16,061 15,722 Replacement reserve escrows 7,194 7,999 Other 243 217 Subtotal 41,341 27,735 Long term: Insurance deposits 15,961 18,230 CCRCs escrows 10,813 15,847 Debt service reserve 3,472 13,779 Letters of credit collateral 110 107 Subtotal 30,356 47,963 Total $ 71,697 $ 75,698 The following table provides a reconciliation of cash, cash equivalents, and restricted cash reported within the consolidated balance sheets that sums to the total of the same such amounts shown in the consolidated statements of cash flows. December 31, (in thousands) 2023 2022 Reconciliation of cash, cash equivalents, and restricted cash: Cash and cash equivalents $ 277,971 $ 398,850 Restricted cash 41,341 27,735 Long-term restricted cash 30,356 47,963 Total cash, cash equivalents, and restricted cash $ 349,668 $ 474,548

COVID-19 Pandemic

COVID-19 Pandemic	12 Months Ended
COVID-19 Pandemic	Dec. 31, 2023
Unusual or Infrequent Items, or Both [Abstract]
COVID-19 Pandemic	19. COVID-19 Pandemic The COVID-19 pandemic has adversely impacted the Company's occupancy and resident fee revenue beginning in March 2020, resulted in incremental direct costs to respond to the pandemic, and for the year ended December, 31, 2021, resulted in net cash used in operating activities. While the Federal COVID-19 Public Health Emergency Declaration expired on May 11, 2023, the Company cannot predict with reasonable certainty the impacts that the COVID-19 pandemic and the continued recovery ultimately will have on the Company's business, results of operations, cash flow, and liquidity. Government Provided Financial Relief . The Coronavirus Aid, Relief, and Economic Security Act of 2020 ("CARES Act"), signed into law on March 27, 2020, and Paycheck Protection Program and Health Care Enhancement Act, signed into law on April 24, 2020, provided liquidity and financial relief to certain businesses, among other things. Certain impacts of such programs are provided below. • During the years ended December 31, 2022 and 2021, the Company accepted $61.1 million and $0.8 million, respectively, of cash from grants from the Public Health and Social Services Emergency Fund ("Provider Relief Fund") administered by U.S. Department of Health and Human Services, under which grants have been made available to eligible healthcare providers for healthcare related expenses or lost revenues attributable to the COVID-19 pandemic. • During the year ended December 31, 2020, the Company received $87.5 million under the Accelerated and Advance Payment Program administered by CMS, $75.2 million of which related to its former Health Care Services segment and $12.3 million of which related to its CCRCs segment. During the years ended December 31, 2022 and 2021, $3.1 million and $20.8 million, respectively, of the advanced payments were recouped per the terms of the program. Pursuant to the sale of 80% of the Company's equity in its Health Care Services segment (as described in Note 3), $63.6 million of such obligations related to its former Health Care Services segment were retained by the unconsolidated HCS Venture. As of December 31, 2023, the Company has no remaining obligations under the program. • During the year ended December 31, 2020, the Company deferred payment of $72.7 million of the employer portion of social security payroll taxes incurred from March 27, 2020 through December 31, 2020 pursuant to the CARES Act. Pursuant to the sale of 80% of the Company's equity in its Health Care Services segment, $9.6 million of such obligations related to its former Health Care Services segment were retained by the unconsolidated HCS Venture. In both December 2021 and 2022, the Company paid $31.6 million of its retained deferred amount. As of December 31, 2023, the Company has no remaining obligations for the deferred payroll tax program. • The Company was eligible to claim the employee retention credit on wages paid from March 12, 2020 to December 31, 2021 for certain of its associates under the CARES Act and subsequent legislation. During the years ended December 31, 2022 and 2021, the Company recognized $9.4 million and $9.9 million, respectively, of employee retention credits on wages paid from March 12, 2020 to December 31, 2021 within other operating income. During the years ended December 31, 2023 and 2022, the Company received cash of $14.7 million and $4.6 million, respectively, for such employee retention credits. As of December 31, 2023, the Company has no remaining receivables under the program. The Company had a receivable for $14.7 million included within prepaid expenses and other current assets, net on the consolidated balance sheet as of December 31, 2022. In addition to the grants previously described, during the years ended December 31, 2023, 2022, and 2021, the Company recognized $9.1 million, $10.0 million, and $1.7 million, respectively, of other operating income from grants from other government sources.

Segment Information

Segment Information	12 Months Ended
Segment Information	Dec. 31, 2023
Segment Reporting [Abstract]
Segment Information	20. Segment Information The Company has three reportable segments: Independent Living; Assisted Living and Memory Care; and CCRCs. Operating segments are defined as components of an enterprise that engage in business activities from which it may earn revenues and incur expenses; for which separate financial information is available; and whose operating results are regularly reviewed by the chief operating decision maker to assess the performance of the individual segment and make decisions about resources to be allocated to the segment. Prior to July 1, 2021, the Company had an additional reportable segment, Health Care Services, as described in Note 3. Independent Living . The Company's Independent Living segment includes owned or leased communities that are primarily designed for middle to upper income seniors who desire to live in a residential setting that feels like home, without the efforts of ownership. The majority of the Company's independent living communities consist of both independent and assisted living units in a single community, which allows residents to age-in-place by providing them with a broad continuum of senior independent and assisted living services to accommodate their changing needs. Assisted Living and Memory Care. The Company's Assisted Living and Memory Care segment includes owned or leased communities that offer housing and 24-hour assistance with activities of daily living for the Company's residents. The Company's assisted living and memory care communities include both freestanding, multi-story communities, as well as smaller, freestanding, single story communities. The Company also provides memory care services at freestanding memory care communities that are specially designed for residents with Alzheimer's disease and other dementias. CCRCs. The Company's CCRCs segment includes large owned or leased communities that offer a variety of living arrangements and services to accommodate a broad spectrum of physical ability and healthcare needs. Most of the Company's CCRCs have independent living, assisted living, memory care, and skilled nursing available on one campus. All Other. All Other includes communities operated by the Company pursuant to management agreements. Under the management agreements for these communities, the Company receives management fees as well as reimbursement of expenses it incurs on behalf of the owners. Health Care Services . The Company's former Health Care Services segment included the home health, hospice, and outpatient therapy services provided to residents of many of its communities and to seniors living outside its communities. The Health Care Services segment did not include the skilled nursing and inpatient healthcare services provided in the Company's skilled nursing units, which are included in the Company's CCRCs segment. The accounting policies of the Company's reportable segments are the same as those described in the summary of significant accounting policies in Note 2. The following tables set forth selected segment financial data. For the Years Ended December 31, (in thousands) 2023 2022 2021 Revenue and other operating income: Independent Living (1)(2) $ 564,499 $ 518,699 $ 477,050 Assisted Living and Memory Care (1)(2) 1,968,440 1,815,722 1,595,684 CCRCs (1)(2) 333,404 331,577 306,213 All Other (3) 149,486 159,381 202,043 Health Care Services (1)(2) — — 177,269 Total revenue and other operating income 3,015,829 2,825,379 2,758,259 Segment operating income: (4) Independent Living 184,645 158,950 146,108 Assisted Living and Memory Care 502,317 379,958 294,320 CCRCs 49,581 43,485 34,109 All Other 10,161 12,020 20,598 Health Care Services — — 5,816 Total segment operating income 746,704 594,413 500,951 For the Years Ended December 31, (in thousands) 2023 2022 2021 General and administrative expense (including non-cash stock-based compensation expense) 178,894 168,594 184,916 Facility operating lease expense: Independent Living 39,114 39,700 42,162 Assisted Living and Memory Care 146,166 106,961 111,117 CCRCs 12,943 13,883 15,932 Corporate and All Other 4,187 4,750 5,147 Depreciation and amortization: Independent Living 83,637 79,521 74,922 Assisted Living and Memory Care 196,994 207,344 200,677 CCRCs 36,951 38,039 37,891 Corporate and All Other 25,130 22,540 23,783 Health Care Services — — 340 Asset impairment: Independent Living 1,647 10,893 3,483 Assisted Living and Memory Care 11,574 11,613 14,384 CCRCs 1,368 5,970 4,790 Corporate and All Other 25,983 1,142 346 Loss (gain) on sale of communities, net (36,296) (73,850) — Loss (gain) on facility operating lease termination, net — — (2,003) Income (loss) from operations $ 18,412 $ (42,687) $ (216,936) Total interest expense: Independent Living $ 61,624 $ 48,788 $ 45,209 Assisted Living and Memory Care 141,330 133,139 121,785 CCRCs 24,889 21,251 18,756 Corporate and All Other 10,431 1,539 9,390 $ 238,274 $ 204,717 $ 195,140 Total capital expenditures for property, plant and equipment, and leasehold intangibles: Independent Living $ 51,188 $ 44,857 $ 36,992 Assisted Living and Memory Care 121,240 111,978 105,177 CCRCs 37,414 20,467 19,086 Corporate and All Other 18,750 22,707 21,463 $ 228,592 $ 200,009 $ 182,718 As of December 31, (in thousands) 2023 2022 Total assets: Independent Living (5) $ 1,206,021 $ 1,267,825 Assisted Living and Memory Care 3,315,921 3,329,516 CCRCs 612,521 664,502 Corporate and All Other 438,972 675,219 Total assets $ 5,573,435 $ 5,937,062 (1) All revenue and other operating income is earned from external third parties in the United States. (2) Includes other operating income recognized for the credits or grants pursuant to the Provider Relief Fund, employee retention credit, and other government sources, as described in Note 19. Allocations to the applicable segment generally reflect the credits earned by the segment, the segment’s receipt and acceptance of the grant, or the segment’s proportional utilization of the grant. Other operating income by segment is as follows. For the Years Ended December 31, (in thousands) 2023 2022 2021 Independent Living $ 487 $ 10,906 $ 1,512 Assisted Living and Memory Care 8,008 60,630 5,963 CCRCs 578 8,933 1,788 Health Care Services — — 3,105 Total other operating income $ 9,073 $ 80,469 $ 12,368 (3) All Other revenue and other operating income includes management fees and reimbursements of costs incurred on behalf of managed communities. For the years ended December 31, 2023, 2022, and 2021, revenue and other operating income includes $0.9 million, $4.2 million, and $17.2 million of revenue earned from unconsolidated ventures in which the Company had or has an ownership interest. (4) Segment operating income is defined as segment revenues and other operating income less segment facility operating expenses (excluding facility depreciation and amortization) and costs incurred on behalf of managed communities. (5) The Company's total carrying amount of goodwill is included on the Independent Living segment and was $27.3 million as of December 31, 2023, 2022, and 2021.

Pay vs Performance Disclosure

Pay vs Performance Disclosure - USD ($) $ in Thousands	12 Months Ended
Pay vs Performance Disclosure - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Pay vs Performance Disclosure
Net income (loss)	$ (189,011)	$ (238,427)	$ (99,290)

