National Health Investors (NHI) 10-Q6 May 242024 Q1 Quarterly reportFinancial data

Company Profile

Cover

Cover - shares	3 Months Ended
Cover - shares	Mar. 31, 2024	May 01, 2024
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Mar. 31, 2024
Document Transition Report	false
Entity File Number	001-10822
Entity Registrant Name	National Health Investors, Inc.
Entity Incorporation, State or Country Code	MD
Entity Tax Identification Number	62-1470956
Entity Address, Address Line One	222 Robert Rose Drive
Entity Address, City or Town	Murfreesboro
Entity Address, State or Province	TN
Entity Address, Postal Zip Code	37129
City Area Code	(615)
Local Phone Number	890-9100
Title of 12(b) Security	Common Stock, $0.01 par value
Trading Symbol	NHI
Security Exchange Name	NYSE
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
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		43,424,841
Amendment Flag	false
Document Fiscal Year Focus	2024
Document Fiscal Period Focus	Q1
Entity Central Index Key	0000877860
Current Fiscal Year End Date	--12-31

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands		Mar. 31, 2024	Dec. 31, 2023
Real estate properties:
Land		$ 180,749	$ 180,749
Buildings and improvements		2,596,232	2,593,696
Construction in progress		6,389	5,913
Real estate properties, gross		2,783,370	2,780,358
Less accumulated depreciation		(690,790)	(673,276)
Real estate properties, net		2,092,580	2,107,082
Mortgage and other notes receivable, net of reserve of $15,475 and $15,476, respectively		258,874	245,271
Cash and cash equivalents		11,357	22,347
Straight-line rent receivable		84,257	84,713
Assets held for sale, net		5,004	5,004
Other assets, net		26,053	24,063
Total Assets	[1]	2,478,125	2,488,480
Liabilities and Stockholders’ Equity:
Debt		1,139,266	1,135,051
Accounts payable and accrued expenses		26,782	34,304
Dividends payable		39,082	39,069
Deferred income		5,429	6,009
Total Liabilities	[1]	1,210,559	1,214,433
Commitments and contingencies
Redeemable noncontrolling interest		9,425	9,656
National Health Investors, Inc. Stockholders’ Equity:
Common stock		434	434
Capital in excess of par value		1,605,912	1,603,757
Retained earnings		2,497,791	2,466,844
Cumulative dividends		(2,856,165)	(2,817,083)
Total National Health Investors, Inc. Stockholders’ Equity		1,247,972	1,253,952
Noncontrolling interests		10,169	10,439
Total Equity		1,258,141	1,264,391
Total Liabilities and Equity		$ 2,478,125	$ 2,488,480

[1] The consolidated balance sheets include the following amounts related to our consolidated Variable Interest Entities (VIEs): $510.1 million and $513.2 million of Real estate properties, net; $5.4 million and $10.9 million of Cash and cash equivalents;$9.7 million and $9.7 million of Straight-line rent receivable; $9.8 million and $9.4 million of Other assets, net; and $2.6 million and $4.7 million of Accounts payable and accrued expenses, in each case as of March 31, 2024 and December 31, 2023, respectively.

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Statement of Financial Position [Abstract]
Mortgage and other notes receivable, net of reserve	$ 15,475	$ 15,476
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, shares authorized (in shares)	100,000,000	100,000,000
Common stock, shares issued (in shares)	43,424,841	43,424,841
Common stock, shares outstanding (in shares)	43,409,841	43,409,841
Real estate properties, net	$ 2,092,580	$ 2,107,082
Cash and cash equivalents	11,357	22,347
Straight-line rent receivable	84,257	84,713
Other assets, net	26,053	24,063
Accounts payable and accrued expenses	$ (26,782)	$ (34,304)
Common stock, shares outstanding (in shares)	43,409,841	43,409,841
Common stock, shares issued (in shares)	43,424,841	43,424,841
Variable Interest Entity, Primary Beneficiary
Real estate properties, net	$ 510,100	$ 513,200
Cash and cash equivalents	5,400	10,900
Straight-line rent receivable	9,700	9,700
Other assets, net	9,800	9,400
Accounts payable and accrued expenses	$ (2,600)	$ (4,700)

Condensed Consolidated Statemen

Condensed Consolidated Statements Of Income - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Revenues:
Rental income	$ 62,187	$ 65,299
Resident fees and services	13,256	11,700
Interest income and other	6,070	5,389
Total revenues	81,513	82,388
Expenses:
Depreciation	17,505	17,617
Interest	14,869	14,027
Senior housing operating expenses	10,314	9,799
Legal	236	122
Franchise, excise and other taxes	(187)	183
General and administrative	5,642	5,653
Taxes and insurance on leased properties	2,733	2,619
Loan and realty losses (gains)	10	(418)
Total operating expenses	51,122	49,602
Gains on sales of real estate, net	100	1,397
Gains from equity method investment	166	0
Net income	30,657	34,183
Add: net loss attributable to noncontrolling interests	290	301
Net income attributable to stockholders	30,947	34,484
Less: net income attributable to unvested restricted stock awards	(32)	0
Net income attributable to common stockholders - basic	$ 30,915	$ 34,484
Weighted average common shares outstanding:
Basic (in shares)	43,388,841	43,388,742
Diluted (in shares)	43,424,550	43,391,429
Earnings per common share - basic (in dollars per share)	$ 0.71	$ 0.79
Earnings per common share - diluted (in dollars per share)	$ 0.71	$ 0.79

Condensed Consolidated Statem_2

Condensed Consolidated Statements Of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Cash flows from operating activities:
Net income	$ 30,657	$ 34,183
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation	17,505	17,617
Amortization of debt issuance costs, debt discounts and prepaids	1,440	1,048
Amortization of commitment fees and note receivable discounts	(94)	(148)
Amortization of lease incentives	723	299
Straight-line rent adjustments	308	(2,097)
Non-cash rental income	0	(2,500)
Non-cash interest income on mortgage and other notes receivable	(25)	(376)
Gains on sales of real estate, net	(100)	(1,397)
Gains from equity method investment	(166)	0
Loan and realty losses (gains)	10	(418)
Payment of lease incentive	0	(10,000)
Non-cash share-based compensation	2,155	2,105
Changes in operating assets and liabilities:
Other assets, net	(3,631)	(3,772)
Accounts payable and accrued expenses	(7,523)	(3,277)
Deferred income	(432)	(219)
Net cash provided by operating activities	40,827	31,048
Cash flows from investing activities:
Investments in mortgage and other notes receivable	(16,004)	(7,219)
Collections of mortgage and other notes receivable	2,621	7,211
Acquisitions of real estate	0	(38,081)
Proceeds from sales of real estate	0	10,201
Investments in renovations of existing real estate	(2,293)	(1,147)
Investments in equipment	(683)	(986)
Distributions from equity method investment	166	2,500
Net cash used in investing activities	(16,193)	(27,521)
Cash flows from financing activities:
Proceeds from revolving credit facility	59,000	192,000
Payments on revolving credit facility	(55,500)	(19,000)
Payments on term loans	(105)	(145,103)
Distributions to noncontrolling interests	(248)	(363)
Dividends paid to stockholders	(39,069)	(39,050)
Proceeds from noncontrolling interest	0	2,000
Net cash used in financing activities	(35,922)	(9,516)
Decrease in cash and cash equivalents and restricted cash	(11,288)	(5,989)
Cash and cash equivalents and restricted cash, beginning of period	24,617	21,516
Cash and cash equivalents and restricted cash, end of period	13,329	15,527
Supplemental disclosure of cash flow information:
Interest paid, net of amounts capitalized	16,949	15,878
Supplemental disclosure of non-cash investing and financing activities:
Real estate acquired in exchange for mortgage note receivable	0	14,200
Change in accounts payable related to renovations of existing real estate	36	20
Change in accounts payable related to distributions to noncontrolling interests	37	90
Reclassification of prepaid equity issuance costs to capital in excess of par value	$ 0	$ 275

Condensed Consolidated Statem_3

Condensed Consolidated Statement Of Equity - USD ($) $ in Thousands	Total	Total National Health Investors, Inc. Stockholders’ Equity	Common Stock	Capital in Excess of Par Value	Retained Earnings	Cumulative Dividends	Noncontrolling Interests
Beginning balance (in shares) at Dec. 31, 2022			43,388,742
Beginning balance at Dec. 31, 2022	$ 1,280,081	$ 1,270,225	$ 434	$ 1,599,427	$ 2,331,190	$ (2,660,826)	$ 9,856
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Noncontrolling interest capital contribution	2,000						2,000
Distributions declared to noncontrolling interests	(273)						(273)
Net income, excluding loss attributable to redeemable noncontrolling interest	34,488	34,484			34,484		4
Equity issuance cost	(275)	(275)		(275)
Share-based compensation	2,105	2,105		2,105
Dividends declared, $0.90 per common share	(39,050)	(39,050)				(39,050)
Ending balance (in shares) at Mar. 31, 2023			43,388,742
Ending balance at Mar. 31, 2023	$ 1,279,076	1,267,489	$ 434	1,601,257	2,365,674	(2,699,876)	11,587
Beginning balance (in shares) at Dec. 31, 2023	43,409,841		43,409,841
Beginning balance at Dec. 31, 2023	$ 1,264,391	1,253,952	$ 434	1,603,757	2,466,844	(2,817,083)	10,439
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Distributions declared to noncontrolling interests	(205)						(205)
Net income, excluding loss attributable to redeemable noncontrolling interest	30,882	30,947			30,947		(65)
Grants of restricted stock (in shares)			15,000
Share-based compensation	2,155	2,155		2,155
Dividends declared, $0.90 per common share	$ (39,082)	(39,082)				(39,082)
Ending balance (in shares) at Mar. 31, 2024	43,409,841		43,424,841
Ending balance at Mar. 31, 2024	$ 1,258,141	$ 1,247,972	$ 434	$ 1,605,912	$ 2,497,791	$ (2,856,165)	$ 10,169

Condensed Consolidated Statem_4

Condensed Consolidated Statement Of Equity (Parenthetical) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Statement of Stockholders' Equity [Abstract]
Distributions	$ 6
Net loss attributable to redeemable noncontrolling interest	$ 225	$ 305
Dividends to common stockholders (in dollars per share)	$ 0.90	$ 0.90

Organization and Nature of Busi

Organization and Nature of Business	3 Months Ended
Organization and Nature of Business	Mar. 31, 2024
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Organization and Nature of Business	Organization and Nature of Business National Health Investors, Inc. (“NHI,” the “Company,” “we,” “us,” or “our”), established in 1991 as a Maryland corporation, is a self-managed real estate investment trust (“REIT”) specializing in sale-leaseback, joint venture and mortgage and mezzanine financing of need-driven and discretionary senior housing and medical facility investments. We operate through two reportable segments: Real Estate Investments and Senior Housing Operating Portfolio (“SHOP”). Our Real Estate Investments segment consists of real estate investments and leases, and mortgage and other notes receivables in independent living facilities (“ILF”), assisted living facilities (“ALF”), entrance-fee communities (“EFC”), senior living campuses (“SLC”), skilled nursing facilities (“SNF”) and a hospital (“HOSP”). As of March 31, 2024, we had gross investments of approximately $2.4 billion in 163 healthcare real estate properties located in 31 states and leased pursuant primarily to triple-net leases to 25 tenants consisting of 97 senior housing communities, 65 SNFs and one HOSP, excluding one property classified as an asset held for sale. Our portfolio of nine mortgages alon g with other notes receivable totaled $274.3 million, excluding an allowance for expected credit losses of $15.5 million, as of March 31, 2024. Our SHOP segment is comprised of two ventures that own the operations of ILFs. For this segment, as of March 31, 2024, we had gross investments of approximately $348.7 million in 15 ILFs located in eight states with a combined 1,732 units that are operated on behalf of the Company by independent managers pursuant to the terms of separate management agreements. The third-party managers, or related parties of the managers, own equity interests in the respective ventures. Units, beds and property count disclosures in these footnotes to the condensed consolidated financial statements are outside the scope of our independent registered accounting firm’s review.

Basis of Presentation and Signi

Basis of Presentation and Significant Accounting Policies	3 Months Ended
Basis of Presentation and Significant Accounting Policies	Mar. 31, 2024
Accounting Policies [Abstract]
Basis of Presentation and Significant Accounting Policies	Basis of Presentation and Significant Accounting Policies Basis of Presentation The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with United States generally accepted accounting principles (“GAAP”) for interim financial statements. In our opinion, the accompanying unaudited condensed consolidated financial statements reflect all adjustments consisting of normal recurring adjustments necessary for a fair presentation. Interim results of operations are not necessarily indicative of the results that may be achieved for a full year. The condensed consolidated financial statements and related notes do not include all information and footnotes required by GAAP for annual reports. These interim condensed consolidated financial statements should be read in conjunction with our audited consolidated financial statements and notes thereto as of and for the year ended December 31, 2023, included in our Annual Report on Form 10-K for the year ended December 31, 2023 filed with the Securities and Exchange Commission (the “SEC”). Principles of Consolidation The condensed consolidated financial statements include the accounts of the Company, and its wholly owned subsidiaries, joint ventures and subsidiaries in which we have a controlling interest. We also consolidate certain entities when control of such entities can be achieved through means other than voting rights (“variable interest entities” or “VIEs”) if the Company is deemed to be the primary beneficiary of such entities. All material intercompany transactions and balances are eliminated in consolidation. Our consolidated total assets and liabilities include two consolidated ventures comprising our SHOP activities, each formed with a separate partner - Merrill Gardens, L.L.C. (“Merrill”) and DSHI NHI Holiday LLC (the “Discovery member”), a related party of Discovery Senior Living (“Discovery”). We consider both ventures to be VIEs as the members of each, as a group, lack the characteristics of a controlling financial interest. We are deemed to be the primary beneficiary of each VIE because we have the ability to control the activities that most significantly impact each VIE’s economic performance. Reference Notes 5 and 16 for further discussion of our SHOP ventures. We also consolidate two real estate partner ships formed with our partners, Discovery Senior Housing Investor XXIV, LLC, a related party of Discovery and LCS Timber Ridge LLC (“LCS”) to invest in senior housing facilities. We consider both partnerships to be VIEs, as either the members, as a group, lack the characteristics of a controlling financial interest or the total equity at risk is insufficient to finance activities without additional subordinated financial support. NHI directs the activities that most significantly impact economic performance of these partnerships, subject to limited protective rights extended to our partners for specified business decisions. Because of our control of these partnerships, we include their assets, liabilities, noncontrolling interests and operations in our condensed consolidated financial statements. Reference Note 16 for further discussion of these real estate partnerships. We use the equity method of accounting when we own an interest in an entity over which we can exert significant influence but cannot control the entity’s operations. We discontinue equity method accounting if our investment in an entity (and net advances) is reduced to zero unless we have guaranteed obligations of the entity or are otherwise committed to provide further financial support for the entity. Reference Note 6 for further discussion of our equity method investment. We have concluded that the Company is not the primary beneficiary for certain investments where we lack either directly or through related parties the power to direct the activities that most significantly impact their economic performance. See Note 16 for information on unconsolidated VIEs. Noncontrolling Interests Contingently redeemable noncontrolling interests are recorded at their initial carrying amounts upon issuance and are subsequently adjusted to reflect their share of gains or losses and distributions attributable to the noncontrolling interests. In periods where they are or will become probable of redemption, an adjustment to the redemption value of the noncontrolling interests is also recognized through “ Capital in excess of par value ” on the Company’s Condensed Consolidated Balance Sheets and included in our computation of earnings per share. As of March 31, 2024, the Merrill SHOP venture noncontrolling interest was classified in mezzanine equity, as discussed further in Note 10. The noncontrolling interests associated with our two consolidated real estate partnerships and our Discovery member SHOP venture were classified in equity as of March 31, 2024. Cash and Cash Equivalents and Restricted Cash Cash equivalents consist of all highly liquid investments with original maturities of three months or less. Restricted cash includes amounts required to be held on deposit or subject to an agreement ( e.g ., with a qualified intermediary subject to an exchange agreement pursuant to Section 1031 of the Internal Revenue Code of 1986, as amended (the “Internal Revenue Code”) or in accordance with agency agreements governing our mortgages). The following table sets forth our “ Cash and cash equivalents and restricted cash ” reported within the Company’s Condensed Consolidated Statements of Cash Flows ( $ in thousands ): March 31, 2024 March 31, 2023 Beginning of period: Cash and cash equivalents $ 22,347 $ 19,291 Restricted cash (included in Other assets, net) 2,270 2,225 Cash, cash equivalents, and restricted cash $ 24,617 $ 21,516 End of period: Cash and cash equivalents $ 11,357 $ 13,875 Restricted cash (included in Other assets, net) 1,972 1,652 Cash, cash equivalents, and restricted cash $ 13,329 $ 15,527 Concentration of Credit Risks Our credit risks primarily relate to cash and cash equivalents and investments in mortgage and other notes receivable. Cash and cash equivalents are primarily held in bank accounts and overnight investments. We maintain our bank deposit accounts with large financial institutions in amounts that may exceed federally insured limits. We have not experienced any losses in such accounts. Our mortgage and other notes receivable consist primarily of secured loans on facilities. Our financial instruments, principally our investments in notes receivable, are subject to the possibility of loss of the carrying values as a result of the failure of other parties to perform according to their contractual obligations which may make the instruments less valuable. We obtain collateral in the form of mortgage liens and other protective rights for notes receivable and continually monitor these rights in order to reduce such possibilities of loss. We evaluate the need to provide for reserves for potential losses on our financial instruments based on management’s periodic review of our portfolio on an instrument-by-instrument basis. Impairment of Long-Lived Assets We evaluate the recoverability of the carrying amount of our long-lived assets when events or circumstances, including significant physical changes, significant adverse changes in general economic conditions or significant deterioration of the underlying cash flows of the long-lived assets, indicate that the carrying amount of the long-lived assets may not be recoverable. The need to recognize an impairment charge is based on estimated undiscounted future cash flows compared to the carrying amount. If recognition of an impairment charge is necessary, it is measured as the amount by which the carrying amount of the property exceeds the estimated fair value of the long-lived asset. Revenue Recognition Rental Income - Our leases generally provide for rent escalators throughout the term of the lease. Base rental income is recognized using the straight-line method over the term of the lease to the extent that lease payments are considered collectable and the lease provides for specific contractual escalators. Under certain leases, we receive additional contingent rent, which is calculated on the increase in revenues of the tenant over a base year or base quarter. We recognize contingent rent annually or quarterly based on the actual revenues of the tenant once the target threshold has been achieved. Lease payments that depend on a factor directly related to future use of the property, such as an increase in annual revenues over a base year, are considered to be contingent rent and are excluded from the schedule of minimum lease payments. The Company reviews its operating lease receivables for collectability on a regular basis, taking into consideration changes in factors such as the tenant’s payment history, the financial condition of the tenant, business conditions in which the tenant operates and economic conditions in the area where the property is located. In the event that collectability with respect to any tenant is not probable, a direct write-off of the receivable is made as an adjustment to rental income and any future rental revenue is recognized only when the tenant makes a rental payment. Reference Note 3 for further discussion. Resident Fees and Services - Resident fee and services revenue associated with our SHOP activities is recognized as the related performance obligations are satisfied and includes resident room charges, community fees and other resident charges. Residency agreements are generally short-term (30 days to one year), and entitle the resident to certain room and care services for a monthly fee billed in advance. Revenue for certain related services is billed monthly in arrears. The Company has elected the lessor practical expedient within Accounting Standards Codification (“ASC”) 842, Leases, not to separate the lease and nonlease components within our resident agreements as the timing and pattern of transfer to the resident are the same. The Company has determined that the nonlease component is the predominant component within the contract and will recognize revenue under ASC 606, Revenue Recognition from Contracts with Customers. Interest Income from Mortgage and Other Notes Receivable Interest income is recognized based on the interest rates and principal amounts outstanding on the notes receivable. We identify a mortgage note as non-performing based on various criteria including timeliness of required payments, compliance with other provisions under the related note agreement, and an evaluation of the borrower’s current financial condition for indicators that it is probable it cannot pay its contractual amounts. A non-performing loan is returned to accrual status at such time as the note becomes contractually current and management believes all future principal and interest will be received according to the contractual terms of the note. As of March 31, 2024, we had two mortgage notes receivable and a mezzanine loan totaling an aggregate of $26.5 million due from affiliates of two operators/borrowers, including Bickford Senior Living (“Bickford”) , designated as non-performing. Income Taxes We intend at all times to qualify as a REIT under Sections 856 through 860 of the Internal Revenue Code. Accordingly, we will generally not be subject to U.S. federal income tax, provided that we continue to qualify as a REIT and make distributions to stockholders equal to or in excess of 90% our taxable income. A failure to qualify under the applicable REIT qualification rules and regulations would have a material adverse impact on our financial position, results of operations and cash flows. Certain activities that we undertake may be conducted by subsidiary entities that have elected to be treated as taxable REIT subsidiaries (“TRSs”). TRSs are subject to federal, state, and local income taxes. Accordingly, a provision for income taxes has been made in the condensed consolidated financial statements. Segments We operate our business through two reportable segments: Re al Estate Investments and SHOP. In our Real Estate Investments segment, we invest in (i) senior housing and healthcare real estate and lease those properties to healthcare operating companies under primarily triple-net leases that obligate tenants to pay all property-related expenses and (ii) mortgage and other notes receivable throughout the United States. Our SHOP segment is comprised of the operations of 15 ILFs located throughout the United States that are operated on behalf of the Company by independent managers pursuant to the terms of separate management agreements. Reference Notes 5 and 15 for additional information. Earnings Per Share Our unvested restricted stock awards contain non-forfeitable rights to dividends, and accordingly, these awards are deemed to be participating securities. Therefore, the Company applies the two-class method to calculate basic and diluted earnings. Under the two-class method, we allocate net income attributable to stockholders to common stockholders and holders of unvested restricted stock by using the weighted-average shares of each class outstanding for quarter-to-date and year-to-date periods, based on their respective participation rights to dividends declared and undistributed earnings. Basic earnings per common share is computed by dividing net income attributable to common stockholders by the weighted average number of shares of common stock outstanding during the period. Diluted earnings per common share reflects the effect of dilutive securities. Recent Accounting Pronouncements