Insider Trading Arrangements

Insider Trading Arrangements	12 Months Ended
Insider Trading Arrangements	Dec. 31, 2023
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	12 Months Ended
Summary of Significant Accounting Policies (Policies)	Dec. 31, 2023
Accounting Policies [Abstract]
Principles of Consolidation	Principles of Consolidation The consolidated financial statements include the accounts of Brookdale and its consolidated subsidiaries. The ownership interest of consolidated entities not wholly-owned by the Company are presented as noncontrolling interests in the accompanying consolidated financial statements. Intercompany balances and transactions have been eliminated in consolidation, and net income (loss) is reduced by the portion of net income (loss) attributable to noncontrolling interests.
Use of Estimates	Use of Estimates The preparation of the consolidated financial statements and related disclosures in conformity with GAAP requires management to make estimates and assumptions that affect the amounts reported in the consolidated financial statements and accompanying notes. Estimates are used for, but not limited to, revenue, asset impairments, self-insurance reserves, performance-based compensation, allowance for credit losses, depreciation and amortization, leasing transactions, income taxes, and other contingencies. Although these estimates are based on management's best knowledge of current events and actions that the Company may undertake in the future, actual results may differ from the original estimates.
Revenue Recognition and Government Grants	Revenue Recognition Resident Fees Resident fee revenue is reported at the amount that reflects the consideration the Company expects to receive in exchange for the services provided. These amounts are due from residents or third-party payors and include variable consideration for retroactive adjustments from estimated reimbursements, if any, under reimbursement programs. Performance obligations are determined based on the nature of the services provided. Resident fee revenue is recognized as performance obligations are satisfied. Under the Company's senior living residency agreements, which are generally for a contractual term of 30 days to one year, the Company provides senior living services to residents for a stated daily or monthly fee. The Company has elected the lessor practical expedient within ASC 842, Leases ("ASC 842") and recognizes, measures, presents, and discloses the revenue for services under the Company's senior living residency agreements based upon the predominant component, either the lease or nonlease component, of the contracts. The Company has determined that the services included under the Company's independent living, assisted living, and memory care residency agreements have the same timing and pattern of transfer and are performance obligations that are satisfied over time. The Company recognizes revenue under ASC 606, Revenue Recognition from Contracts with Customers ("ASC 606") for its independent living, assisted living, and memory care residency agreements for which it has estimated that the nonlease components of such residency agreements are the predominant component of the contract. The Company receives payment for services under various third-party payor programs which include Medicare, Medicaid, and other third-party payors. Estimates for settlements with third-party payors for retroactive adjustments from estimated reimbursements due to audits, reviews, or investigations are included in the determination of the estimated transaction price for providing services. The Company estimates the transaction price based on the terms of the contract with the payor, correspondence with the payor, and historical payment trends. Changes to these estimates for retroactive adjustments are recognized in the period the change or adjustment becomes known or when final settlements are determined. Billings for services under third-party payor programs are recorded net of estimated retroactive adjustments, if any. Retroactive adjustments are accrued on an estimated basis in the period the related services are rendered and adjusted in future periods or as final settlements are determined. Contractual or cost related adjustments from Medicare or Medicaid are accrued when assessed (without regard to when the assessment is paid or withheld). Subsequent adjustments to these accrued amounts are recorded in net revenues when known. Management Services The Company manages certain communities under contracts which provide periodic management fee payments to the Company and reimbursement for costs and expense related to such communities. Management fees are generally determined by an agreed upon percentage of gross revenues (as defined in the management agreement). Certain management contracts also provide for an annual incentive fee to be paid to the Company upon achievement of certain metrics identified in the contract. The Company has determined that all community management activities are a single performance obligation, which is satisfied over time as the services are rendered. The Company estimates the amount of incentive fee revenue expected to be earned, if any, during the annual contract period and revenue is recognized as services are provided. The Company's estimate of the transaction price for management services also includes the amount of reimbursement due from the owners of the communities for services provided and related costs incurred. Such revenue is included in reimbursed costs incurred on behalf of managed communities on the consolidated statements of operations. The related costs are included in costs incurred on behalf of managed communities on the consolidated statements of operations. Government Grants The Company recognizes income for government grants on a systematic and rational basis over the periods in which the Company recognizes the related expenses or loss of revenue for which the grants are intended to compensate when there is reasonable assurance that the Company will comply with the applicable terms and conditions of the grant and there is reasonable assurance that the grant will be received.
Lease Accounting	Lease Accounting The Company, as lessee, recognizes a right-of-use asset and a lease liability on the Company's consolidated balance sheet for its long-term leases. As of the commencement date of a lease, a lease liability and corresponding right-of-use asset is established on the Company's consolidated balance sheet at the estimated present value of future minimum lease payments. The Company's community leases generally contain fixed annual rent escalators or annual rent escalators based on an index, such as the consumer price index. The future minimum lease payments recognized on the consolidated balance sheet include fixed payments (including in-substance fixed payments) and variable payments estimated utilizing the index or rate on the lease commencement date. The Company recognizes lease expense as incurred for additional variable payments. For the Company's leases for which the rate implicit in the lease is not readily determinable, the Company utilizes its estimated incremental borrowing rate to determine the present value of lease payments based on information available at commencement of the lease. The Company's estimated incremental borrowing rate reflects the fixed rate at which the Company could borrow a similar amount for the same term on a collateralized basis. For accounting purposes, renewal or extension options are included in the lease term at lease inception or modification when it is reasonably certain that the Company will exercise the option. The Company elected the short-term lease exception policy which permits leases with an initial term of 12 months or less to not be recorded on the Company's consolidated balance sheet. The Company, as lessee, makes a determination with respect to each of its leases as to whether each should be accounted for as an operating lease or financing lease. The classification criteria is based on estimates regarding the fair value of the leased asset, minimum lease payments, effective cost of funds, economic life of the asset, and certain other terms in the lease agreements. Lease right-of-use assets are reviewed for impairment whenever changes in circumstances indicate that the carrying amount of an asset group may not be recoverable. Recoverability of right-of-use assets are assessed by a comparison of the carrying amount of the asset group to the estimated future undiscounted net cash flows expected to be generated by the asset group, calculated utilizing the lowest level of identifiable cash flows. If estimated future undiscounted net cash flows are less than the carrying amount of the asset group then the fair value of the asset is estimated. The impairment loss is determined by comparing the estimated fair value of the asset to its carrying amount, with any amount in excess of fair value recognized as an impairment loss in the current period. Undiscounted cash flow projections and estimates of fair value amounts are based on a number of assumptions such as revenue and expense growth rates and estimated lease coverage ratios (Level 3). Operating Leases The Company recognizes operating lease expense for actual rent paid, generally plus or minus a straight-line adjustment for estimated minimum lease escalators if applicable. The right-of-use asset is generally reduced each period by an amount equal to the difference between the operating lease expense and the amount of expense on the lease liability utilizing the effective interest method. Subsequent to the impairment of an operating lease right-of-use asset, the Company recognizes operating lease expense consisting of the reduction of the right-of-use asset on a straight-line basis over the remaining lease term and the amount of expense on the lease liability utilizing the effective interest method. Financing Leases Financing lease right-of-use assets are recognized within property, plant and equipment and leasehold intangibles, net on the Company's consolidated balance sheets. The Company recognizes interest expense on the financing lease liabilities utilizing the effective interest method. The right-of-use asset is generally amortized to depreciation and amortization expense on a straight-line basis over the lease term unless the lease contains an option to purchase the underlying asset that the Company is reasonably certain to exercise. If the Company is reasonably certain to exercise the purchase option, the asset is amortized over the useful life. Sale-Leaseback Transactions For transactions in which an owned community is sold and leased back from the buyer (sale-leaseback transactions), the Company recognizes an asset sale and lease accounting is applied if the Company has transferred control of the community. For such transactions, the Company removes the transferred assets from the consolidated balance sheet and a gain or loss on the sale is recognized for the difference between the carrying amount of the asset and the transaction price for the sale transaction. For sale‑leaseback transactions in which the Company has not transferred control of the underlying asset, the Company does not recognize an asset sale or derecognize the underlying asset until control is transferred. For such transactions, the Company recognizes the underlying assets within assets under financing leases as a component of property, plant and equipment and leasehold intangibles, net on the consolidated balance sheets and continues to depreciate the assets over their useful lives. Additionally, the Company accounts for any amounts received as a financing lease liability and the Company recognizes interest expense on the financing lease liability utilizing the effective interest method with the interest expense limited to an amount that is not greater than the cash payments on the financing lease liability over the term of the lease. The Company reviews for sale accounting whenever events or changes in circumstances indicate that control may have been transferred and the Company recognizes an asset sale and lease accounting is applied if the Company has transferred control of the underlying asset. When an asset sale is recognized for such transactions, the Company removes the transferred assets and financing lease liability from the consolidated balance sheet and a gain or loss on the sale is recognized for the difference between the carrying amount of the asset and the financing lease liability.
Gain (Loss) on Sale of Assets	Gain (Loss) on Sale of Assets The Company regularly enters into real estate transactions which may include the disposition of certain communities, including the associated real estate. The Company recognizes a gain or loss from real estate sales when the transfer of control is complete. The Company recognizes a gain or loss from the sale of equity method investments when the transfer of control is complete and the Company has no continuing involvement with the transferred financial assets.
Purchase Accounting	Purchase Accounting For the acquisition of assets that do not meet the definition of a business, the Company accounts for the transaction as an asset acquisition at the purchase price, including acquisition costs, allocated among the acquired assets and assumed liabilities, including identified intangible assets and liabilities, based upon the relative fair values using Level 3 inputs at the date of acquisition. For acquisitions of a business, the Company accounts for the transaction as a business combination pursuant to the acquisition method and assets acquired and liabilities assumed, including identified intangible assets and liabilities, are recorded at fair value. In determining the allocation of the purchase price of companies and communities to net tangible and identified intangible assets acquired and liabilities assumed, the Company makes estimates of fair value using information obtained as a result of pre-acquisition due diligence, marketing, leasing activities, and/or independent appraisals. In connection with a business combination, the excess of the fair value of liabilities assumed and common stock issued and cash paid over the fair
Deferred Financing Costs	Deferred Financing Costs
Stock-Based Compensation	Stock-Based Compensation Measurement of the cost of employee services received in exchange for stock-based compensation is based on the grant-date fair value of the employee stock awards, which is based on the quoted price of the Company's common shares on the grant date for the majority of the Company's awards. The Company evaluates if grant-date fair value adjustments are necessary based on whether the Company is in possession of material non-public information at the grant date and the changes in the Company’s stock price subsequent to the release of such information and no adjustments were made. The Company recognizes forfeitures of stock-based awards as they occur and any previously recognized compensation expense is reversed for forfeited awards. Stock-based awards that vest over a requisite service period, other than those with performance or market conditions, generally vest ratably in annual installments over a period of three Certain of the Company's employee stock-based awards vest only upon the achievement of performance conditions. The Company recognizes compensation cost only when achievement of performance conditions is considered probable. Consequently, the Company’s determination of the amount of stock-based compensation expense requires judgment in estimating the probability of achievement of these performance conditions. Performance conditioned awards that vest dependent upon attainment of various levels of performance that equal or exceed threshold levels generally vest based upon performance at the end of a three-year performance period. The number of shares that ultimately vest can range from 0% to 150% of the stock-based awards granted depending on the level of achievement of the performance criteria. Certain of the Company's employee stock-based awards vest only upon the achievement of a market condition where the measurement period is three years and vesting of the awards is based on the Company's level of attainment of a specified total stockholder return relative to the percentage appreciation of a specified index of companies for the respective three-year measurement period. Compensation expense for awards with market conditions is recognized over the service period, which is generally four years, and the actual achievement of the market condition does not impact expense recognition. The Company uses a Monte Carlo valuation model to estimate the grant date fair value of such awards. Depending on the results achieved during the three-year measurement period, the number of shares that ultimately vest may range from 0% to 150% of the stock-based awards granted. The expected volatility of the Company's common stock at the date of grant is estimated based on a historical average volatility rate for the approximate three-year performance period and the estimated expected weighted average volatility was 83.3% and 76.0% for awards granted in 2023 and 2022, respectively. The risk-free interest rate assumption is based on observed interest rates consistent with the approximate three-year measurement period and the estimated weighted average risk free interest rate was 4.4% and 1.8% for awards granted in 2023 and 2022, respectively. For all share-based awards with graded vesting other than performance conditioned awards, the Company records compensation expense for the entire award on a straight-line basis (or, if applicable, on the accelerated method) over the requisite service period. For performance conditioned awards, total compensation expense is recognized over the requisite service period for each separately vesting tranche of the award as if the award is, in substance, multiple awards once the performance condition is deemed probable of achievement. Performance conditions are evaluated quarterly. If such conditions are not ultimately met or it is not probable the conditions will be achieved, no compensation expense for performance conditioned awards is recognized and any previously recognized compensation expense is reversed.
Income Taxes	Income Taxes The Company accounts for income taxes under the asset and liability approach which requires recognition of deferred tax assets and liabilities for the differences between the financial reporting and tax basis of assets and liabilities using the tax rates in effect for the year in which the differences are expected to affect taxable income. A valuation allowance reduces deferred tax assets when it is more likely than not that some portion or all of the deferred tax assets will not be realized. When it is determined that it is more likely than not that the Company will be able to realize deferred tax assets in the future in excess of
Fair Value of Financial Instruments	Fair Value of Financial Instruments Fair value measurements are based on a three-level valuation hierarchy for disclosure of fair value measurements. The valuation hierarchy is based upon the transparency of inputs to the valuation of an asset or liability as of the measurement date. Categorization within the valuation hierarchy is based upon the lowest level of input that is significant to the fair value measurement. The three levels are defined as follows. • Level 1 – quoted prices (unadjusted) for identical assets or liabilities in active markets; • Level 2 – quoted prices for similar assets and liabilities in active markets; quoted prices for identical or similar instruments in markets that are not active; and model-derived valuations in which significant inputs and significant value drivers are observable in active markets; and • Level 3 – fair value measurements derived from valuation techniques in which one or more significant inputs or significant value drivers are unobservable.
Marketable Securities	Marketable Securities
Accounts Receivable, Net	Accounts Receivable, Net Accounts receivable are reported net of an allowance for credit losses to represent the Company's estimate of expected losses at the balance sheet date. The adequacy of the Company's allowance for credit losses is reviewed on an ongoing basis, using historical payment trends, write-off experience, analyses of receivable portfolios by payor source and aging of receivables, a review of specific accounts, as well as expected future economic conditions and market trends, and adjustments are made to the allowance as necessary.
Property, Plant and Equipment and Leasehold Intangibles, Net	Property, Plant and Equipment and Leasehold Intangibles, Net Property, plant and equipment and leasehold intangibles, net are recorded at cost. Depreciation and amortization is computed using the straight-line method over the estimated useful lives of the assets, which are as follows. Asset Category Estimated Buildings and improvements 40 Furniture and equipment 3 – 10 Resident in-place lease intangibles 1 – 3 Expenditures for ordinary maintenance and repairs are expensed to operations as incurred. Renovations and improvements, which improve and/or extend the useful life of the asset, are capitalized and depreciated over the estimated useful life of the renovations or improvements. For communities subject to operating or financing leases, leasehold improvements are depreciated over the shorter of the estimated useful life of the assets or the term of the lease. For financing leases that have a purchase option the Company is reasonably certain to exercise, the leasehold improvements are depreciated over their estimated useful life. Facility operating expense excludes facility depreciation and amortization. Long-lived assets are reviewed for impairment whenever events or changes in circumstances indicate the carrying amount of an asset group may not be recoverable. Recoverability of an asset group is assessed by comparing its carrying amount to the estimated future undiscounted net cash flows expected to be generated by the asset group through operation or disposition, calculated utilizing the lowest level of identifiable cash flows. If this comparison indicates that the carrying amount of an asset group is not recoverable, the Company is required to recognize an impairment loss. The impairment loss is measured by the amount by which the carrying amount of the asset exceeds its estimated fair value, with any amount in excess of fair value
Investment in Unconsolidated Ventures	Investment in Unconsolidated Ventures The Company reports investments in unconsolidated entities over whose operating and financial policies it has the ability to exercise significant influence under the equity method of accounting. The initial carrying amount of investment in unconsolidated ventures is based on the amount paid to purchase the investment or its fair value in the case of a retained noncontrolling interest upon deconsolidation of a former subsidiary. The Company's reported share of earnings of an unconsolidated venture is adjusted for the impact, if any, of basis differences between its carrying amount of the equity investment and its share of the venture's underlying assets. Distributions received from an investee are recognized as a reduction in the carrying amount of the investment. The Company evaluates realization of its investment in ventures accounted for using the equity method if circumstances indicate that the Company's investment is other than temporarily impaired. A current fair value of an investment that is less than its carrying amount may indicate a loss in value of the investment. If the Company determines that an equity method investment is other than temporarily impaired, it is recorded at its fair value with an impairment charge recognized in asset impairment expense for the difference between its carrying amount and fair value.
Goodwill	Goodwill The Company tests goodwill for impairment annually during the fourth quarter or more frequently if indicators of impairment arise. Factors the Company considers important in its analysis of whether an indicator of impairment exists include a significant decline in the Company's stock price or market capitalization for a sustained period since the last testing date, significant underperformance relative to historical or projected future operating results, and significant negative industry or economic trends. The Company first assesses qualitative factors to determine if it is more likely than not that the fair value of a reporting unit is less than its carrying amount. If so, the Company performs a quantitative goodwill impairment test based upon a comparison of the estimated fair value of the reporting unit to which the goodwill has been assigned with the reporting unit's carrying amount. The fair values used in the quantitative goodwill impairment test are estimated using Level 3 inputs based upon discounted future cash flow projections for the reporting unit. These cash flow projections are based upon a number of estimates and assumptions such as revenue and expense growth rates, capitalization rates, and discount rates. The Company also considers market-based measures such as earnings multiples in its analysis of estimated fair values of its reporting units. If the quantitative goodwill impairment test results in a reporting unit's carrying amount exceeding its estimated fair value, an impairment charge will be recorded based on the difference, with the impairment charge limited to the amount of goodwill allocated to the reporting unit.
Self-Insurance Liability Accruals	Self-Insurance Liability Accruals The Company is subject to various legal proceedings and claims that arise in the ordinary course of its business. Although the Company maintains general liability and professional liability insurance policies for its owned, leased, and managed communities under a master insurance program, the Company's current policies provide for deductibles for each claim and contain various exclusions from coverage. The Company uses its wholly-owned captive insurance company for the purpose of insuring certain portions of its risk retention under its general and professional liability insurance programs. Accordingly, the Company is, in effect, self-insured for claims that are less than the deductible amounts, for claims that exceed the funding level of the Company’s wholly-owned captive insurance company, and for claims or portions of claims that are not covered by such policies and/or exceed the policy limits. In addition, the Company maintains a high deductible workers' compensation program and a self-insured employee medical program. The Company reviews the adequacy of its accruals related to these liabilities on an ongoing basis using historical claims, actuarial valuations, third-party administrator estimates, consultants, advice from legal counsel, and industry data, and adjusts accruals periodically. Estimated costs related to these self-insurance programs are accrued based on known claims and projected claims incurred but not yet reported. Subsequent changes in actual experience are monitored, and estimates are updated as information becomes available.
Treasury Stock	Treasury Stock
Reclassifications	Reclassifications Certain prior period amounts have been reclassified to conform to the current financial statement presentation, with no effect on the Company's consolidated financial position or results of operations.