Investment Activity

Investment Activity	3 Months Ended
Investment Activity	Mar. 31, 2024
Real Estate [Abstract]
Investment Activity	Investment Activity Tenant Concentration The following table contains information regarding concentration in our Real Estate Investments portfolio of tenants or affiliates of tenants, that exceed 10% of total revenues for the three months ended March 31, 2024 and 2023, excluding $2.6 million for our corporate office, a credit loss reserve of $15.5 million and $348.7 million in real estate assets in the SHOP segment ( $ in thousands ): As of March 31, 2024 Revenues 1 Asset Gross Real Notes Three Months Ended March 31, Class Estate 2 Receivable 2024 2023 Senior Living Communities, LLC (“Senior Living”) EFC $ 573,631 $ 48,200 $ 12,815 16% $ 12,833 16% National HealthCare Corporation (“NHC”) SNF 133,770 — 11,246 14% 9,807 12% Bickford ALF 429,043 16,747 10,054 12% 11,162 14% All others, net Various 1,307,634 209,402 31,409 39% 34,267 41% Escrow funds received from tenants for property operating expenses Various — — 2,733 3% 2,619 3% $ 2,444,078 $ 274,349 68,257 70,688 Resident fees and services 3 13,256 16% 11,700 14% $ 81,513 $ 82,388 1 Includes interest income on notes receivable and rental income from properties classified as assets held for sale. 2 Amounts include any properties classified as held for sale. 3 There is no tenant concentration in “Resident fees and services” because these agreements are with individual residents. At March 31, 2024, the two states in which we had an investment concentration of 10% or more were South Carolina (12.1%) and Texas (10.7%). Senior Living As of March 31, 2024, we leased ten retirement communities to Senior Living. We recognized straight-line rent revenue of $(0.7) million and $(0.3) million from Senior Living for the three months ended March 31, 2024 and 2023, respectively. NHC As of March 31, 2024, we leased three ILFs and 32 SNFs to NHC, a publicly held company, under a master lease (four of which are subleased to other parties for whom the lease payments are guaranteed to us by NHC). Straight-line rental revenue of $0.1 million and $(0.3) million was recognized from NHC for the three months ended March 31, 2024 and 2023, respectively. NHC Percentage Rent - Under the terms of our master lease agreement with NHC, rent escalates by 4% of the increase, if any, in each of the facility’s revenue over a base year and is referred to as “percentage rent.” The following table summarizes the percentage rent income from NHC ( $ in thousands ): Three Months Ended March 31, 2024 2023 Current year $ 1,379 $ 965 Prior year final certification 1 1,656 630 Total percentage rent income $ 3,035 $ 1,595 1 For purposes of the percentage rent calculation described in the master lease agreement, NHC’s annual revenue by facility for a given year is certified to NHI by March 31st of the following year. Two of the members of our Board of Directors, including our chairman, are also members of NHC’s board of directors. Bickford As of March 31, 2024, we leased 39 facilities to Bickford under four leases. During 2022, we converted Bickford to the cash basis of revenue recognition based upon information obtained from Bickford regarding its financial condition that raised substantial doubt as to its ability to continue as a going concern. During the three months ended March 31, 2024, Bickford repaid $1.5 million of its outstanding pandemic-related deferrals. During the three months ended March 31, 2023, Bickford repaid $0.2 million of its outstanding pandemic-related deferrals in addition to the reduction in deferrals of $2.5 million recognized in connection with the acquisition of an ALF located in Chesapeake, Virginia from Bickford through a note receivable conversion. As of March 31, 2024, Bickford’s outstanding pandemic-related rent deferrals were $16.5 million. Effective April 1, 2024, the combined rent for the portfolio was reset to $34.5 million per year through April 1, 2026, at which time the rent will be reset and will increase annually thereafter based on the Consumer Price Index. The minimum annual increase will be 2% with a cap on the annual increase of 3%. As part of the lease amendments, we agreed to fund up to $8.0 million of capital improvements on various properties. Rental revenue will increase at a lease rate of 8.0% applied to the amount expended. Assets Held for Sale and Long-Lived Assets As of March 31, 2024 and December 31, 2023 , one property in our Real Estate Investments portfolio was classified as an asset held for sale with a net real estate balance of $5.0 million . Rental income associated with assets held for sale totaled $0.3 million and $0.5 million for the three months ended March 31, 2024 and 2023, respectively. In March 2024, we executed a purchase and sale agreement with a tenant to acquire its leased SLC for a purchase price of $38.5 million subject to the tenant’s ability to secure financing for the purchase. The purchase and sale agreement expires in December 2024. Until the tenant provides notification that it has obtained financing, the property continues to be classified as held and used and leased pursuant to the existing triple-net lease that generates approximately $2.9 million in annual rent and expires in July 2027. The property had a net investment of $19.6 million as of March 31, 2024. During the three months ended March 31, 2023, we recorded impairment charges of approximately $0.3 million on three properties in our Real Estate Investments segment. The impairment charges are included in “ Loan and realty losses (gains) ” in the Condensed Consolidated Statement of Income for the three months ended March 31, 2023. We reduce the carrying value of impaired properties to their estimated fair value or, with respect to the properties classified as assets held for sale, to estimated fair value less costs to sell. To estimate the fair values of the properties, we utilized a market approach which considered binding agreements for sales (Level 1 inputs), non-binding offers to purchase from unrelated third parties and/or broker quotes of estimated values (Level 3 inputs), and/or independent third-party valuations (Level 1 and 3 inputs). Cash Basis Operators We have three tenants on the cash basis of accounting for their leasing arrangements based on our assessment of each tenant’s ability to satisfy its contractual obligations. Cash rents received for the three months ended March 31, 2024 and 2023 were as follows ( $ in thousands ): Three Months Ended March 31, 2024 2023 Bickford 1 $ 9,364 $ 7,807 All others 2,401 4,199 Total rental income from cash basis operators $ 11,765 $ 12,006 1 Excludes $2.5 million of rental income related to the reduction of pandemic-related rent deferrals recognized in connection with the acquisition of an ALF from Bickford in 2023. Tenant Transition In the first quarter of 2024, we began negotiations with a tenant to transition its leased SNF located in Wisconsin to a new operator. We wrote off in the first quarter of 2024 the straight-line rent receivable of approximately $0.8 million associated with the existing lease that is expected to be terminated by the third quarter of 2024. Second Quarter 2024 Dispositions In the second quarter of 2024, we completed the sale of two ALFs located in Louisiana, previously leased to one of our tenants on cash basis, for net cash proceeds of $4.6 million, resulting in a gain of approximately $1.3 million. The properties were classified as held and used as of March 31, 2024 based on our assessment at that date of the buyer’s ability to obtain financing to complete the purchase. Tenant Purchase Options Certain of our leases contain purchase options allowing tenants to acquire the leased properties at a fixed base price plus a specified share in any appreciation or a fixed base price. At March 31, 2024, tenants had purchase options on three properties with an aggregate net investment of $58.0 million that will become exercisable between 2027 and 2028. Rental income from these properties with tenant purchase options was $1.8 million for both the three months ended March 31, 2024 and 2023, respectively. We cannot reasonably estimate at this time the probability that any purchase options will be exercised in the future. Consideration to be received from the exercise of any tenant purchase option is expected to exceed our net investment in the leased property or properties. Future Minimum Base Rent Future minimum lease payments to be received by us under our operating leases at March 31, 2024, were as follows ( $ in thousands ): Remainder of 2024 $ 175,434 2025 237,719 2026 245,066 2027 197,770 2028 191,509 2029 174,278 Thereafter 525,045 $ 1,746,821 Variable Lease Payments Most of our leases contain annual escalators in rent payments. Some of our leases contain escalators that are determined annually based on a variable index or other factors that are indeterminable at the inception of the lease. The table below indicates the rental income recognized as a result of fixed and variable lease escalators ( $ in thousands ): Three Months Ended March 31, 2024 2023 Lease payments based on fixed escalators $ 56,592 $ 58,937 Lease payments based on variable escalators 3,893 1,945 Straight-line rent, net of write-offs (308) 2,097 Escrow funds received from tenants for property operating expenses 2,733 2,619 Amortization of lease incentives (723) (299) Rental income $ 62,187 $ 65,299

Mortgage And Other Notes Receiv

Mortgage And Other Notes Receivable	3 Months Ended
Mortgage And Other Notes Receivable	Mar. 31, 2024
Accounts, Notes, Loans and Financing Receivable, Gross, Allowance, and Net [Abstract]
Mortgage and Other Notes Receivable	Mortgage and Other Notes Receivable At March 31, 2024, our investments in mortgage notes receivable totaled $177.4 million secured by real estate and other assets of the borrowers ( e.g ., Uniform Commercial Code liens on personal property) related to 17 facilities and in other notes receivable totaled $96.9 million, substantially all of which are guaranteed by significant parties to the notes or by cross-collateralization of properties with the same owner. These balances exclude a credit loss reserve of $15.5 million at March 31, 2024. Our loans designated as non-performing as of March 31, 2024 and December 31, 2023 include a mortgage note receivable of $2.0 million and $2.1 million, respectively, due from Bickford and a mortgage note receivable of $10.0 million and a mezzanine loan of $14.5 million due from affiliates of one operator/borrower. This operator/borrower is also one of the tenants on the cash basis of accounting for its leases. Interest income recognized, representing cash received, from these non-performing loans was $0.5 million for both the three months ended March 31, 2024 and 2023. All other loans were on full accrual basis as of March 31, 2024. Carriage Crossing Senior Living Bloomington In February 2024, we funded $15.0 million on a mortgage note receivable with Carriage Crossing Senior Living Bloomington (“Carriage Crossing”), with an additional $2.0 million available to be funded contingent upon the performance of facility operations until March 31, 2027. The five year loan agreement has an annual interest rate of 8.75% and two one-year extensions. Montecito Medical Real Estate We have a $50.0 million mezzanine loan and security agreement with Montecito Medical Real Estate for a fund that invests in medical real estate, including medical office buildings, throughout the United States. As of March 31, 2024, we have funded $20.3 million of our commitment that was used to acquire nine medical office buildings for a combined purchase price of approximately $86.7 million. For the three months ended March 31, 2024 and 2023, we recognized interest income of $0.5 million and $0.4 million, respectively. Bickford Construction and Mortgage Loans As of March 31, 2024, we had one fully funded construction loan of $14.7 million to Bickford. The construction loan is secured by a first mortgage lien on substantially all of the related real and personal property as well as a pledge of any and all leases or agreements which may grant a right of use to the property. Usual and customary covenants extend to the agreement, including the borrower’s obligation for payment of insurance and taxes. NHI has a fair market value purchase option on the property upon stabilization of the underlying operations . At March 31, 2024, we held a $12.6 million second mortgage as a component of the purchase price consideration in connection with the sale of six properties to Bickford in 2021. This second mortgage note receivable bears interest at a 10% annual rate and matures in April 2026. Interest income was $0.3 million for both the three months ended March 31, 2024 and 2023, respectively, related to the second mortgage. We did not include this note receivable in the determination of the gain recognized upon sale of the portfolio. Therefore, this note receivable is not reflected in “ Mortgage and other notes receivable, net ” in the Condensed Consolidated Balance Sheets as of March 31, 2024 and December 31, 2023. During both the three months ended March 31, 2024 and 2023, Bickford repaid $0.1 million of principal on this note receivable which is reflected in “ Gains on sale of real estate, net ” in the Condensed Consolidated Statements of Income. Senior Living We have provided a $20.0 million revolving line of credit to Senior Living whose borrowings under the revolver are to be used for working capital needs and to finance construction projects within its portfolio, including building additional units. Beginning January 1, 2025, availability under the revolver will reduce to $15.0 million. The revolver matures in December 2029 at the time of lease maturity. At March 31, 2024, the $15.5 million outstanding under the revolver bore interest at 8.0% per annum. The Company also has a mortgage loan of $32.7 million with Senior Living that originated in July 2019 for the acquisition of a 248-unit continuing care retirement community (“CCRC”) in Columbia, South Carolina. The mortgage loan is for a term of five years with two one-year extensions and carries an interest rate of 7.25%. Additionally, the loan conveys to NHI a purchase option at a stated minimum price of $38.3 million, subject to adjustment for market conditions. Credit Loss Reserve Our principal measures of credit quality, except for construction mortgages, are debt service coverage for amortizing loans and interest or fixed charge coverage for non-amortizing loans, collectively referred to as “Coverage.” A Coverage ratio provides a measure of the borrower’s ability to make scheduled principal and interest payments. The Coverage ratios presented in the table below have been calculated utilizing the most recent date for which data is available, December 31, 2023, using EBITDARM (earnings before interest, taxes, depreciation, amortization, rent and management fees) and the requisite debt service, interest service or fixed charges, as defined in the applicable loan agreement. We categorize Coverage into three levels: (i) more than 1.5x, (ii) between 1.0x and 1.5x, and (iii) less than 1.0x. We update the calculation of Coverage on a quarterly basis. Coverage is not a meaningful credit quality indicator for construction mortgages as either these developments are not generating any operating income, or they have insufficient operating income as occupancy levels necessary to stabilize the properties have not yet been achieved. We measure credit quality for these mortgages by considering the construction and stabilization timeline and the financial condition of the borrower, as well as economic and market conditions. We consider the guidance in ASC 310-20, Receivables - Nonrefundable Fees and Other Costs, when determining whether a modification, extension or renewal constitutes a current period origination. The credit quality indicator as of March 31, 2024 is presented below for the amortized cost, net by year of origination ( $ in thousands ): 2024 2023 2022 2021 2020 Prior Total Mortgages more than 1.5x $ — $ — $ 70,278 $ — $ 22,367 $ 35,232 $ 127,877 between 1.0x and 1.5x 14,855 930 — — — 6,423 22,208 less than 1.0x — 620 — — — 14,700 15,320 14,855 1,550 70,278 — 22,367 56,355 165,405 Mezzanine more than 1.5x — 506 — 14,520 — — 15,026 between 1.0x and 1.5x — — — 23,924 — — 23,924 less than 1.0x — 221 — — — 25,000 25,221 — 727 — 38,444 — 25,000 64,171 Non-performing between 1.0x and 1.5x — — — — — 24,500 24,500 less than 1.0x — — — — 2,047 — 2,047 — — — — 2,047 — 26,547 Revolver more than 1.5x 15,500 between 1.0x and 1.5x 2,726 18,226 Credit loss reserve (15,475) $ 258,874 Due to the continuing challenges in financial markets and the potential impact on the collectability of our mortgages and other notes receivable, we forecasted a 20% increase in the probability of a default and a 20% increase in the amount of loss from a default on all loans, other than those designated as non-performing, resulting in an effective adjustment of 44%. The methodology for estimating the reserves for non-performing loans incorporates the sufficiency of the underlying collateral and the current conditions and forecasts of future economic conditions of these loans, including qualitative factors, which may differ from conditions existing in the historical period. The allowance for expected credit losses is presented in the following table for the three months ended March 31, 2024 ( $ in thousands ): Beginning balance at January 1, 2024 $ 15,476 Provision for expected credit losses (1) Balance at March 31, 2024 $ 15,475

Senior Housing Operating Portfo

Senior Housing Operating Portfolio Structure	3 Months Ended
Senior Housing Operating Portfolio Structure	Mar. 31, 2024
Senior Housing Operating Portfolio Structure [Abstract]
Senior Housing Operating Portfolio Structure	Senior Housing Operating Portfolio Structure Our SHOP segment is comprised of two ventures that own the operations of 15 ILFs. These ventures are structured to comply with REIT requirements and utilize the TRS for activities that would otherwise be non-qualifying for REIT purposes. The properties in each venture are operated by a property manager in exchange for a management fee. The ventures were capitalized with preferred and common equity interests with the Company owning 100% of the preferred equity and a controlling common equity interest in each venture. The managers, or related parties of the managers, own a non-controlling common equity interest in their respective ventures. Each venture is discussed in more detail below. Merrill Managed Portfolio We have six ILFs located in California and Washington in a consolidated venture with Merrill which owns a 20% common equity interest in the venture . The operating agreement for the venture provides for contingent distributions to the members based on the attainment of certain yiel ds on investment calculated on an annual basis. The properties are managed by Merrill pursuant to a management agreement with an initial term through March 2032 that automatically renews on a year-to-year basis thereafter unless terminated by either party with notice. The management agreement entitles Merrill to a base management fee of 5% of net revenue and a real estate services fee of 5% of real estate costs incurred during any calendar year that exceed $1,000 times the number of units at each facility. The noncontrolling interest associated with the venture was determined to be contingently redeemable and is classified in mezzanine equity as of March 31, 2024 and December 31, 2023, as discussed further in Note 10. Discovery Managed Portfolio We have nine ILFs located in Arkansas, Georgia, Ohio, Oklahoma, New Jersey, and South Carolina in a consolidated venture with the Discovery member which owns a 2% common equity interest in the venture. T he operating agreement for the venture provides for contingent distributions to the members based on the attainment of certain yields on investment calculated on an annual basis. The noncontrolling interest associated with the venture is included in “ Equity ” on the Condensed Consolidated Balance Sheets as of March 31, 2024 and December 31, 2023. The properties are managed by separate related parties of Discovery pursuant to management agreements, each with an initial term through March 2032 that automatically renews on a year-to-year basis thereafter unless terminated by either party with notice. The management agreements entitle the managers to a base management fee of 5% of net revenue.