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Tables)	12 Months Ended
Summary of Significant Accounting Policies (Tables)	Dec. 31, 2023
Accounting Policies [Abstract]
Schedule of Property, Plant and Equipment and Leasehold Intangibles, Net	Depreciation and amortization is computed using the straight-line method over the estimated useful lives of the assets, which are as follows. Asset Category Estimated Buildings and improvements 40 Furniture and equipment 3 – 10 Resident in-place lease intangibles 1 – 3 As of December 31, 2023 and 2022, net property, plant and equipment and leasehold intangibles, which include assets under financing leases, consisted of the following. As of December 31, (in thousands) 2023 2022 Land $ 500,649 $ 506,968 Buildings and improvements 5,348,133 5,323,736 Furniture and equipment 1,111,408 1,055,304 Resident in-place lease intangibles 282,411 286,122 Construction in progress 33,905 41,778 Assets under financing leases and leasehold improvements 1,070,900 1,375,521 Property, plant and equipment and leasehold intangibles 8,347,406 8,589,429 Accumulated depreciation and amortization (4,016,777) (4,053,727) Property, plant and equipment and leasehold intangibles, net $ 4,330,629 $ 4,535,702

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	12 Months Ended
Fair Value Measurements (Tables)	Dec. 31, 2023
Fair Value Disclosures [Abstract]
Schedule of Interest Rate Caps	The following table summarizes the Company's SOFR interest rate cap instruments as of December 31, 2023. ($ in thousands) Current notional balance $ 1,231,920 Weighted average fixed cap rate 4.07 % Earliest maturity date 2024 Latest maturity date 2025 Weighted average remaining term 0.8 years Estimated asset fair value (included in other assets, net) at December 31, 2023 $ 13,268 Estimated asset fair value (included in other assets, net) at December 31, 2022 $ 10,599 The following table summarizes the Company's SOFR interest rate swap instrument as of December 31, 2023. ($ in thousands) Current notional balance $ 220,000 Fixed interest rate 3.00 % Remaining term 0.3 years Estimated asset fair value (included in other assets, net) at December 31, 2023 $ 1,611 Estimated asset fair value (included in other assets, net) at December 31, 2022 $ 4,834
Schedule of Asset Impairment Expense	The following is a summary of asset impairment expense. For the Years Ended December 31, (in millions) 2023 2022 2021 Operating lease right-of-use assets $ 8.3 $ 13.7 $ 16.6 Property, plant and equipment and leasehold intangibles, net 6.3 15.9 6.4 Investment in unconsolidated ventures 26.0 — — Asset impairment $ 40.6 $ 29.6 $ 23.0

Revenue (Tables)

Revenue (Tables)	12 Months Ended
Revenue (Tables)	Dec. 31, 2023
Revenue from Contract with Customer [Abstract]
Schedule of Disaggregation of Revenue	Resident fee revenue by payor source is as follows. For the Years Ended December 31, 2023 2022 2021 Private pay 93.7 % 93.5 % 86.8 % Government reimbursement 4.8 % 5.1 % 10.3 % Other third-party payor programs 1.5 % 1.4 % 2.9 %
Schedule of Accounts Receivable, Allowance for Credit Loss	The following table presents the changes in allowance for credit losses on accounts receivable for the periods indicated. For the Years Ended December 31, (in millions) 2023 2022 2021 Balance at beginning of period $ 12.8 $ 13.3 $ 9.8 Provision within facility operating expense 22.6 20.0 21.6 Write-offs (22.5) (22.2) (19.2) Recoveries and other 1.2 1.7 1.1 Balance at end of period $ 14.1 $ 12.8 $ 13.3

Property, Plant and Equipment_2

Property, Plant and Equipment and Leasehold Intangibles, Net (Tables)	12 Months Ended
	Dec. 31, 2023
Property, Plant and Equipment [Abstract]
Schedule of Property, Plant and Equipment	Depreciation and amortization is computed using the straight-line method over the estimated useful lives of the assets, which are as follows. Asset Category Estimated Buildings and improvements 40 Furniture and equipment 3 – 10 Resident in-place lease intangibles 1 – 3 As of December 31, 2023 and 2022, net property, plant and equipment and leasehold intangibles, which include assets under financing leases, consisted of the following. As of December 31, (in thousands) 2023 2022 Land $ 500,649 $ 506,968 Buildings and improvements 5,348,133 5,323,736 Furniture and equipment 1,111,408 1,055,304 Resident in-place lease intangibles 282,411 286,122 Construction in progress 33,905 41,778 Assets under financing leases and leasehold improvements 1,070,900 1,375,521 Property, plant and equipment and leasehold intangibles 8,347,406 8,589,429 Accumulated depreciation and amortization (4,016,777) (4,053,727) Property, plant and equipment and leasehold intangibles, net $ 4,330,629 $ 4,535,702

Debt (Tables)

Debt (Tables)	12 Months Ended
Debt (Tables)	Dec. 31, 2023
Debt Disclosure [Abstract]
Schedule of Debt	Long-term debt consists of the following. December 31, (in thousands) 2023 2022 Fixed mortgage notes payable due 2025 through 2047; weighted average interest rate of 4.26% and 4.14%, as of December 31, 2023 and 2022, respectively. $ 1,953,414 $ 2,055,867 Variable mortgage notes payable due 2025 through 2030; weighted average interest rate of 7.74% and 6.68% as of December 31, 2023 and 2022, respectively. 1,524,907 1,568,555 Convertible notes payable due October 2026; interest rate of 2.00% as of both December 31, 2023 and 2022. 230,000 230,000 Tangible equity units senior amortizing notes due November 2025; interest rate of 10.25% as of both December 31, 2023 and 2022. 17,990 25,586 Deferred financing costs, net (28,998) (29,866) Total long-term debt 3,697,313 3,850,142 Current portion 41,463 66,043 Total long-term debt, less current portion $ 3,655,850 $ 3,784,099
Schedule of Maturities	The annual aggregate scheduled maturities (including recurring principal payments) of long-term debt outstanding as of December 31, 2023 are as follows (in thousands). Year Ending December 31, Long-term Weighted Rate 2024 $ 49,485 6.46 % 2025 (1) 573,035 7.30 % 2026 305,614 2.71 % 2027 960,971 6.00 % 2028 563,548 5.79 % Thereafter 1,273,658 5.03 % Total obligations 3,726,311 5.58 % Less amount representing deferred financing costs, net (28,998) Total $ 3,697,313 (1) Includes the initial maturity of $320.0 million of mortgage debt for which the Company has the option to extend the maturity for two additional terms of one year each subject to the satisfaction of certain conditions.

Leases (Tables)

Leases (Tables)	12 Months Ended
Leases (Tables)	Dec. 31, 2023
Leases [Abstract]
Schedule of Lease Cost	A summary of operating and financing lease expense (including the respective presentation on the consolidated statements of operations) and net cash outflows from leases is as follows. Years Ended December 31, Operating Leases (in thousands) 2023 2022 2021 Facility operating expense $ 7,105 $ 6,329 $ 12,606 Facility lease expense 202,410 165,294 174,358 Operating lease expense 209,515 171,623 186,964 Operating lease expense adjustment (1) 45,739 34,896 23,280 Changes in operating lease assets and liabilities for lessor capital expenditure reimbursements (9,844) (13,718) (30,965) Operating net cash outflows from operating leases $ 245,410 $ 192,801 $ 179,279 (1) Represents the difference between the amount of cash operating lease payments and the amount of operating lease expense. Years Ended December 31, Financing Leases (in thousands) 2023 2022 2021 Depreciation and amortization $ 16,444 $ 38,126 $ 37,921 Interest expense: financing lease obligations 21,950 48,061 46,282 Financing lease expense $ 38,394 $ 86,187 $ 84,203 Operating cash outflows from financing leases $ 21,950 $ 48,061 $ 46,282 Financing cash outflows from financing leases 8,473 22,221 19,874 Changes in financing lease assets and liabilities for lessor capital expenditure reimbursement (475) (11,932) (11,135) Total net cash outflows from financing leases $ 29,948 $ 58,350 $ 55,021
Schedule of Lessee, Operating Lease, Liability, Maturity	The aggregate amounts of future minimum lease payments, including community, office, and equipment leases, recognized on the consolidated balance sheet as of December 31, 2023 are as follows (in thousands). Year Ending December 31, Operating Leases Financing Leases 2024 $ 260,694 $ 20,266 2025 260,501 6,849 2026 145,832 6,833 2027 147,660 6,082 2028 84,767 5,917 Thereafter 251,579 20,625 Total lease payments 1,151,033 66,572 Purchase option liability and non-cash gain on future sale of property — 145,136 Imputed interest and variable lease payments (274,526) (59,859) Total lease obligations $ 876,507 $ 151,849
Schedule of Finance Lease, Liability, Maturity	The aggregate amounts of future minimum lease payments, including community, office, and equipment leases, recognized on the consolidated balance sheet as of December 31, 2023 are as follows (in thousands). Year Ending December 31, Operating Leases Financing Leases 2024 $ 260,694 $ 20,266 2025 260,501 6,849 2026 145,832 6,833 2027 147,660 6,082 2028 84,767 5,917 Thereafter 251,579 20,625 Total lease payments 1,151,033 66,572 Purchase option liability and non-cash gain on future sale of property — 145,136 Imputed interest and variable lease payments (274,526) (59,859) Total lease obligations $ 876,507 $ 151,849

Tangible Equity Units (Tables)

Tangible Equity Units (Tables)	12 Months Ended
Tangible Equity Units (Tables)	Dec. 31, 2023
Equity [Abstract]
Schedule of Proceeds from Issuance Allocated to Equity and Debt Component	The proceeds from the issuance of the Units were allocated to equity and debt based on the relative fair value of the respective components of each Unit as follows: (in thousands, except value per unit) Equity Component Debt Component Total Value per unit $ 41.10 $ 8.90 $ 50.00 Gross proceeds $ 118,164 $ 25,586 $ 143,750 Less: underwriters' discount (3,544) (768) (4,312) Proceeds from issuance of Units $ 114,620 $ 24,818 $ 139,438 Less: issuance costs (1,163) (252) (1,415) Net proceeds $ 113,457 $ 24,566 $ 138,023
Schedule of Debt Instrument Settlement Prepaid Stock Purchase Contract	Unless settled early in accordance with the terms of the instruments, each prepaid stock purchase contract will automatically settle on November 15, 2025 (the mandatory settlement date) for a number of shares of the Company’s common stock based on the arithmetic average of the VWAPs of the Company’s common stock on each of the 20 consecutive trading days beginning on, and including, the 21st scheduled trading day immediately preceding November 15, 2025 (applicable market value) with reference to the following settlement rates: Applicable Market Value Common Stock Issued Equal to or greater than the threshold appreciation price 12.9341 shares (minimum settlement rate) Less than the threshold appreciation price, but greater than the reference price $50 divided by applicable market value Less than or equal to the reference price 15.1976 shares (maximum settlement rate)

Accrued Expenses (Tables)

Accrued Expenses (Tables)	12 Months Ended
Accrued Expenses (Tables)	Dec. 31, 2023
Accounts Payable and Accrued Liabilities, Current [Abstract]
Schedule of Accrued Expenses	Accrued expenses reflected within current liabilities on the Company’s consolidated balance sheets consist of the following. As of December 31, (in thousands) 2023 2022 Employee compensation $ 104,322 $ 85,610 Insurance reserves 54,834 65,757 Real estate taxes 26,988 26,661 Interest 17,838 17,569 Utilities 8,444 8,533 Income taxes payable 2,071 2,081 Other 28,171 30,937 Total $ 242,668 $ 237,148

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	12 Months Ended
Stock-Based Compensation (Tables)	Dec. 31, 2023
Share-Based Payment Arrangement [Abstract]
Schedule of Restricted Stock Units and Stock Awards Activity	The following table sets forth information about the Company's restricted stock units and stock awards. (in thousands, except for weighted average amounts) Number of Restricted Stock Units and Stock Awards Weighted Outstanding on January 1, 2021 8,505 $ 7.68 Granted 1,998 5.12 Vested (2,641) 8.40 Cancelled/forfeited (2,851) 6.77 Outstanding on December 31, 2021 5,011 6.80 Granted 2,921 5.58 Vested (2,039) 7.15 Cancelled/forfeited (520) 6.88 Outstanding on December 31, 2022 5,373 6.00 Granted 3,992 2.98 Vested (2,001) 5.87 Cancelled/forfeited (961) 5.90 Outstanding on December 31, 2023 6,403 4.17
Schedule of Restricted Stock Units and Stock Awards Grants	During 2023, grants of restricted stock units and stock awards under the Company's 2014 Omnibus Incentive Plan were as follows. (in thousands, except for weighted average amounts) Restricted Stock Unit and Stock Award Grants Weighted Average Grant Date Fair Value Total Grant Date Fair Value Three months ended March 31, 2023 3,959 $ 2.97 $ 11,778 Three months ended June 30, 2023 10 $ 2.95 $ 29 Three months ended September 30, 2023 16 $ 4.01 $ 65 Three months ended December 31, 2023 7 $ 4.14 $ 29

Earnings Per Share (Tables)

Earnings Per Share (Tables)	12 Months Ended
Earnings Per Share (Tables)	Dec. 31, 2023
Earnings Per Share [Abstract]
Schedule of Earnings Per Share, Basic and Diluted	Years Ended December 31, (in thousands) 2023 2022 2021 Weighted average common shares outstanding 188,023 186,574 184,975 Weighted average minimum shares issuable under purchase contracts 37,186 3,889 — Weighted average shares outstanding - basic 225,209 190,463 184,975
Schedule of Potentially Dilutive Securities	The Company has the following potentially outstanding shares of common stock, which were excluded from the computation of diluted net income (loss) per share attributable to common stockholders in all periods as a result of the net loss. As of December 31, (in millions) 2023 2022 2021 Convertible senior notes 38.3 38.3 38.3 Warrants 16.3 16.3 16.3 Restricted stock and restricted stock units 6.4 5.4 5.0 Incremental shares issuable under purchase contracts 6.5 6.5 — Total 67.5 66.5 59.6

Income Taxes (Tables)

Income Taxes (Tables)	12 Months Ended
Income Taxes (Tables)	Dec. 31, 2023
Income Tax Disclosure [Abstract]
Schedule of Components of Income Tax Expense (Benefit)	The benefit (provision) for income taxes is comprised of the following. For the Years Ended December 31, (in thousands) 2023 2022 2021 Federal: Current $ (183) $ (17) $ 161 Deferred (7,590) 1,325 9,837 Total federal (7,773) 1,308 9,998 State: Current (1,011) 251 (1,835) Deferred (included in federal above) — — — Total state (1,011) 251 (1,835) Total $ (8,784) $ 1,559 $ 8,163
Schedule of Reconciliation of Income Tax Expense (Benefit)	A reconciliation of the benefit (provision) for income taxes to the amount computed at the U.S. Federal statutory rate of 21% is as follows. For the Years Ended December 31, (in thousands) 2023 2022 2021 Tax benefit (provision) at U.S. statutory rate $ 37,848 $ 50,397 $ 22,565 State taxes, net of federal income tax 5,766 10,811 7,673 Valuation allowance (49,109) (57,080) 13,027 Goodwill derecognition — — (31,829) Stock compensation (1,312) (181) (1,856) Other (1,977) (2,388) (1,417) Total $ (8,784) $ 1,559 $ 8,163
Schedule of Deferred Tax Assets and Liabilities	Significant components of the Company's deferred tax assets and liabilities are as follows. As of December 31, (in thousands) 2023 2022 Deferred income tax assets: Operating loss carryforwards $ 392,577 $ 361,160 Operating lease obligations 220,003 199,226 Tax credits 50,415 50,415 Accrued expenses 46,814 42,828 Intangible assets 26,816 39,360 Financing lease obligations — 12,749 Capital loss carryforward 2,102 2,140 Other 3,268 3,091 Total gross deferred income tax asset 741,995 710,969 Valuation allowance (474,152) (425,043) Net deferred income tax assets 267,843 285,926 Deferred income tax liabilities: Operating lease right-of-use assets (168,398) (149,881) Property, plant and equipment (92,580) (122,377) Investment in unconsolidated ventures — (12,064) Financing lease obligations (10,273) — Other (2,579) — Total gross deferred income tax liability (273,830) (284,322) Net deferred tax asset (liability) $ (5,987) $ 1,604 A reconciliation of the beginning and ending amounts of the deferred tax valuation allowance is as follows: Year Ended Balance at beginning of period Charged to deferred income tax (benefit) provision Balance at end of period December 31, 2021 $ 380,990 $ (13,027) (1) $ 367,963 December 31, 2022 $ 367,963 $ 57,080 (2) $ 425,043 December 31, 2023 $ 425,043 $ 49,109 (2) $ 474,152 (1) Reduction of valuation allowance for federal and state net operating losses and credits. (2) Increase to valuation allowance for federal and state net operating losses and credits.
Schedule of Reconciliation of Unrecognized Tax Benefits	A reconciliation of the unrecognized tax benefits is as follows. For the Years Ended December 31, (in thousands) 2023 2022 Balance at beginning of period $ 18,088 $ 18,089 Additions for tax positions related to prior years 173 — Reductions for tax positions related to prior years (56) (1) Balance at end of period $ 18,205 $ 18,088

Supplemental Disclosure of Ca_2

Supplemental Disclosure of Cash Flow Information (Tables)	12 Months Ended
Supplemental Disclosure of Cash Flow Information (Tables)	Dec. 31, 2023
Supplemental Cash Flow Elements [Abstract]
Schedule of Supplemental Disclosure of Cash Flow Information	(in thousands) For the Years Ended December 31, Supplemental Disclosure of Cash Flow Information: 2023 2022 2021 Interest paid $ 231,786 $ 200,308 $ 188,791 Income taxes paid, net of (refunds) $ (1,429) $ (330) $ 5,923 Capital expenditures, net of related payables: Capital expenditures - non-development, net $ 216,511 $ 168,166 $ 137,410 Capital expenditures - development, net 1,762 6,193 3,208 Capital expenditures - non-development - reimbursable from lessor 10,319 25,650 42,100 Trade accounts payable 4,613 (3,085) (6,061) Net cash paid $ 233,205 $ 196,924 $ 176,657 For the Years Ended December 31, (in thousands) 2023 2022 2021 Acquisition of assets, net of cash acquired: Prepaid expenses and other assets, net $ 23 $ — $ — Property, plant and equipment and leasehold intangibles, net 6,872 4 — Investment in unconsolidated ventures (3,395) — — Financing lease obligations — 6,000 — Other liabilities (384) — — Other non-operating loss (income) (2,542) — — Net cash paid $ 574 $ 6,004 $ — Proceeds from HCS Sale, net: Accounts receivable, net $ — $ — $ (57,582) Property, plant and equipment and leasehold intangibles, net — — (1,806) Operating lease right-of-use assets — — (8,145) Investment in unconsolidated ventures — — 100,000 Goodwill — — (126,810) Prepaid expenses and other assets, net — — (32,963) Trade accounts payable — — 1,387 Accrued expenses — — 25,226 Refundable fees and deferred revenue — — 57,314 Operating lease obligations — — 8,145 Other liabilities — — 9,165 Non-operating loss (gain) on sale of assets, net — — (286,489) Net cash received $ — $ — $ (312,558) Proceeds from sale of other assets, net: Prepaid expenses and other assets, net $ (1,889) $ (1,308) $ (1,983) Assets held for sale — (3,668) (16,166) Property, plant and equipment and leasehold intangibles, net (36,545) (107) (878) Investment in unconsolidated ventures (27,392) — — Refundable fees and deferred revenue 9,347 — — Other liabilities 10,690 1,025 (75) Non-operating loss (gain) on sale of assets, net (1,441) (595) (2,346) Loss (gain) on sale of communities, net (36,296) — — Net cash received $ (83,526) $ (4,653) $ (21,448) Supplemental Schedule of Non-cash Operating, Investing and Financing Activities: For the Years Ended December 31, (in thousands) 2023 2022 2021 Gain on sale for master lease amendment: Property, plant and equipment and leasehold intangibles, net $ — $ (220,477) $ — Operating lease right-of-use assets — 91,641 — Financing lease obligations — 294,327 — Operating lease obligations — (91,641) — Loss (gain) on sale of communities, net — (73,850) — Net $ — $ — $ — Other non-cash lease transactions, net: Property, plant and equipment and leasehold intangibles, net $ (51,518) $ 11,098 $ 4,056 Operating lease right-of-use assets 223,309 11,419 17,197 Operating lease obligations (260,611) (16,179) (17,197) Financing lease obligations 88,820 (6,338) (4,056) Net $ — $ — $ —
Schedule of Cash and Restricted Cash	Restricted cash consists principally of escrow deposits for interest rate caps, real estate taxes, property insurance, capital expenditures, and debt service reserves required by certain lenders under mortgage debt agreements, deposits as security for self-insured retention risk under workers' compensation programs and property insurance programs, and regulatory reserves for certain CCRCs. The components of restricted cash are as follows. December 31, (in thousands) 2023 2022 Current: Interest rate cap escrows $ 17,843 $ 3,797 Real estate tax and property insurance escrows 16,061 15,722 Replacement reserve escrows 7,194 7,999 Other 243 217 Subtotal 41,341 27,735 Long term: Insurance deposits 15,961 18,230 CCRCs escrows 10,813 15,847 Debt service reserve 3,472 13,779 Letters of credit collateral 110 107 Subtotal 30,356 47,963 Total $ 71,697 $ 75,698 The following table provides a reconciliation of cash, cash equivalents, and restricted cash reported within the consolidated balance sheets that sums to the total of the same such amounts shown in the consolidated statements of cash flows. December 31, (in thousands) 2023 2022 Reconciliation of cash, cash equivalents, and restricted cash: Cash and cash equivalents $ 277,971 $ 398,850 Restricted cash 41,341 27,735 Long-term restricted cash 30,356 47,963 Total cash, cash equivalents, and restricted cash $ 349,668 $ 474,548