Equity Method Investment

Equity Method Investment	3 Months Ended
Equity Method Investment	Mar. 31, 2024
Equity Method Investments and Joint Ventures [Abstract]
Equity Method Investment	Equity Method Investment Concurrently with the acquisition of a CCRC from LCS-Westminster Partnership III, LLP in January 2020, we invested $0.9 million in the operating company, Timber Ridge OpCo, LLC (“Timber Ridge OpCo”), representing a 25.0% equity interest. This investment is held by our TRS to be compliant with the provisions of the REIT Investment Diversification and Empowerment Act of 2007. As part of our investment, we provided Timber Ridge OpCo a revolving credit facility of up to $5.0 million of which no funds have been drawn. We account for our investment in Timber Ridge OpCo under the equity method and decrease the carrying value of our investment for losses in the entity and distributions to NHI for cumulative amounts up to and including our basis plus any guaranteed or implied commitments to fund operations. In February 2023, we received $2.5 million from Timber Ridge OpCo representing the Company’s proportionate share of the lease incentive earned, as discussed in Note 7, based on its equity interest in the entity. Our guaranteed and implied commitments are currently limited to the additional $5.0 million under the revolving credit facility and the $2.5 million lease incentive distribution received. As of March 31, 2024, we have recognized our share of Timber Ridge OpCo’s operating losses in excess of our initial investment. These cumulative losses of $5.0 million in excess of our original basis and the $2.5 million lease incentive distribution received are included in “ Accounts payable and accrued expenses ” in our Condensed Consolidated Balance Sheet as of March 31, 2024. Excess unrecognized equity method losses for this investment for both the three months ended March 31, 2024 and 2023 were $0.6 million. Cumulative unrecognized losses for this investment were $9.9 million through March 31, 2024. We recognized gains of approximately $0.2 million, representing cash distributions received related to our investment in Timber Ridge OpCo for the three months ended March 31, 2024. The Timber Ridge property is subject to early resident mortgages secured by a Deed of Trust and Indenture of Trust (the “Deed and Indenture”). As part of our acquisition, NHI-LCS JV I, LLC (“Timber Ridge PropCo”) acquired the Timber Ridge CCRC property and a subordination agreement was entered into pursuant to which the trustee acknowledged and confirmed that the security interests created under the Deed and Indenture were subordinate to any security interests granted in connection with the loan made by NHI to Timber Ridge PropCo. In addition, under the terms of the resident loan assumption agreements, during the term of the lease (seven years with two renewal options), Timber Ridge OpCo is to indemnify Timber Ridge PropCo for any repayment by Timber Ridge PropCo of these early resident mortgage liabilities under the guarantee. As a result of the subordination agreement and the resident loan assumption agreements, no liability has been recorded as of March 31, 2024. The balance secured by the Deed and Indenture was $11.8 million at March 31, 2024.

Other Assets

Other Assets	3 Months Ended
Other Assets	Mar. 31, 2024
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]
Other Assets	Other Assets Other assets, net consist of the following ( $ in thousands ): March 31, 2024 December 31, 2023 SHOP accounts receivable, net of allowance of $375 and $343, and other assets $ 2,563 $ 1,620 Real estate investments accounts receivable and prepaid expenses 5,364 3,296 Lease incentive payments, net 9,946 10,669 Regulatory escrows 6,208 6,208 Restricted cash 1,972 2,270 $ 26,053 $ 24,063 In February 2023, Timber Ridge PropCo, the consolidated senior housing partnership with LCS that owns the Timber Ridge CCRC, paid a $10.0 million lease incentive earned by Timber Ridge OpCo. The lease incentive is being amortized on a straight-line basis through the remaining initial lease term ending January 2027.

Debt

Debt	3 Months Ended
Debt	Mar. 31, 2024
Debt Instruments [Abstract]
Debt	Debt Debt consisted of the following ( $ in thousands ): March 31, 2024 December 31, 2023 Revolving credit facility - unsecured $ 248,500 $ 245,000 Bank term loans - unsecured 200,000 200,000 2031 Senior Notes - unsecured, net of discount of $2,198 and $2,278 397,802 397,722 Private placement notes - unsecured 225,000 225,000 Fannie Mae term loans - secured, non-recourse 76,136 76,241 Unamortized loan costs (8,172) (8,912) $ 1,139,266 $ 1,135,051 Aggregate principal maturities of debt as of March 31, 2024 were as follows ( $ in thousands ): Remainder of 2024 $ 75,425 2025 325,711 2026 248,500 2027 100,000 2028 — 2029 — Thereafter 400,000 1,149,636 Less: discount (2,198) Less: unamortized loan costs (8,172) $ 1,139,266 Unsecured revolving credit facility and bank term loan Our unsecured bank credit facility consists of a $700.0 million unsecured revolving credit facility (the “2022 Credit Agreement”) that matures in March 2026, but may be extended at our option, subject to the satisfaction of certain conditions, for two additional six-month periods. Borrowings under the 2022 Credit Agreement bear interest, at our election, at one of the following (i) Term Secured Overnight Financing Rate (“SOFR”) (plus a credit spread adjustment) plus a margin ranging from 0.725% to 1.40%, (ii) Daily SOFR (plus a credit spread adjustment) plus a margin ranging from 0.725% to 1.40% or (iii) the base rate plus a margin ranging from 0.00% to 0.40%. In each election, the actual margin is determined according to our credit ratings. The base rate means, for any day, a fluctuating rate per annum equal to the highest of (i) the agent’s prime rate, (ii) the federal funds rate on such day plus 0.50% or (iii) the adjusted Term SOFR for a one-month tenor in effect on such day plus 1.0%. In addition, the 2022 Credit Agreement requires a facility fee equal to 0.125% to 0.30%, based on our credit rating. We have a $200.0 million term loan agreement (the “2025 Term Loan”) that matures June 2025 and bears interest at a variable rate which is SOFR-based with a margin determined according to our credit ratings plus a 0.10% credit spread adjustment . At March 31, 2024, we had $451.5 million available to draw on the revolving portion of our credit facility, subject to usual and customary covenants. Among other stipulations, the unsecured credit facility agreement requires that we maintain certain financial ratios within limits set by our creditors. At March 31, 2024, we were in compliance with these ratios. Pinnacle Bank is a participating member of our banking group. A member of NHI’s Board of Directors and chairperson of the Audit Committee of the Board of Directors is also the chairman of Pinnacle Financial Partners, Inc., the holding company for Pinnacle Bank. NHI’s local banking transactions are conducted primarily through Pinnacle Bank. 2031 Senior Notes In January 2021, we issued $400.0 million in aggregate principal amount of 3.00% senior notes that mature on February 1, 2031 and pay interest semi-annually (the “2031 Senior Notes”). The 2031 Senior Notes were sold at an issue price of 99.196% of face value before the underwriters’ discount. Our net proceeds from the 2031 Senior Notes offering, after deducting underwriting discounts and expenses, were approximately $392.3 million. The 2031 Senior Notes are subject to affirmative and negative covenants, including financial covenants with which we were in compliance at March 31, 2024. Private Placement Notes Our unsecured private placement notes as of March 31, 2024, payable interest-only, are summarized below ( $ in thousands ): Amount Inception Maturity Fixed Rate $ 75,000 September 2016 September 2024 3.93% 50,000 November 2015 November 2025 4.33% 100,000 January 2015 January 2027 4.51% $ 225,000 Covenants pertaining to the unsecured private placement notes are generally conformed with those governing our credit facility, except for specific debt-coverage ratios that are more restrictive. Our unsecured private placement notes include a rate increase provision that is effective if any rating agency lowers our credit rating on our senior unsecured debt below investment grade and our compliance leverage increases to 50% or more. Fannie Mae Term Loans As of March 31, 2024, we had $60.1 million in Fannie Mae term-debt financing, that originated in March 2015, requiring interest-only payments at an annual rate of 3.79% with a 10-year maturity. The mortgages are non-recourse and secured by 11 properties leased to Bickford. In a December 2017 acquisition, we assumed additional Fannie Mae debt that amortizes through 2025 when a balloon payment will be due, is subject to prepayment penalties until September 2024, bears interest at a rate of 4.60%, and has a remaining balance of $16.0 million at March 31, 2024. Collectively, the Fannie Mae debt is secured by properties having a net book value of $100.0 million at March 31, 2024. Interest Expense The following table summarizes interest expense ($ in thousands ): Three Months Ended March 31, 2024 2023 Interest expense on debt at contractual rates $ 14,087 $ 13,440 Capitalized interest (39) (19) Amortization of debt issuance costs, debt discount and other 821 606 Total interest expense $ 14,869 $ 14,027