Segment Information (Tables)

Segment Information (Tables)	12 Months Ended
Segment Information (Tables)	Dec. 31, 2023
Segment Reporting [Abstract]
Schedule of Segment Reporting Information	The following tables set forth selected segment financial data. For the Years Ended December 31, (in thousands) 2023 2022 2021 Revenue and other operating income: Independent Living (1)(2) $ 564,499 $ 518,699 $ 477,050 Assisted Living and Memory Care (1)(2) 1,968,440 1,815,722 1,595,684 CCRCs (1)(2) 333,404 331,577 306,213 All Other (3) 149,486 159,381 202,043 Health Care Services (1)(2) — — 177,269 Total revenue and other operating income 3,015,829 2,825,379 2,758,259 Segment operating income: (4) Independent Living 184,645 158,950 146,108 Assisted Living and Memory Care 502,317 379,958 294,320 CCRCs 49,581 43,485 34,109 All Other 10,161 12,020 20,598 Health Care Services — — 5,816 Total segment operating income 746,704 594,413 500,951 For the Years Ended December 31, (in thousands) 2023 2022 2021 General and administrative expense (including non-cash stock-based compensation expense) 178,894 168,594 184,916 Facility operating lease expense: Independent Living 39,114 39,700 42,162 Assisted Living and Memory Care 146,166 106,961 111,117 CCRCs 12,943 13,883 15,932 Corporate and All Other 4,187 4,750 5,147 Depreciation and amortization: Independent Living 83,637 79,521 74,922 Assisted Living and Memory Care 196,994 207,344 200,677 CCRCs 36,951 38,039 37,891 Corporate and All Other 25,130 22,540 23,783 Health Care Services — — 340 Asset impairment: Independent Living 1,647 10,893 3,483 Assisted Living and Memory Care 11,574 11,613 14,384 CCRCs 1,368 5,970 4,790 Corporate and All Other 25,983 1,142 346 Loss (gain) on sale of communities, net (36,296) (73,850) — Loss (gain) on facility operating lease termination, net — — (2,003) Income (loss) from operations $ 18,412 $ (42,687) $ (216,936) Total interest expense: Independent Living $ 61,624 $ 48,788 $ 45,209 Assisted Living and Memory Care 141,330 133,139 121,785 CCRCs 24,889 21,251 18,756 Corporate and All Other 10,431 1,539 9,390 $ 238,274 $ 204,717 $ 195,140 Total capital expenditures for property, plant and equipment, and leasehold intangibles: Independent Living $ 51,188 $ 44,857 $ 36,992 Assisted Living and Memory Care 121,240 111,978 105,177 CCRCs 37,414 20,467 19,086 Corporate and All Other 18,750 22,707 21,463 $ 228,592 $ 200,009 $ 182,718 As of December 31, (in thousands) 2023 2022 Total assets: Independent Living (5) $ 1,206,021 $ 1,267,825 Assisted Living and Memory Care 3,315,921 3,329,516 CCRCs 612,521 664,502 Corporate and All Other 438,972 675,219 Total assets $ 5,573,435 $ 5,937,062 (1) All revenue and other operating income is earned from external third parties in the United States. (2) Includes other operating income recognized for the credits or grants pursuant to the Provider Relief Fund, employee retention credit, and other government sources, as described in Note 19. Allocations to the applicable segment generally reflect the credits earned by the segment, the segment’s receipt and acceptance of the grant, or the segment’s proportional utilization of the grant. Other operating income by segment is as follows. For the Years Ended December 31, (in thousands) 2023 2022 2021 Independent Living $ 487 $ 10,906 $ 1,512 Assisted Living and Memory Care 8,008 60,630 5,963 CCRCs 578 8,933 1,788 Health Care Services — — 3,105 Total other operating income $ 9,073 $ 80,469 $ 12,368 (3) All Other revenue and other operating income includes management fees and reimbursements of costs incurred on behalf of managed communities. For the years ended December 31, 2023, 2022, and 2021, revenue and other operating income includes $0.9 million, $4.2 million, and $17.2 million of revenue earned from unconsolidated ventures in which the Company had or has an ownership interest. (4) Segment operating income is defined as segment revenues and other operating income less segment facility operating expenses (excluding facility depreciation and amortization) and costs incurred on behalf of managed communities. (5) The Company's total carrying amount of goodwill is included on the Independent Living segment and was $27.3 million as of December 31, 2023, 2022, and 2021.

Description of Business - Narra

Description of Business - Narrative (Details)	Dec. 31, 2023 community
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of communities leased	277
Current Property Ownership Status
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of senior living communities	652
Number of communities owned	345
Number of communities leased	277
Number of communities managed by third party	30

Summary of Significant Accoun_4

Summary of Significant Accounting Policies - Narrative (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Oct. 01, 2021
Revenue Recognition
Term of residency agreements - minimum (in days)	30 days
Term of residency agreements - maximum (in years)	1 year
Stock-Based Compensation
Award vesting period (in years)	3 years
Award requisite service period (in years)	4 years
Weighted average volatility rate (as percent)	83.30%	76%
Risk free interest rate (as percent)	4.40%	1.80%
Convertible Senior Notes Due 2026 \| Convertible notes payable
Accounting Standards Update and Change in Accounting Principle
Debt face amount			$ 230,000,000
Interest rate (as percent)			2%
Minimum
Stock-Based Compensation
Award vesting period (in years)	3 years
Award vesting rights percentage	0%
Fair value vesting rights, percentage	0%
Maximum
Stock-Based Compensation
Award vesting period (in years)	4 years
Award vesting rights percentage	150%
Fair value vesting rights, percentage	150%

Summary of Significant Accoun_5

Summary of Significant Accounting Policies - Property, Plant and Equipment and Leasehold Intangibles, Net (Details)	Dec. 31, 2023
Buildings and improvements
Property, Plant and Equipment [Line Items]
Estimated Useful Life (in years)	40 years
Furniture and equipment \| Minimum
Property, Plant and Equipment [Line Items]
Estimated Useful Life (in years)	3 years
Furniture and equipment \| Maximum
Property, Plant and Equipment [Line Items]
Estimated Useful Life (in years)	10 years
Resident in-place lease intangibles \| Minimum
Property, Plant and Equipment [Line Items]
Estimated Useful Life (in years)	1 year
Resident in-place lease intangibles \| Maximum
Property, Plant and Equipment [Line Items]
Estimated Useful Life (in years)	3 years

Acquisitions, Dispositions, a_2

Acquisitions, Dispositions, and Other Significant Leasing Transactions - Welltower Lease Amendments (Details) $ in Thousands	3 Months Ended	12 Months Ended
	Jun. 30, 2023 USD ($) community lease	Dec. 31, 2023 USD ($) community	Dec. 31, 2022 USD ($)
Business Acquisition [Line Items]
Operating lease right-of-use assets		$ 670,907	$ 597,130
Mortgages
Business Acquisition [Line Items]
Operating lease, covenant provisions, required minimum tangible net worth		2,000,000
Welltower Inc.
Business Acquisition [Line Items]
Number of communities company continues to lease \| community	74
Number of communities leased \| community	69
Maximum fund costs	$ 17,000
Operating lease right-of-use assets		122,300
Operating lease, covenant provisions, required minimum stockholders equity		400,000
Welltower Inc. \| Mortgages
Business Acquisition [Line Items]
Operating lease, covenant provisions, required minimum tangible net worth		$ 1,500,000
Welltower Inc. \| Revision of Prior Period, Reclassification, Adjustment
Business Acquisition [Line Items]
Number of communities leased \| community		35
Lease expense		$ 19,300
Welltower Inc. \| Lease Expire From December 31, 2026 Until June 30, 2032
Business Acquisition [Line Items]
Number of leases extended \| lease	1
Number of communities leased \| community	39
Welltower Inc. \| Lease Expire On June 30, 2032
Business Acquisition [Line Items]
Number of communities leased \| community	69
Welltower Inc. \| Lease Expire On December 31, 2024
Business Acquisition [Line Items]
Number of communities leased \| community	5
Welltower Inc. \| Minimum Rent Leasing Arrangement \| Secured Overnight Financing Rate (SOFR)
Business Acquisition [Line Items]
Annual escalator rate (as percent)	4%
Welltower Inc. \| Minimum Rent Leasing Arrangement \| Minimum \| Secured Overnight Financing Rate (SOFR)
Business Acquisition [Line Items]
Annual escalator rate (as percent)	3%

Acquisitions, Dispositions, a_3

Acquisitions, Dispositions, and Other Significant Leasing Transactions - Community Transactions (Details) $ in Millions	12 Months Ended			36 Months Ended
	Dec. 31, 2023 USD ($) community	Dec. 31, 2022 USD ($) community	Dec. 31, 2021 USD ($) community	Dec. 31, 2023 community
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of communities leased		1
Remaining equity interest	50%
Number of communities acquired	1
Communities Disposed of Through Lease Terminations
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of communities disposed of	18	4	2	24
Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations \| Communities Disposed of Through Sale
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of communities disposed of	2	2	3
Cash proceeds \| $	$ 25.6	$ 4.4	$ 16.5
Mortgage debt repaid \| $	29.6
Gain on sale of communities \| $	$ 36.3

Acquisitions, Dispositions, a_4

Acquisitions, Dispositions, and Other Significant Leasing Transactions - Sale of Health Care Services (Details) - USD ($) $ in Thousands			1 Months Ended		3 Months Ended		12 Months Ended
	Nov. 01, 2021	Jul. 01, 2021	Dec. 31, 2023	Oct. 31, 2021	Dec. 31, 2023	Sep. 30, 2023	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Investment in unconsolidated ventures			$ 1,906		$ 1,906		$ 1,906	$ 55,333
Distributions from unconsolidated ventures from cumulative share of net earnings							$ 430	561	$ 6,191
Healthcare Services Venture \| Variable Interest Entity, Not Primary Beneficiary
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Contribution to venture						$ 7,500
Health Care Services \| HCA Healthcare, Inc.
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Percentage of ownership sold in transaction		80%	20%
Purchase price		$ 400,000
Net cash proceeds		312,600
Cash proceeds		$ 305,800	$ 27,400
Proceeds from post closing working capital adjustment				$ 6,800
Percentage of ownership after transaction		20%
Investment in unconsolidated ventures		$ 100,000
Gain on sale of equity method investment								$ 286,500
Distributions from unconsolidated ventures from cumulative share of net earnings	$ 35,000
Impairment of unconsolidated ventures					$ 26,000

Acquisitions, Dispositions, a_5

Acquisitions, Dispositions, and Other Significant Leasing Transactions - Master Lease Amendment (Details) $ in Thousands	3 Months Ended	12 Months Ended
	Dec. 31, 2022 USD ($) community	Dec. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Gain on sale of communities		$ 36,296	$ 73,850	$ 0
Operating lease expense		209,515	$ 171,623	$ 186,964
Ventas, Inc
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of communities company continues to lease \| community	24
Number of communities previously accounted \| community	16
Gain on sale of communities	$ 73,900
Operating lease expense		$ 22,200

Fair Value Measurements - Narra

Fair Value Measurements - Narrative (Details) $ in Thousands		3 Months Ended	12 Months Ended
	Jul. 01, 2021 USD ($)	Dec. 31, 2023 USD ($) community lease	Dec. 31, 2023 USD ($) community lease	Dec. 31, 2022 USD ($) community	Dec. 31, 2021 USD ($) community
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities		$ 29,755	$ 29,755	$ 48,680
Total long-term debt		3,697,313	3,697,313	3,850,142
Long-term debt, fair value		$ 3,400,000	$ 3,400,000	3,400,000
Number of communities leased \| lease		263	263
investment in unconsolidated ventures		$ 1,906	$ 1,906	55,333
HCA Healthcare, Inc. \| Health Care Services
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Long-term debt, fair value		27,400	27,400
investment in unconsolidated ventures	$ 100,000
Percentage of ownership after transaction	20%
Purchase price	$ 400,000
Non-cash impairment charge		$ 26,000
Nonrecurring
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Operating lease right-of-use assets			8,300	13,700	$ 16,600
Property, plant and equipment and leasehold intangibles, net			$ 6,300	$ 15,900	$ 6,400
Condensed Consolidated Balance Sheet
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Number of communities leased \| community		12	12	8	11
Estimated fair value		$ 16,400	$ 16,400	$ 30,900	$ 31,000
Reported Value Measurement
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Total long-term debt		3,700,000	3,700,000	3,900,000
Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Marketable securities		$ 29,800	$ 29,800	$ 48,700

Fair Value Measurements - Inter

Fair Value Measurements - Interest Rate Caps (Details) - Level 2 - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Interest Rate Cap
Derivative [Line Items]
Derivative asset, notional amount	$ 1,231,920
Weighted average fixed cap rate	4.07%
Weighted average remaining term	9 months 18 days
Estimated asset fair value (included in other assets, net)	$ 13,268	$ 10,599
Interest Rate Swap
Derivative [Line Items]
Derivative asset, notional amount	$ 220,000
Fixed interest rate	3%
Remaining term	3 months 18 days
Estimated asset fair value (included in other assets, net)	$ 1,611	$ 4,834

Fair Value Measurements - Asset

Fair Value Measurements - Asset Impairment Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Asset impairment	$ 40,572	$ 29,618	$ 23,003
Nonrecurring
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Operating lease right-of-use assets	8,300	13,700	16,600
Property, plant and equipment and leasehold intangibles, net	6,300	15,900	6,400
Investment in unconsolidated ventures	26,000	0	0
Asset impairment	$ 40,600	$ 29,600	$ 23,000

Revenue - Disaggregation of Rev

Revenue - Disaggregation of Revenue (Details) - Revenue Benchmark - Customer Concentration Risk	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Private pay
Disaggregation of Revenue [Line Items]
Revenue (as percent)	93.70%	93.50%	86.80%
Government reimbursement
Disaggregation of Revenue [Line Items]
Revenue (as percent)	4.80%	5.10%	10.30%
Other third-party payor programs
Disaggregation of Revenue [Line Items]
Revenue (as percent)	1.50%	1.40%	2.90%

Revenue - Narrative (Details)

Revenue - Narrative (Details) - USD ($) $ in Millions		1 Months Ended	12 Months Ended
Revenue - Narrative (Details) - USD ($) $ in Millions	Jul. 01, 2021	Dec. 31, 2023	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Disaggregation of Revenue [Line Items]
Monthly resident fees		$ 24.1	$ 24.1	$ 25.2
Revenue recognized			50.2	54.5	$ 60.2
Deferred Revenue and Credits
Disaggregation of Revenue [Line Items]
Deferred revenue		$ 48.3	$ 48.3	$ 67.3
Government reimbursement \| Revenue Benchmark \| Customer Concentration Risk
Disaggregation of Revenue [Line Items]
Revenue (as percent)			4.80%	5.10%	10.30%
CCRCs \| Government reimbursement \| Revenue Benchmark \| Customer Concentration Risk
Disaggregation of Revenue [Line Items]
Revenue (as percent)			16.90%	18%	18.80%
HCA Healthcare, Inc. \| Health Care Services
Disaggregation of Revenue [Line Items]
Percentage of ownership sold in transaction	80%	20%

Revenue - Accounts Receivable,

Revenue - Accounts Receivable, Allowance for Credit Loss (Details) - Allowance for Doubtful Accounts - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Valuation and qualifying accounts [Roll forward]
Balance at beginning of period	$ 12.8	$ 13.3	$ 9.8
Provision within facility operating expense	22.6	20	21.6
Write-offs	(22.5)	(22.2)	(19.2)
Recoveries and other	1.2	1.7	1.1
Balance at end of period	$ 14.1	$ 12.8	$ 13.3

Property, Plant and Equipment_3

Property, Plant and Equipment and Leasehold Intangibles, Net - Property, Plant and Equipment (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles	$ 8,347,406	$ 8,589,429
Accumulated depreciation and amortization	(4,016,777)	(4,053,727)
Property, plant and equipment and leasehold intangibles, net	4,330,629	4,535,702
Depreciation and amortization expense for plant and equipment and leasehold intangibles	342,700	347,400	$ 337,600
Land
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles	500,649	506,968
Buildings and improvements
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles	5,348,133	5,323,736
Furniture and equipment
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles	1,111,408	1,055,304
Resident in-place lease intangibles
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles	282,411	286,122
Construction in progress
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles	33,905	41,778
Assets under financing leases and leasehold improvements
Property, Plant and Equipment [Line Items]
Property, plant and equipment and leasehold intangibles	$ 1,070,900	$ 1,375,521

Debt - Schedule of Debt (Detail

Debt - Schedule of Debt (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022	Oct. 01, 2021
Debt Instrument [Line Items]
Long-term debt, gross	$ 3,726,311
Deferred financing costs, net	(28,998)	$ (29,866)
Total long-term debt	3,697,313	3,850,142
Current portion	41,463	66,043
Total long-term debt, less current portion	3,655,850	3,784,099
Fixed Mortgage Notes Payable
Debt Instrument [Line Items]
Long-term debt, gross	$ 1,953,414	$ 2,055,867
Weighted average interest rate (as percent)	4.26%	4.14%
Variable mortgages note payble
Debt Instrument [Line Items]
Long-term debt, gross	$ 1,524,907	$ 1,568,555
Weighted average interest rate (as percent)	7.74%	6.68%
Convertible notes payable
Debt Instrument [Line Items]
Long-term debt, gross	$ 230,000	$ 230,000
Convertible notes payable \| Convertible Senior Notes Due 2026
Debt Instrument [Line Items]
Total long-term debt			$ 223,300
Weighted average interest rate (as percent)	2%	2%
Other notes payable \| Tangible equity units senior amortizing notes due November 2025; interest rate of 10.25% as of both December 31, 2023 and 2022.
Debt Instrument [Line Items]
Long-term debt, gross	$ 17,990	$ 25,586
Weighted average interest rate (as percent)	10.25%	10.25%

Debt - Narrative (Details)

Debt - Narrative (Details) $ in Billions	Dec. 31, 2023 USD ($)
Debt Instrument [Line Items]
Percentage of total debt	91.90%
Mortgages
Debt Instrument [Line Items]
Long term mortgage debt	$ 3.4

Debt - Maturities (Details)

Debt - Maturities (Details) $ in Thousands	12 Months Ended
Debt - Maturities (Details) $ in Thousands	Dec. 31, 2023 USD ($) extension_option	Dec. 31, 2022 USD ($)
Maturities of Long-term Debt [Abstract]
2024	$ 49,485
2025	573,035
2026	305,614
2027	960,971
2028	563,548
Thereafter	1,273,658
Total	3,726,311
Less amount representing deferred financing costs, net	(28,998)	$ (29,866)
Total long-term debt	$ 3,697,313	$ 3,850,142
Weighted Rate
2024	6.46%
2025	7.30%
2026	2.71%
2027	6%
2028	5.79%
Thereafter	5.03%
Debt, weighted average interest rate (as percent)	5.58%
Mortgages
Maturities of Long-term Debt [Abstract]
Total long-term debt	$ 320,000
Weighted Rate
Extension option \| extension_option	2
Extension option term (in years)	1 year

Debt - Convertible Debt Offerin

Debt - Convertible Debt Offering and Capped Call Transactions (Details)		12 Months Ended
	Oct. 01, 2021 USD ($) day $ / shares	Dec. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)	Sep. 28, 2021 $ / shares
Line of Credit Facility [Line Items]
Cost of the capped call transactions		$ 0	$ 0	$ 15,916,000
Repayments of notes payable	$ 45,000,000
Total long-term debt		3,697,313,000	$ 3,850,142,000
Mortgages
Line of Credit Facility [Line Items]
Repayments of long-term debt	284,400,000
Total long-term debt		$ 320,000,000
Convertible Senior Notes Due 2026 \| Convertible notes payable
Line of Credit Facility [Line Items]
Debt face amount	$ 230,000,000
Interest rate (as percent)	2%
Net proceeds received	$ 224,300,000
Cost of the capped call transactions	$ 15,900,000			$ 15,900,000
Threshold trading days \| day	20
Threshold consecutive trading days \| day	30
Threshold percentage of stock price trigger	130%
Threshold business days \| day	5
Threshold consecutive trading days, measurement period \| day	10
Percentage of product of the last reported sale price of the common stock and the conversion rate	98%
Debt instrument, convertible, conversion ratio	0.1234568
Debt instrument, convertible, conversion price (in dollars per share) \| $ / shares	$ 8.10
Scheduled trading day \| day	51
Redemption price percentage	100%
Total long-term debt	$ 223,300,000
Debt discount	5,700,000
Debt issuance costs	$ 1,000,000
Derivative, exercise price (in dollars per share) \| $ / shares	$ 8.10
Derivative, cap price (in dollars per share) \| $ / shares	$ 9.90
Share price, premium percentage	65%
Share price (in dollars per share) \| $ / shares					$ 6

Debt - Credit Facilities (Detai

Debt - Credit Facilities (Details) - Line of Credit	1 Months Ended	12 Months Ended
Debt - Credit Facilities (Details) - Line of Credit	Dec. 31, 2023 USD ($) term	Dec. 31, 2023 USD ($) term	Dec. 11, 2020 USD ($)
Credit Agreement with Capital One, National Association \| Revolving Credit Facility
Line of Credit Facility [Line Items]
Credit facility, maximum borrowing capacity	$ 100,000,000	$ 100,000,000	$ 100,000,000
Line of credit facility, option to extend \| term	2	2
Line of credit facility, additional terms (in years)	1 year
Commitment fee percentage (as percent)		0.25%
Credit Agreement with Capital One, National Association \| Revolving Credit Facility \| Secured Overnight Financing Rate (SOFR)
Line of Credit Facility [Line Items]
Basis spread on variable rate basis (as percent)		3%
Fifth Amended and Restated Credit Agreement \| Letter of credit sublimit
Line of Credit Facility [Line Items]
Letters of credit outstanding	$ 63,600,000	$ 63,600,000
Fifth Amended and Restated Credit Agreement \| Letters of credit collateral
Line of Credit Facility [Line Items]
Credit facility, maximum borrowing capacity	15,000,000	15,000,000
Letters of credit outstanding	$ 14,500,000	$ 14,500,000

Debt - 2024, 2023 and 2022 Fina

Debt - 2024, 2023 and 2022 Financing (Details)		1 Months Ended
Debt - 2024, 2023 and 2022 Financing (Details)	Feb. 09, 2024 USD ($) community renewal_option	Dec. 31, 2023 USD ($) community	Oct. 31, 2022 USD ($) renewal_option community
Interest Rate Swap
Debt Instrument [Line Items]
Derivative liability			$ 6,100,000
Derivative, notional amount			$ 220,000,000
Derivative, fixed interest rate (as percent)			3%
Derivative, term of contract (in months)			18 months
First Mortgage
Debt Instrument [Line Items]
Number of communities securing debt \| community		47	24
Number of debt renewal options \| renewal_option			2
Debt instrument, term of renewal option			1 year
Debt instrument, liquidity maintenance amount			$ 130,000,000
Debt instrument, percentage of debt subject to guaranty			25%
First Mortgage \| Subsequent event
Debt Instrument [Line Items]
Number of communities securing debt \| community	11
Number of debt renewal options \| renewal_option	2
Debt instrument, term of renewal option	1 year
First Mortgage \| Mortgages
Debt Instrument [Line Items]
Debt face amount		$ 179,500,000	$ 220,000,000
Interest rate (as percent)		5.97%
Debt instrument, term of interest (in years)			3 years
First Mortgage \| Mortgages \| Subsequent event
Debt Instrument [Line Items]
Debt face amount	$ 50,000,000
First Mortgage \| Mortgages \| Secured Overnight Financing Rate (SOFR)
Debt Instrument [Line Items]
Basis spread on variable rate basis (as percent)			2.45%
First Mortgage \| Mortgages \| Secured Overnight Financing Rate (SOFR) \| Subsequent event
Debt Instrument [Line Items]
Basis spread on variable rate basis (as percent)	3.50%
Secured Debt \| Mortgages
Debt Instrument [Line Items]
Debt face amount		$ 580,400,000
Mortgage Debt Due 2024
Debt Instrument [Line Items]
Repayment of debt		$ 260,100,000
Mortgage Debt Due 2023
Debt Instrument [Line Items]
Repayment of debt			$ 199,600,000

Leases - Narrative (Details)

Leases - Narrative (Details)	12 Months Ended
Leases - Narrative (Details)	Dec. 31, 2023 lease community
Lessee, Lease, Description [Line Items]
Number of communities leased \| community	277
Number of operating communities leased	263
Number of financing communities leased	14
Operating lease, weighted average remaining lease term (in years)	5 years 8 months 12 days
Finance lease, weighted average remaining lease term (in years)	2 years 3 months 18 days
Operating lease, weighted average discount rate (as percent)	8.40%
Finance lease, weighted average discount rate (as percent)	10.30%
Minimum
Lessee, Lease, Description [Line Items]
Renewal term (in years)	5 years
Maximum
Lessee, Lease, Description [Line Items]
Renewal term (in years)	20 years

Leases - Lease Cost (Details)

Leases - Lease Cost (Details) - USD ($) $ in Thousands	12 Months Ended
Leases - Lease Cost (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Operating Leases
Facility operating expense	$ 7,105	$ 6,329	$ 12,606
Facility lease expense	202,410	165,294	174,358
Operating lease expense	209,515	171,623	186,964
Operating lease expense adjustment	45,739	34,896	23,280
Changes in operating lease assets and liabilities for lessor capital expenditure reimbursements	(9,844)	(13,718)	(30,965)
Operating net cash outflows from operating leases	245,410	192,801	179,279
Financing Leases
Depreciation and amortization	16,444	38,126	37,921
Interest expense: financing lease obligations	21,950	48,061	46,282
Financing lease expense	38,394	86,187	84,203
Operating cash outflows from financing leases	21,950	48,061	46,282
Financing cash outflows from financing leases	8,473	22,221	19,874
Changes in financing lease assets and liabilities for lessor capital expenditure reimbursement	(475)	(11,932)	(11,135)
Total net cash outflows from financing leases	$ 29,948	$ 58,350	$ 55,021