Commitments. Contingencies and

Commitments. Contingencies and Uncertainties	3 Months Ended
Commitments. Contingencies and Uncertainties	Mar. 31, 2024
Commitments and Contingencies Disclosure [Abstract]
Commitments, Contingencies and Uncertainties	Commitments, Contingencies and Uncertainties In the normal course of business, we enter into a variety of commitments, typically consisting of funding revolving credit arrangements, construction and mezzanine loans to our operators to conduct expansions and acquisitions for their own account, and commitments for the funding of construction for expansion or renovation to our existing properties under lease. In our leasing operations, we offer to our tenants and to sellers of newly acquired properties a variety of inducements that originate contractually as contingencies but which may become commitments upon the satisfaction of the contingent event. Contingent payments earned will be included in the respective lease bases when funded. As of March 31, 2024, we had working capital, mortgage, construction and mezzanine loan commitments to six operators or borrowers for an aggregate of $132.7 million, of which we had funded $88.5 million toward these commitments. Loan funded amounts do not reflect the effects of discounts or commitment fees. As of March 31, 2024, we had $15.5 million of development commitments for construction and renovation for four properties of which we had funded $12.6 million toward these commitments. One of our consolidated real estate partnerships, NHI-REIT of DSL PropCo, LLC, has committed to fund up to $2.0 million toward the purchase of condominium units located at one of the facilities of which $1.0 million had been funded as of March 31, 2024. As of March 31, 2024, we had an aggregate of $8.9 million in remaining contingent lease inducement commitments in four lease agreements which are generally based on the performance of facility operations and may or may not be met by the tenant. In the second quarter of 2024, we committed to fund up to $8.0 million and $10.0 million to Bickford and Senior Living, respectively, for capital improvements on various properties in their leased portfolios. Rental revenue will increase at a lease rate of no less than 8.0% applied to the amount expended. See Note 3 for more detail. The credit loss liability for unfunded loan commitments is estimated using the same methodology as used for our funded mortgage and other notes receivable based on the estimated amount that we expect to fund. We applied the same market adjustments as discussed in Note 4. The liability for expected credit losses on our unfunded loan commitments reflected in “ Accounts payable and accrued expenses ” on the Condensed Consolidated Balance Sheets as of March 31, 2024 and December 31, 2023 is presented in the following table for the three months ended March 31, 2024 ( $ in thousands ): Beginning balance January 1, 2024 $ 279 Provision for expected credit losses 10 Balance at March 31, 2024 $ 289 Litigation Our facilities are subject to claims and suits in the ordinary course of business. Such claims may include, among other things professional liability and general liability claims, as well as regulatory proceedings related to our SHOP segment. Our managers, tenants and borrowers have indemnified, and are obligated to continue to indemnify us, against all liabilities arising from the operation of the facilities, and are further obligated to indemnify us against environmental or title problems affecting the real estate underlying such facilities. While there may be lawsuits pending against us and certain of the owners and/or lessees of the facilities, management believes that the ultimate resolution of all such pending proceedings will have no direct material adverse effect on our financial condition, results of operations or cash flows.

Redeemable Noncontrolling Inter

Redeemable Noncontrolling Interests	3 Months Ended
Redeemable Noncontrolling Interests	Mar. 31, 2024
Noncontrolling Interest [Abstract]
Redeemable Noncontrolling Interests	Redeemable Noncontrolling Interest The interest held by Merrill in its SHOP venture was classified as a “ Redeemable noncontrolling interest ” in the mezzanine section between “ Total liabilities” and “ Stockholders’ equity ” on our Condensed Consolidated Balance Sheets as of March 31, 2024 and December 31, 2023. Certain provisions within the operating agreement of the Merrill venture provide Merrill with put rights upon certain contingent events that are not solely within the control of the Company. Therefore, Merrill’s noncontrolling interest was determined to be contingently redeemable. The redeemable noncontrolling interest is not currently redeemable and we concluded a contingent redemption event is not probable to occur as of March 31, 2024. Consequently, the noncontrolling interest will not be subsequently remeasured to its redemption amount until such contingent event and the related redemption are probable to occur. We will continue to reflect the attribution of gains or losses to the redeemable noncontrolling interest in each period. The following table presents the change in “ Redeemable noncontrolling interest” for the three months ended March 31, 2024 ( $ in thousands ): Three Months Ended March 31, 2024 Balance at January 1, $ 9,656 Net loss (225) Distributions (6) Balance at March 31, $ 9,425

Equity and Dividends

Equity and Dividends	3 Months Ended
Equity and Dividends	Mar. 31, 2024
Equity [Abstract]
Equity and Dividends	Equity and Dividends Share Repurchase Plan On February 16, 2024, our Board of Directors renewed our stock repurchase program (the “Repurchase Plan”) pursuant to which we may purchase up to $160.0 million in shares of our issued and outstanding common stock, par value $0.01 per share. The Repurchase Plan is effective for a period of one year and does not require us to repurchase any specific number of shares. The Repurchase Plan may be suspended or discontinued at any time. Shares may be repurchased from time-to-time in open market transactions at prevailing market prices, in privately negotiated transactions or by other means in accordance with the terms of Rule 10b-18 of the Securities Exchange Act of 1934, as amended, and repurchases shall be made in accordance with all applicable laws and regulations in effect. The timing and number of shares repurchased, if any, will depend on a variety of factors, including price, general market and economic conditions, alternative investment opportunities and other corporate considerations. No common stock was repurchased during the three months ended March 31, 2024 and 2023. At-the-Market (ATM) Equity Program We maintain an ATM equity program which allows us to sell our common stock directly into the market and have entered into an ATM equity offering sales agreement pursuant to which the Company may sell, from time to time, up to an aggregate sales price of $500.0 million of the Company’s common shares. No shares were issued under the ATM equity program during the three months ended March 31, 2024 and 2023. Dividends The following table summarizes dividends declared by the Board of Directors or paid during the three months ended March 31, 2024 and 2023: Three Months Ended March 31, 2024 Date of Declaration Date of Record Date Paid/Payable Quarterly Dividend November 3, 2023 December 29, 2023 January 26, 2024 $0.90 February 16, 2024 March 28, 2024 May 3, 2024 $0.90 Three Months Ended March 31, 2023 Date of Declaration Date of Record Date Paid/Payable Quarterly Dividend November 6, 2022 December 30, 2022 January 27, 2023 $0.90 February 17, 2023 March 31, 2023 May 5, 2023 $0.90

Share-Based Compensation

Share-Based Compensation	3 Months Ended
Share-Based Compensation	Mar. 31, 2024
Share-Based Payment Arrangement [Abstract]
Stock-Based Compensation	Share-Based Compensation The Company’s outstanding stock incentive awards have been granted under two incentive plans – the 2012 Stock Incentive Plan and the 2019 Stock Incentive Plan, as amended and restated (the “2019 Plan”). During the three months ended March 31, 2024, we granted options to purchase 431,000 shares of common stock under the 2019 Plan. In February 2024, 15,000 shares of restricted stock were issued to executive officers with a grant date fair value of $57.76 per share based on the market value of our common stock on the date of grant. The restricted stock will vest over five years, with 20% vesting on each anniversary of the date of grant. The restricted stock awards contain non-forfeitable rights to dividends or dividend equivalents during the vesting periods. The weighted average fair value of options granted during the three months ended March 31, 2024 and 2023 was $7.36 and $10.56 per option, respectively. The fair value of each grant is estimated on the date of grant using the Black-Scholes option-pricing model with the following weighted average assumptions: 2024 2023 Dividend yield 6.4% 7.0% Expected volatility 26.1% 39.7% Expected lives 2.9 years 2.9 years Risk-free interest rate 4.49% 4.65% The following table summarizes our outstanding stock options: Weighted Average Number Weighted Average Remaining of Shares Exercise Price Contractual Life (Years) Options outstanding, January 1, 2023 2,216,175 $70.97 Options granted 385,500 $54.73 Options forfeited (25,000) $74.67 Options expired (60,002) $64.33 Options outstanding, March 31, 2023 2,516,673 $68.61 Exercisable at March 31, 2023 2,132,828 $71.21 Options outstanding, January 1, 2024 2,447,171 $68.80 Options granted 431,000 $57.76 Options expired (301,837) $79.96 Options outstanding, March 31, 2024 2,576,334 $65.89 2.74 Exercisable at March 31, 2024 2,235,640 $66.99 2.45 At March 31, 2024, the intrinsic value of stock options outstanding and exercisable was $11.1 million and $9.1 million, respectively. The following is a summary of share-based compensation expense, net of any forfeitures, included in “ General and administrative expenses ” in the Condensed Consolidated Statements of Income ( $ in thousands ): Three Months Ended March 31, 2024 2023 Share-based compensation components: Restricted stock expense $ 158 $ — Stock option expense 1,997 2,105 Total share-based compensation expense $ 2,155 $ 2,105 As of March 31, 2024, unrecognized compensation expense totaling $3.7 million associated with stock-based awards was expected to be recognized over the following periods: remainder of 2024 - $2.0 million, 2025 - $1.1 million, 2026 - $0.3 million, 2027 - $0.1 million, and thereafter - $0.1 million.

Earnings Per Common Share

Earnings Per Common Share	3 Months Ended
Earnings Per Common Share	Mar. 31, 2024
Earnings Per Share [Abstract]
Earnings Per Common Share	Earnings Per Common Share The following table summarizes the average number of common shares and the net income used in the calculation of basic and diluted earnings per common share ($ in thousands, except share and per share amounts) : Three Months Ended March 31, 2024 2023 Net income $ 30,657 $ 34,183 Add: net loss attributable to noncontrolling interests 290 301 Net income attributable to stockholders 30,947 34,484 Less: net income attributable to unvested restricted stock awards (32) — Net income attributable to common stockholders - basic $ 30,915 $ 34,484 BASIC: Weighted average common shares outstanding 43,388,841 43,388,742 DILUTED: Weighted average common shares outstanding 43,388,841 43,388,742 Stock options 35,709 2,687 Weighted average dilutive common shares outstanding 43,424,550 43,391,429 Earnings per common share - basic $ 0.71 $ 0.79 Earnings per common share - diluted $ 0.71 $ 0.79 Incremental anti-dilutive shares excluded: Net share effect of stock options with an exercise price in excess of the average market price for our common shares 492,675 728,524 Regular dividends declared per common share $ 0.90 $ 0.90

Fair Value of Financial Instrum

Fair Value of Financial Instruments	3 Months Ended
Fair Value of Financial Instruments	Mar. 31, 2024
Fair Value Disclosures [Abstract]
Fair Value of Financial Instruments	Fair Value of Financial Instruments Carrying amounts and fair values of financial instruments that are not carried at fair value at March 31, 2024 and December 31, 2023 in the Condensed Consolidated Balance Sheets are as follows ($ in thousands ): Carrying Amount Fair Value Measurement March 31, 2024 December 31, 2023 March 31, 2024 December 31, 2023 Level 2 Variable rate debt $ 443,758 $ 439,693 $ 448,500 $ 445,000 Fixed rate debt $ 695,508 $ 695,358 $ 614,295 $ 616,852 Level 3 Mortgage and other notes receivable, net $ 258,874 $ 245,271 $ 249,999 $ 237,646 Fixed rate debt. Fixed rate debt is classified as Level 2 and its fair value is based on quoted prices for similar instruments or calculated utilizing model derived valuations in which significant inputs are observable in active markets. Variable rate debt. Variable rate debt is classified as Level 2 and the fair values of our borrowings under our revolving credit facility and other variable rate debt are reasonably estimated at their notional amounts due to the predominance of floating interest rates, which generally reflect market conditions. Mortgage and other notes receivable. The fair value of mortgage and other notes receivable is based on credit risk and discount rates that are not observable in the marketplace and therefore represents a Level 3 measurement.