Leases - Maturity (Details)

Leases - Maturity (Details) $ in Thousands	Dec. 31, 2023 USD ($)
Operating Leases
2024	$ 260,694
2025	260,501
2026	145,832
2027	147,660
2028	84,767
Thereafter	251,579
Total lease payments	1,151,033
Purchase option liability and non-cash gain on future sale of property	0
Imputed interest and variable lease payments	(274,526)
Total lease obligations	876,507
Financing Leases
2024	20,266
2025	6,849
2026	6,833
2027	6,082
2028	5,917
Thereafter	20,625
Total lease payments	66,572
Purchase option liability and non-cash gain on future sale of property	145,136
Imputed interest and variable lease payments	(59,859)
Total lease obligations	$ 151,849

Tangible Equity Units - TEU Amo

Tangible Equity Units - TEU Amortizing Notes (Details) $ / shares in Units, $ in Millions	12 Months Ended
	Dec. 31, 2022 USD ($) day component $ / shares shares
Debt Instrument [Line Items]
Number of components \| component	2
Tangible equity units senior amortizing notes due November 2025; interest rate of 10.25% as of both December 31, 2023 and 2022. \| Other notes payable
Debt Instrument [Line Items]
Number of shares issued (in shares)	2,875,000
Interest rate (as percent)	7%
Stated amount, per unit (in dollars per share) \| $ / shares	$ 50
Aggregate offering \| $	$ 143.8
Proceeds from debt, net of issuance costs \| $	$ 139.4
Prepaid stock purchase contracts \| $ / shares	$ 8.8996
Debt instrument, settlement, threshold trading days \| day	20
Debt instrument, interest rate during period	10.25%
Tangible equity units senior amortizing notes due November 2025; interest rate of 10.25% as of both December 31, 2023 and 2022. \| Other notes payable \| Minimum
Debt Instrument [Line Items]
Equity units, required to be delivered to the holder (in shares)	12.9341
Tangible equity units senior amortizing notes due November 2025; interest rate of 10.25% as of both December 31, 2023 and 2022. \| Other notes payable \| Maximum
Debt Instrument [Line Items]
Equity units, required to be delivered to the holder (in shares)	15.1976

Tangible Equity Units - Proceed

Tangible Equity Units - Proceeds From Issuance Allocated To Equity and Debt Component (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Debt Instrument [Line Items]
Less: issuance costs	$ (10,831)	$ (7,077)	$ (3,904)
Total \| Other notes payable
Debt Instrument [Line Items]
Value per unit (in dollars per share)	$ 50
Gross proceeds	$ 143,750
Less: underwriters' discount	(4,312)
Proceeds from issuance of Units	139,438
Less: issuance costs	(1,415)
Net proceeds	$ 138,023
Equity Component \| Other notes payable
Debt Instrument [Line Items]
Value per unit (in dollars per share)	$ 41.10
Gross proceeds	$ 118,164
Less: underwriters' discount	(3,544)
Proceeds from issuance of Units	114,620
Less: issuance costs	(1,163)
Net proceeds	$ 113,457
Debt Component \| Other notes payable
Debt Instrument [Line Items]
Value per unit (in dollars per share)	$ 8.90
Gross proceeds	$ 25,586
Less: underwriters' discount	(768)
Proceeds from issuance of Units	24,818
Less: issuance costs	(252)
Net proceeds	$ 24,566

Tangible Equity Units - Debt In

Tangible Equity Units - Debt Instrument Settlement Prepaid Stock Purchase Contract (Details)	Dec. 31, 2023 day $ / shares shares
Common Stock Issued [Abstract]
Debt instrument, settlement, threshold consecutive trading days \| day	20
Debt instrument, settlement, prepaid stock, minimum settlement rate (in shares) \| shares	12.9341
Debt instrument, settlement, prepaid stock values, divided by applicable market value (in dollars per share)	$ 50
Debt instrument, settlement, prepaid stock, maximum settlement rate (in shares) \| shares	15.1976
Applicable Market Value [Abstract]
Threshold appreciation price (in dollars per share)	$ 3.87
Reference price (in dollars per share)	$ 3.29

Accrued Expenses (Details)

Accrued Expenses (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Accounts Payable and Accrued Liabilities, Current [Abstract]
Employee compensation	$ 104,322	$ 85,610
Insurance reserves	54,834	65,757
Real estate taxes	26,988	26,661
Interest	17,838	17,569
Utilities	8,444	8,533
Income taxes payable	2,071	2,081
Other	28,171	30,937
Total	$ 242,668	$ 237,148

Commitments and Contingencies (

Commitments and Contingencies (Details)	12 Months Ended
Commitments and Contingencies (Details)	Dec. 31, 2023 lawsuit
Commitments and Contingencies Disclosure [Abstract]
Number of lawsuits	2

Self-Insurance (Details)

Self-Insurance (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Self Insurance Reserves [Abstract]
Self insurance reserve	$ 122.6	$ 135.9
Self insurance reserves, noncurrent	67.8	70.2
Accrual receivable	4.3	9.9
Cash deposits for self insured retention risk	8.3	14.5
Letters of credit associated to the secured self-insured retention risk	57.2	62.1
Restricted cash	$ 10.3	$ 6

Stock-Based Compensation - Rest

Stock-Based Compensation - Restricted Stock Units and Stock Awards Activity (Details) - $ / shares shares in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Number of Restricted Stock Units and Stock Awards
Beginning balance (in shares)	5,373	5,011	8,505
Granted (in shares)	3,992	2,921	1,998
Vested (in shares)	(2,001)	(2,039)	(2,641)
Cancelled/forfeited (in shares)	(961)	(520)	(2,851)
Ending balance (in shares)	6,403	5,373	5,011
Weighted Average Grant Date Fair Value
Beginning balance (in dollars per share)	$ 6	$ 6.80	$ 7.68
Granted (in dollars per share)	2.98	5.58	5.12
Vested (in dollars per share)	5.87	7.15	8.40
Cancelled/forfeited (in dollars per share)	5.90	6.88	6.77
Ending balance (in dollars per share)	$ 4.17	$ 6	$ 6.80

Stock-Based Compensation - Narr

Stock-Based Compensation - Narrative (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation cost related to nonvested share-based compensation arrangements granted	$ 15.8
Period over which cost is expected to be recognized (in years)	2 years 3 months 18 days
Unvested restricted shares (in shares)	6,403,000	5,373,000	5,011,000	8,505,000
Restricted stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unvested restricted shares (in shares)	0	422,542

Stock-Based Compensation - Re_2

Stock-Based Compensation - Restricted Stock Units and Stock Awards Grants (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended				12 Months Ended
	Dec. 31, 2023	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Granted (in shares)					3,992	2,921	1,998
Restricted stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Granted (in shares)	7	16	10	3,959
Shares granted (in dollars per share)	$ 4.14	$ 4.01	$ 2.95	$ 2.97
Total value of restricted shares granted	$ 29	$ 65	$ 29	$ 11,778

Earnings Per Share - Narrative

Earnings Per Share - Narrative (Details) - $ / shares shares in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Jul. 26, 2020
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Weighted average shares outstanding - basic (in shares)	225,209	190,463	184,975
Ventas, Inc \| The Warrant
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Number of shares authorized to be purchased				16,300
Common stock, par value (in dollars per share)				$ 0.01
Share price (in usd per share)				$ 3
Convertible Senior Notes Due 2026
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Number of shares issuable upon conversion (in shares)	38,300
Incremental shares issuable under purchase contracts
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Number of shares issuable upon conversion (in shares)	43,700
Weighted average shares outstanding - basic (in shares)	37,200	37,200

Earnings Per Share - Earnings P

Earnings Per Share - Earnings Per Share, Basic and Diluted (Details) - shares shares in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Earnings Per Share [Abstract]
Weighted average common shares outstanding (in shares)	188,023	186,574	184,975
Weighted average minimum shares issuable under purchase contracts (in shares)	37,186	3,889	0
Weighted average shares outstanding - basic (in shares)	225,209	190,463	184,975

Earnings Per Share - Potentiall

Earnings Per Share - Potentially Dilutive Securities (Details) - shares shares in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities (in shares)	67.5	66.5	59.6
Convertible senior notes
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities (in shares)	38.3	38.3	38.3
Warrants
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities (in shares)	16.3	16.3	16.3
Restricted stock and restricted stock units
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities (in shares)	6.4	5.4	5
Incremental shares issuable under purchase contracts
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities (in shares)	6.5	6.5	0

Share Repurchase Program (Detai

Share Repurchase Program (Details) - USD ($)	12 Months Ended
Share Repurchase Program (Details) - USD ($)	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2016
Equity, Class of Treasury Stock [Line Items]
Total number of shares repurchased (in shares)	0	0	0
Amount available under the share repurchase program	$ 44,000,000
2016 Repurchase Program
Equity, Class of Treasury Stock [Line Items]
Authorized share repurchased program amount				$ 100,000,000

Retirement Plans (Details)

Retirement Plans (Details) - USD ($) $ in Millions	12 Months Ended
Retirement Plans (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Retirement Benefits [Abstract]
Matching contribution (as percent)	25%
Maximum contributed compensation (as percent)	4%
Additional matching contribution (as percent)	12.50%
Expense related to retirement savings plan	$ 4.8	$ 4.1	$ 4.6

Income Taxes - Income Tax Expen

Income Taxes - Income Tax Expense (Benefit) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Federal:
Current	$ (183)	$ (17)	$ 161
Deferred	(7,590)	1,325	9,837
Total federal	(7,773)	1,308	9,998
State:
Current	(1,011)	251	(1,835)
Deferred (included in federal above)	0	0	0
Total state	(1,011)	251	(1,835)
Total	$ (8,784)	$ 1,559	$ 8,163

Income Taxes - Reconciliation o

Income Taxes - Reconciliation of Income Tax Expense (Benefit) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Statutory income tax rate	21%	21%	21%
Tax benefit (provision) at U.S. statutory rate	$ 37,848	$ 50,397	$ 22,565
State taxes, net of federal income tax	5,766	10,811	7,673
Valuation allowance	(49,109)	(57,080)	13,027
Goodwill derecognition	0	0	(31,829)
Stock compensation	(1,312)	(181)	(1,856)
Other	(1,977)	(2,388)	(1,417)
Total	$ (8,784)	$ 1,559	$ 8,163

Income Taxes - Deferred Tax Ass

Income Taxes - Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Deferred income tax assets:
Operating loss carryforwards	$ 392,577	$ 361,160
Operating lease obligations	220,003	199,226
Tax credits	50,415	50,415
Accrued expenses	46,814	42,828
Intangible assets	26,816	39,360
Financing lease obligations	0	12,749
Capital loss carryforward	2,102	2,140
Other	3,268	3,091
Total gross deferred income tax asset	741,995	710,969
Valuation allowance	(474,152)	(425,043)
Net deferred income tax assets	267,843	285,926
Deferred income tax liabilities:
Operating lease right-of-use assets	(168,398)	(149,881)
Property, plant and equipment	(92,580)	(122,377)
Investment in unconsolidated ventures	0	(12,064)
Financing lease obligations	(10,273)	0
Other	(2,579)	0
Total gross deferred income tax liability	(273,830)	(284,322)
Net deferred tax asset (liability)	(5,987)
Net deferred tax asset (liability)		1,604
Deferred Tax Valuation Allowance
Valuation and qualifying accounts [Roll forward]
Balance at beginning of period	425,043	367,963	$ 380,990
Charged to deferred income tax (benefit) provision	49,109	57,080	(13,027)
Balance at end of period	$ 474,152	$ 425,043	$ 367,963

Income Taxes - Narrative (Detai

Income Taxes - Narrative (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Operating Loss Carryforwards [Line Items]
Valuation allowance	$ (474,152)	$ (425,043)
Gross unrecognized tax benefits	18,200	18,100
Penalties and interest accrued	200	100
Federal
Operating Loss Carryforwards [Line Items]
Net operating loss carryforwards	790,800	802,200
Operating loss carryforwards, indefinite lived	799,300	659,700
State \| Capital loss carryforward
Operating Loss Carryforwards [Line Items]
Net operating loss carryforwards	2,100	2,100
Federal and state
Operating Loss Carryforwards [Line Items]
Net operating loss carryforwards valuation allowance	421,600	372,500
Tax credit valuation allowance	50,400	50,400
Federal and state \| Capital loss carryforward
Operating Loss Carryforwards [Line Items]
Tax credit valuation allowance	$ 2,100	$ 2,100

Income Taxes - Unrecognized Tax

Income Taxes - Unrecognized Tax Benefits (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Unrecognized tax benefits [Roll Forward]
Balance at beginning of period	$ 18,088	$ 18,089
Additions for tax positions related to prior years	173	0
Reductions for tax positions related to prior years	(56)	(1)
Balance at end of period	$ 18,205	$ 18,088

Supplemental Disclosure of Ca_3

Supplemental Disclosure of Cash Flow Information - Supplemental Disclosure of Cash Flow Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Supplemental Disclosure of Cash Flow Information:
Interest paid	$ 231,786	$ 200,308	$ 188,791
Income taxes paid, net of (refunds)	(1,429)	(330)	5,923
Capital expenditures, net of related payables	233,205	196,924	176,657
Prepaid expenses and other assets, net	21,629	(21,240)	(15,483)
Investment in unconsolidated ventures	(7,589)	(218)	(5,436)
Other non-operating loss (income)	(21,687)	(12,114)	(5,903)
Accounts receivable, net	7,380	(4,624)	502
Refundable fees and deferred revenue	(654)	(1,934)	(10,066)
Loss (gain) on sale of communities, net	(36,296)	(73,850)	0
Capital expenditures, net of related payables:
Supplemental Disclosure of Cash Flow Information:
Capital expenditures, net of related payables	233,205	196,924	176,657
Trade accounts payable	4,613	(3,085)	(6,061)
Acquisition of assets, net of cash acquired:
Supplemental Disclosure of Cash Flow Information:
Prepaid expenses and other assets, net	23	0	0
Property, plant and equipment and leasehold intangibles, net	6,872	4	0
Investment in unconsolidated ventures	(3,395)	0	0
Financing lease obligations	0	6,000	0
Other liabilities	(384)	0	0
Other non-operating loss (income)	(2,542)	0	0
Net cash paid	574	6,004	0
Proceeds from HCS Sale, net:
Supplemental Disclosure of Cash Flow Information:
Trade accounts payable	0	0	1,387
Prepaid expenses and other assets, net	0	0	(32,963)
Property, plant and equipment and leasehold intangibles, net	0	0	(1,806)
Other liabilities	0	0	9,165
Operating lease right-of-use assets	0	0	(8,145)
Accounts receivable, net	0	0	(57,582)
Investment in unconsolidated ventures	0	0	100,000
Goodwill	0	0	(126,810)
Accrued expenses	0	0	25,226
Refundable fees and deferred revenue	0	0	57,314
Operating lease obligations	0	0	8,145
Non-operating loss (gain) on sale of assets, net	0	0	(286,489)
Net cash received	0	0	(312,558)
Proceeds from sale of other assets, net:
Supplemental Disclosure of Cash Flow Information:
Prepaid expenses and other assets, net	(1,889)	(1,308)	(1,983)
Property, plant and equipment and leasehold intangibles, net	(36,545)	(107)	(878)
Investment in unconsolidated ventures	(27,392)	0	0
Other liabilities	10,690	1,025	(75)
Refundable fees and deferred revenue	9,347	0	0
Non-operating loss (gain) on sale of assets, net	(1,441)	(595)	(2,346)
Loss (gain) on sale of communities, net	(36,296)	0	0
Assets held for sale	0	(3,668)	(16,166)
Net cash received	(83,526)	(4,653)	(21,448)
Non-Development \| Capital expenditures, net of related payables:
Supplemental Disclosure of Cash Flow Information:
Capital expenditures, net of related payables	216,511	168,166	137,410
Development \| Capital expenditures, net of related payables:
Supplemental Disclosure of Cash Flow Information:
Capital expenditures, net of related payables	1,762	6,193	3,208
Non-development - Reimbursable \| Capital expenditures, net of related payables:
Supplemental Disclosure of Cash Flow Information:
Capital expenditures, net of related payables	$ 10,319	$ 25,650	$ 42,100

Supplemental Disclosure of Ca_4

Supplemental Disclosure of Cash Flow Information - Supplemental Schedule of Non-Cash Operating, Investing and Financing Activities (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Acquisition of assets, net of related payables [Line Items]
Loss (gain) on sale of communities, net	$ (36,296)	$ (73,850)	$ 0
Gain on sale for master lease amendment
Acquisition of assets, net of related payables [Line Items]
Property, plant and equipment and leasehold intangibles, net	0	(220,477)	0
Operating lease right-of-use assets	0	91,641	0
Financing lease obligations	0	294,327	0
Operating lease obligations	0	(91,641)	0
Loss (gain) on sale of communities, net	0	(73,850)	0
Net	0	0	0
Lease termination and modification, net
Acquisition of assets, net of related payables [Line Items]
Property, plant and equipment and leasehold intangibles, net	(51,518)	11,098	4,056
Operating lease right-of-use assets	223,309	11,419	17,197
Financing lease obligations	88,820	(6,338)	(4,056)
Operating lease obligations	(260,611)	(16,179)	(17,197)
Net	$ 0	$ 0	$ 0

Supplemental Disclosure of Ca_5

Supplemental Disclosure of Cash Flow Information - Cash and Restricted Cash (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Restricted Cash and Cash Equivalents Items [Line Items]
Restricted cash	$ 41,341	$ 27,735
Long-term restricted cash	30,356	47,963
Cash and escrow deposits - restricted, total	71,697	75,698
Reconciliation of cash, cash equivalents, and restricted cash:
Cash and cash equivalents	277,971	398,850
Restricted cash	41,341	27,735
Long-term restricted cash	30,356	47,963
Total cash, cash equivalents, and restricted cash	349,668	474,548	$ 438,314	$ 465,148
Interest rate cap escrows
Restricted Cash and Cash Equivalents Items [Line Items]
Restricted cash	17,843	3,797
Reconciliation of cash, cash equivalents, and restricted cash:
Restricted cash	17,843	3,797
Real estate tax and property insurance escrows
Restricted Cash and Cash Equivalents Items [Line Items]
Restricted cash	16,061	15,722
Reconciliation of cash, cash equivalents, and restricted cash:
Restricted cash	16,061	15,722
Replacement reserve escrows
Restricted Cash and Cash Equivalents Items [Line Items]
Restricted cash	7,194	7,999
Reconciliation of cash, cash equivalents, and restricted cash:
Restricted cash	7,194	7,999
Other
Restricted Cash and Cash Equivalents Items [Line Items]
Restricted cash	243	217
Reconciliation of cash, cash equivalents, and restricted cash:
Restricted cash	243	217
Insurance deposits
Restricted Cash and Cash Equivalents Items [Line Items]
Long-term restricted cash	15,961	18,230
Reconciliation of cash, cash equivalents, and restricted cash:
Long-term restricted cash	15,961	18,230
CCRCs escrows
Restricted Cash and Cash Equivalents Items [Line Items]
Long-term restricted cash	10,813	15,847
Reconciliation of cash, cash equivalents, and restricted cash:
Long-term restricted cash	10,813	15,847
Debt service reserve
Restricted Cash and Cash Equivalents Items [Line Items]
Long-term restricted cash	3,472	13,779
Reconciliation of cash, cash equivalents, and restricted cash:
Long-term restricted cash	3,472	13,779
Letters of credit collateral
Restricted Cash and Cash Equivalents Items [Line Items]
Long-term restricted cash	110	107
Reconciliation of cash, cash equivalents, and restricted cash:
Long-term restricted cash	$ 110	$ 107

COVID-19 Pandemic (Details)

COVID-19 Pandemic (Details) - USD ($)		1 Months Ended			12 Months Ended
COVID-19 Pandemic (Details) - USD ($)	Jul. 01, 2021	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Unusual or Infrequent Item, or Both [Line Items]
Revenue from government grants					$ 9,100,000	$ 10,000,000	$ 1,700,000
Health Care Services \| HCA Healthcare, Inc.
Unusual or Infrequent Item, or Both [Line Items]
Percentage of ownership sold in transaction	80%	20%
Medicare advance payments	$ 63,600,000
Employer portion of payroll taxes delayed	$ 9,600,000
CARES Act
Unusual or Infrequent Item, or Both [Line Items]
Proceeds from recoupment of accelerated/advanced payments						3,100,000	20,800,000
Employer portion of payroll taxes delayed		$ 0			0			$ 72,700,000
Payment of payroll taxes			$ 31,600,000	$ 31,600,000
Employee Retention Credit, Amount Recognized					0	9,400,000	9,900,000
Employee retention credit, amount received					14,700,000	4,600,000
CARES Act \| Prepaid Expenses and Other Current Assets
Unusual or Infrequent Item, or Both [Line Items]
Employee retention credit, amount received						14,700,000
CARES Act \| Accelerated and Advance Payment Program
Unusual or Infrequent Item, or Both [Line Items]
Amount received from Accelerated and Advance Payment Program					$ 0			87,500,000
CARES Act \| Health Care Services \| Accelerated and Advance Payment Program
Unusual or Infrequent Item, or Both [Line Items]
Amount received from Accelerated and Advance Payment Program								75,200,000
CARES Act \| CCRC Venture \| Accelerated and Advance Payment Program
Unusual or Infrequent Item, or Both [Line Items]
Amount received from Accelerated and Advance Payment Program								$ 12,300,000
Loans Insured or Guaranteed by US Government Authorities \| CARES Act
Unusual or Infrequent Item, or Both [Line Items]
Relief received from Provider Relief Fund						$ 61,100,000	$ 800,000

Segment Information (Details)

Segment Information (Details) $ in Thousands		12 Months Ended
Segment Information (Details) $ in Thousands	Jul. 01, 2021	Dec. 31, 2023 USD ($) segment	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)
Segment Reporting Information [Line Items]
Number of reportable segments \| segment		3
Revenue		$ 3,015,829	$ 2,825,379	$ 2,758,259
Segment operating income		746,704	594,413	500,951
General and administrative expense (including non-cash stock-based compensation expense)		178,894	168,594	184,916
Facility operating lease expense		202,410	165,294	174,358
Depreciation and amortization		342,712	347,444	337,613
Asset impairment		40,572	29,618	23,003
Loss (gain) on sale of communities, net		(36,296)	(73,850)	0
Loss (gain) on facility operating lease termination, net		0	0	(2,003)
Income (loss) from operations		18,412	(42,687)	(216,936)
Total interest expense		238,274	204,717	195,140
Total capital expenditures for property, plant and equipment, and leasehold intangibles		228,592	200,009	182,718
Assets		5,573,435	5,937,062
Equity in earnings (loss) of unconsolidated ventures		(3,996)	(10,782)	10,394
Goodwill		27,321	27,321
CARES Act
Segment Reporting Information [Line Items]
Cash made available for Provider Relief Fund		9,073	80,469	12,368
Independent Living
Segment Reporting Information [Line Items]
Goodwill		27,300	27,300	27,300
Health Care Services \| HCA Healthcare, Inc.
Segment Reporting Information [Line Items]
Percentage of ownership after transaction	20%
Operating segments \| Independent Living
Segment Reporting Information [Line Items]
Revenue		564,499	518,699	477,050
Segment operating income		184,645	158,950	146,108
Facility operating lease expense		39,114	39,700	42,162
Depreciation and amortization		83,637	79,521	74,922
Asset impairment		1,647	10,893	3,483
Total interest expense		61,624	48,788	45,209
Total capital expenditures for property, plant and equipment, and leasehold intangibles		51,188	44,857	36,992
Assets		1,206,021	1,267,825
Operating segments \| Independent Living \| CARES Act
Segment Reporting Information [Line Items]
Cash made available for Provider Relief Fund		487	10,906	1,512
Operating segments \| Assisted Living and Memory Care
Segment Reporting Information [Line Items]
Revenue		1,968,440	1,815,722	1,595,684
Segment operating income		502,317	379,958	294,320
Facility operating lease expense		146,166	106,961	111,117
Depreciation and amortization		196,994	207,344	200,677
Asset impairment		11,574	11,613	14,384
Total interest expense		141,330	133,139	121,785
Total capital expenditures for property, plant and equipment, and leasehold intangibles		121,240	111,978	105,177
Assets		3,315,921	3,329,516
Operating segments \| Assisted Living and Memory Care \| CARES Act
Segment Reporting Information [Line Items]
Cash made available for Provider Relief Fund		8,008	60,630	5,963
Operating segments \| CCRCs
Segment Reporting Information [Line Items]
Revenue		333,404	331,577	306,213
Segment operating income		49,581	43,485	34,109
Facility operating lease expense		12,943	13,883	15,932
Depreciation and amortization		36,951	38,039	37,891
Asset impairment		1,368	5,970	4,790
Total interest expense		24,889	21,251	18,756
Total capital expenditures for property, plant and equipment, and leasehold intangibles		37,414	20,467	19,086
Assets		612,521	664,502
Operating segments \| CCRCs \| CARES Act
Segment Reporting Information [Line Items]
Cash made available for Provider Relief Fund		578	8,933	1,788
Operating segments \| Corporate and All Other
Segment Reporting Information [Line Items]
Revenue		149,486	159,381	202,043
Segment operating income		10,161	12,020	20,598
Facility operating lease expense		4,187	4,750	5,147
Depreciation and amortization		25,130	22,540	23,783
Asset impairment		25,983	1,142	346
Total interest expense		10,431	1,539	9,390
Total capital expenditures for property, plant and equipment, and leasehold intangibles		18,750	22,707	21,463
Assets		438,972	675,219
Equity in earnings (loss) of unconsolidated ventures		$ 900	$ 4,200	17,200
Operating segments \| Health Care Services
Segment Reporting Information [Line Items]
Revenue				177,269
Segment operating income				5,816
Depreciation and amortization				340
Operating segments \| Health Care Services \| CARES Act
Segment Reporting Information [Line Items]
Cash made available for Provider Relief Fund				$ 3,105