Segment Reporting

Segment Reporting	3 Months Ended
Segment Reporting	Mar. 31, 2024
Segment Reporting [Abstract]
Segment Reporting	Segment Reporting We evaluate our business and make resource allocations on our two operating segments: Real Estate Investments and SHOP. Our Real Estate Investments segment includes leases, mortgages and other note investments in ILFs, ALFs, EFCs, SLCs, SNFs and a HOSP. Under the Real Estate Investments segment, we invest in senior housing and healthcare real estate through acquisition and financing of primarily single-tenant properties. Properties acquired are primarily leased under triple-net leases, and we are not involved in the management of the properties. The SHOP segment includes multi-tenant ILFs. The SHOP properties and related operations are controlled by the Company and are operated by property managers in exchange for a management fee. See Note 5 for further discussion. Our chief operating decision maker evaluates performance based upon segment net operating income (“NOI”). We define NOI as total revenues, less tenant reimbursements and property operating expenses. We use NOI to make decisions about resource allocations and to assess the property level performance of our properties. There were no intersegment transactions for either the three months ended March 31, 2024 or 2023. Capital expenditures for the three months ended March 31, 2024 were approximately $1.7 million for the Real Estate Investments segment and $1.3 million for the SHOP segment. Capital expenditures for the three months ended March 31, 2023 were approximately $55.8 million for the Real Estate Investments segment and $1.1 million for the SHOP segment. Non-segment revenue consists mainly of other income. Non-segment assets consist of corporate assets including cash, deferred loan expenses and corporate offices and equipment among others. Non-property specific revenues and expenses are not allocated to individual segments in determining NOI. The accounting policies of the segments are the same as those described in the summary of significant accounting policies discussed in Note 2. Summary information for the reportable segments during the three months ended March 31, 2024 and 2023 is as follows ( $ in thousands ): For the three months ended March 31, 2024: Real Estate Investments SHOP Non-segment/Corporate Total Rental income $ 62,187 $ — $ — $ 62,187 Resident fees and services — 13,256 — 13,256 Interest income and other 5,942 — 128 6,070 Total revenues 68,129 13,256 128 81,513 Senior housing operating expenses — 10,314 — 10,314 Taxes and insurance on leased properties 2,733 — — 2,733 NOI 65,396 2,942 128 68,466 Depreciation 15,058 2,437 10 17,505 Interest 763 — 14,106 14,869 Legal — — 236 236 Franchise, excise and other taxes — — (187) (187) General and administrative — — 5,642 5,642 Loan and realty losses 10 — — 10 Gains on sales of real estate, net (100) — — (100) Gains from equity method investment (166) — — (166) Net income (loss) $ 49,831 $ 505 $ (19,679) $ 30,657 Total assets $ 2,202,511 $ 265,120 $ 10,494 $ 2,478,125 For the three months ended March 31, 2023: Real Estate Investments SHOP Non-segment/Corporate Total Rental income $ 65,299 $ — $ — $ 65,299 Resident fees and services — 11,700 — 11,700 Interest income and other 5,308 — 81 5,389 Total revenues 70,607 11,700 81 82,388 Senior housing operating expenses — 9,799 — 9,799 Taxes and insurance on leased properties 2,619 — — 2,619 NOI 67,988 1,901 81 69,970 Depreciation 15,376 2,227 14 17,617 Interest 759 — 13,268 14,027 Legal — — 122 122 Franchise, excise and other taxes — — 183 183 General and administrative — — 5,653 5,653 Loan and realty gains (418) — — (418) Gains on sales of real estate, net (1,397) — — (1,397) Net income (loss) $ 53,668 $ (326) $ (19,159) $ 34,183 Total assets $ 2,254,939 $ 270,085 $ 8,206 $ 2,533,230

Variable Interest Entities

Variable Interest Entities	3 Months Ended
Variable Interest Entities	Mar. 31, 2024
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Variable Interest Entities	Variable Interest Entities Consolidated Variable Interest Entities SHOP - The assets of the SHOP ventures primarily consist of real estate properties, cash and cash equivalents, and resident fees and services (accounts receivable). The obligations of the ventures primarily consist of operating expenses of the ILFs (accounts payable and accrued expenses) and capital expenditures for the properties. Aggregate assets of the consolidated SHOP ventures that can be used only to settle obligations of each respective SHOP venture primarily include approximately $259.6 million and $260.7 million of real estate properties, net, $2.9 million and $7.7 million of cash and cash equivalents, $2.6 million and $1.7 million of other assets, net, as of March 31, 2024 and December 31, 2023, respectively. Liabilities of the consolidated SHOP ventures for which creditors do not have recourse to the general credit of the Company are $2.6 million and $4.7 million as of March 31, 2024 and December 31, 2023, respectively. Reference Notes 5 and 10 for further discussion of these ventures. Real Estate Partnerships - The aggregate assets of the two consolidated real estate partnerships that can be used only to settle obligations of each respective partnership as of March 31, 2024 and December 31, 2023 include approximately $250.5 million and $252.5 million of real estate properties, net, $9.7 million and $9.7 million in straight-line rent receivable, $2.5 million and $3.2 million of cash and cash equivalents and $7.2 million and $7.8 million of other assets, net, respectively. Liabilities of these partnerships for which creditors do not have recourse to the general credit of the Company are not material. Unconsolidated Variable Interest Entities The Company’s unconsolidated VIEs are summarized below by date of initial involvement. For further discussion of the nature of the relationships, including the sources of exposure to these VIEs, see the notes to our condensed consolidated financial statements cross-referenced below ( $ in thousands ). Date Name Source of Exposure Carrying Amount Maximum Exposure to Loss Note Reference 2014 Senior Living Notes and straight-line receivable $ 87,964 $ 92,464 Notes 3, 4 2016 Senior Living Management Notes $ 24,500 $ 24,500 — 2018 Bickford Notes $ 16,861 $ 29,415 Notes 3, 4 2019 Encore Senior Living Various 1 $ 56,965 $ 57,639 — 2020 Timber Ridge OpCo Various 2 $ 689 $ 5,689 Notes 6, 7 2020 Watermark Retirement Notes and straight-line receivable $ 9,450 $ 11,723 — 2021 Montecito Medical Real Estate Notes and funding commitment $ 20,498 $ 50,243 Note 4 2021 Vizion Health Notes and straight-line receivable $ 16,173 $ 16,173 — 2021 Navion Senior Solutions Various 3 $ 7,990 $ 7,990 — 2023 Kindcare Senior Living Notes 4 $ 758 $ 758 — 1 Notes, straight-line rent receivable, and lease receivables 2 Loan commitment, equity method investment, straight-line rent receivable and unamortized lease incentive 3 Development commitments, straight-line rent receivable, and unamortized lease incentive 4 Represents two mezzanine loans originated from the sales of real estate We are not obligated to provide support beyond our stated commitments to these tenants and borrowers whom we classify as VIEs, and accordingly, our maximum exposure to loss as a result of these relationships is limited to the amount of our commitments, as shown above and discussed in the notes. Economic loss on a lease, in excess of what is presented in the table above, if any, would be limited to that resulting from any period of non-payment of rent before we are able to take effective remedial action, as well as costs incurred in transitioning the lease to a new tenant. The potential extent of such loss would be dependent upon individual facts and circumstances, and is therefore not included in the table above. In the future, NHI may be deemed the primary beneficiary of the operations if the tenants or borrowers do not have adequate liquidity to accept the risks and rewards as the tenants and operators of the properties and NHI may be required to consolidate the financial position and results of operations of the tenants or borrowers into our condensed consolidated financial statements.

Pay vs Performance Disclosure

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended
Pay vs Performance Disclosure - USD ($) $ in Thousands	Mar. 31, 2024	Mar. 31, 2023
Pay vs Performance Disclosure
Net Income (Loss)	$ 30,947	$ 34,484

Insider Trading Arrangements

Insider Trading Arrangements	3 Months Ended
Insider Trading Arrangements	Mar. 31, 2024
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

Basis of Presentation and Sig_2

Basis of Presentation and Significant Accounting Policies (Policy)	3 Months Ended
	Mar. 31, 2024
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with United States generally accepted accounting principles (“GAAP”) for interim financial statements. In our opinion, the accompanying unaudited condensed consolidated financial statements reflect all adjustments consisting of normal recurring adjustments necessary for a fair presentation. Interim results of operations are not necessarily indicative of the results that may be achieved for a full year. The condensed consolidated financial statements and related notes do not include all information and footnotes required by GAAP for annual reports. These interim condensed consolidated financial statements should be read in conjunction with our audited consolidated financial statements and notes thereto as of and for the year ended December 31, 2023, included in our Annual Report on Form 10-K for the year ended December 31, 2023 filed with the Securities and Exchange Commission (the “SEC”).
Principles of Consolidation	Principles of Consolidation The condensed consolidated financial statements include the accounts of the Company, and its wholly owned subsidiaries, joint ventures and subsidiaries in which we have a controlling interest. We also consolidate certain entities when control of such entities can be achieved through means other than voting rights (“variable interest entities” or “VIEs”) if the Company is deemed to be the primary beneficiary of such entities. All material intercompany transactions and balances are eliminated in consolidation. Our consolidated total assets and liabilities include two consolidated ventures comprising our SHOP activities, each formed with a separate partner - Merrill Gardens, L.L.C. (“Merrill”) and DSHI NHI Holiday LLC (the “Discovery member”), a related party of Discovery Senior Living (“Discovery”). We consider both ventures to be VIEs as the members of each, as a group, lack the characteristics of a controlling financial interest. We are deemed to be the primary beneficiary of each VIE because we have the ability to control the activities that most significantly impact each VIE’s economic performance. Reference Notes 5 and 16 for further discussion of our SHOP ventures. We also consolidate two real estate partner ships formed with our partners, Discovery Senior Housing Investor XXIV, LLC, a related party of Discovery and LCS Timber Ridge LLC (“LCS”) to invest in senior housing facilities. We consider both partnerships to be VIEs, as either the members, as a group, lack the characteristics of a controlling financial interest or the total equity at risk is insufficient to finance activities without additional subordinated financial support. NHI directs the activities that most significantly impact economic performance of these partnerships, subject to limited protective rights extended to our partners for specified business decisions. Because of our control of these partnerships, we include their assets, liabilities, noncontrolling interests and operations in our condensed consolidated financial statements. Reference Note 16 for further discussion of these real estate partnerships. We use the equity method of accounting when we own an interest in an entity over which we can exert significant influence but cannot control the entity’s operations. We discontinue equity method accounting if our investment in an entity (and net advances) is reduced to zero unless we have guaranteed obligations of the entity or are otherwise committed to provide further financial support for the entity. Reference Note 6 for further discussion of our equity method investment. We have concluded that the Company is not the primary beneficiary for certain investments where we lack either directly or through related parties the power to direct the activities that most significantly impact their economic performance. See Note 16 for information on unconsolidated VIEs.
Noncontrolling Interests	Noncontrolling Interests Contingently redeemable noncontrolling interests are recorded at their initial carrying amounts upon issuance and are subsequently adjusted to reflect their share of gains or losses and distributions attributable to the noncontrolling interests. In periods where they are or will become probable of redemption, an adjustment to the redemption value of the noncontrolling interests is also recognized through “ Capital in excess of par value
Cash and Cash Equivalents and Restricted Cash	Cash and Cash Equivalents and Restricted Cash Cash equivalents consist of all highly liquid investments with original maturities of three months or less. Restricted cash includes amounts required to be held on deposit or subject to an agreement ( e.g ., with a qualified intermediary subject to an exchange agreement pursuant to Section 1031 of the Internal Revenue Code of 1986, as amended (the “Internal Revenue Code”) or in accordance with agency agreements governing our mortgages).
Concentration of Credit Risks	Concentration of Credit Risks Our credit risks primarily relate to cash and cash equivalents and investments in mortgage and other notes receivable. Cash and cash equivalents are primarily held in bank accounts and overnight investments. We maintain our bank deposit accounts with large financial institutions in amounts that may exceed federally insured limits. We have not experienced any losses in such accounts. Our mortgage and other notes receivable consist primarily of secured loans on facilities. Our financial instruments, principally our investments in notes receivable, are subject to the possibility of loss of the carrying values as a result of the failure of other parties to perform according to their contractual obligations which may make the instruments less valuable. We obtain collateral in the form of mortgage liens and other protective rights for notes receivable and continually monitor these rights in order to reduce such possibilities of loss. We evaluate the need to provide for reserves for potential losses on our financial instruments based on management’s periodic review of our portfolio on an instrument-by-instrument basis.
Impairment of Long-Lived Assets	Impairment of Long-Lived Assets We evaluate the recoverability of the carrying amount of our long-lived assets when events or circumstances, including significant physical changes, significant adverse changes in general economic conditions or significant deterioration of the underlying cash flows of the long-lived assets, indicate that the carrying amount of the long-lived assets may not be recoverable. The need to recognize an impairment charge is based on estimated undiscounted future cash flows compared to the carrying amount. If recognition of an impairment charge is necessary, it is measured as the amount by which the carrying amount of the property exceeds the estimated fair value of the long-lived asset.
Revenue Recognition	Revenue Recognition Rental Income - Our leases generally provide for rent escalators throughout the term of the lease. Base rental income is recognized using the straight-line method over the term of the lease to the extent that lease payments are considered collectable and the lease provides for specific contractual escalators. Under certain leases, we receive additional contingent rent, which is calculated on the increase in revenues of the tenant over a base year or base quarter. We recognize contingent rent annually or quarterly based on the actual revenues of the tenant once the target threshold has been achieved. Lease payments that depend on a factor directly related to future use of the property, such as an increase in annual revenues over a base year, are considered to be contingent rent and are excluded from the schedule of minimum lease payments. The Company reviews its operating lease receivables for collectability on a regular basis, taking into consideration changes in factors such as the tenant’s payment history, the financial condition of the tenant, business conditions in which the tenant operates and economic conditions in the area where the property is located. In the event that collectability with respect to any tenant is not probable, a direct write-off of the receivable is made as an adjustment to rental income and any future rental revenue is recognized only when the tenant makes a rental payment. Reference Note 3 for further discussion. Resident Fees and Services - Resident fee and services revenue associated with our SHOP activities is recognized as the related performance obligations are satisfied and includes resident room charges, community fees and other resident charges. Residency agreements are generally short-term (30 days to one year), and entitle the resident to certain room and care services for a monthly fee billed in advance. Revenue for certain related services is billed monthly in arrears. The Company has elected the lessor practical expedient within Accounting Standards Codification (“ASC”) 842, Leases, not to separate the lease and nonlease components within our resident agreements as the timing and pattern of transfer to the resident are the same. The Company has determined that the nonlease component is the predominant component within the contract and will recognize revenue under ASC 606, Revenue Recognition from Contracts with Customers.
Interest Income from Mortgage and Other Notes Receivable	Interest Income from Mortgage and Other Notes Receivable Interest income is recognized based on the interest rates and principal amounts outstanding on the notes receivable. We identify a mortgage note as non-performing based on various criteria including timeliness of required payments, compliance with other provisions under the related note agreement, and an evaluation of the borrower’s current financial condition for indicators that it is probable it cannot pay its contractual amounts. A non-performing loan is returned to accrual status at such time as the note becomes contractually current and management believes
Income Taxes	Income Taxes We intend at all times to qualify as a REIT under Sections 856 through 860 of the Internal Revenue Code. Accordingly, we will generally not be subject to U.S. federal income tax, provided that we continue to qualify as a REIT and make distributions to stockholders equal to or in excess of 90% our taxable income. A failure to qualify under the applicable REIT qualification rules and regulations would have a material adverse impact on our financial position, results of operations and cash flows.
Segments	Segments We operate our business through two reportable segments: Re al Estate Investments and SHOP. In our Real Estate Investments segment, we invest in (i) senior housing and healthcare real estate and lease those properties to healthcare operating companies under primarily triple-net leases that obligate tenants to pay all property-related expenses and (ii) mortgage and other notes receivable throughout the United States. Our SHOP segment is comprised of the operations of 15 ILFs located throughout the United States that are operated on behalf of the Company by independent managers pursuant to the terms of separate management agreements. Reference Notes 5 and 15 for additional information.
Earnings Per Share	Earnings Per Share
Recent Accounting Pronouncements	Recent Accounting Pronouncements

Basis of Presentation and Sig_3

Basis of Presentation and Significant Accounting Policies (Tables)	3 Months Ended
	Mar. 31, 2024
Accounting Policies [Abstract]
Schedule of Cash and Cash Equivalents	The following table sets forth our “ Cash and cash equivalents and restricted cash ” reported within the Company’s Condensed Consolidated Statements of Cash Flows ( $ in thousands ): March 31, 2024 March 31, 2023 Beginning of period: Cash and cash equivalents $ 22,347 $ 19,291 Restricted cash (included in Other assets, net) 2,270 2,225 Cash, cash equivalents, and restricted cash $ 24,617 $ 21,516 End of period: Cash and cash equivalents $ 11,357 $ 13,875 Restricted cash (included in Other assets, net) 1,972 1,652 Cash, cash equivalents, and restricted cash $ 13,329 $ 15,527
Schedule of Restrictions on Cash and Cash Equivalents	The following table sets forth our “ Cash and cash equivalents and restricted cash ” reported within the Company’s Condensed Consolidated Statements of Cash Flows ( $ in thousands ): March 31, 2024 March 31, 2023 Beginning of period: Cash and cash equivalents $ 22,347 $ 19,291 Restricted cash (included in Other assets, net) 2,270 2,225 Cash, cash equivalents, and restricted cash $ 24,617 $ 21,516 End of period: Cash and cash equivalents $ 11,357 $ 13,875 Restricted cash (included in Other assets, net) 1,972 1,652 Cash, cash equivalents, and restricted cash $ 13,329 $ 15,527

Investment Activity (Tables)

Investment Activity (Tables)	3 Months Ended
Investment Activity (Tables)	Mar. 31, 2024
Real Estate [Abstract]
Schedule of Tenant Concentrations	The following table contains information regarding concentration in our Real Estate Investments portfolio of tenants or affiliates of tenants, that exceed 10% of total revenues for the three months ended March 31, 2024 and 2023, excluding $2.6 million for our corporate office, a credit loss reserve of $15.5 million and $348.7 million in real estate assets in the SHOP segment ( $ in thousands ): As of March 31, 2024 Revenues 1 Asset Gross Real Notes Three Months Ended March 31, Class Estate 2 Receivable 2024 2023 Senior Living Communities, LLC (“Senior Living”) EFC $ 573,631 $ 48,200 $ 12,815 16% $ 12,833 16% National HealthCare Corporation (“NHC”) SNF 133,770 — 11,246 14% 9,807 12% Bickford ALF 429,043 16,747 10,054 12% 11,162 14% All others, net Various 1,307,634 209,402 31,409 39% 34,267 41% Escrow funds received from tenants for property operating expenses Various — — 2,733 3% 2,619 3% $ 2,444,078 $ 274,349 68,257 70,688 Resident fees and services 3 13,256 16% 11,700 14% $ 81,513 $ 82,388 1 Includes interest income on notes receivable and rental income from properties classified as assets held for sale. 2 Amounts include any properties classified as held for sale. 3 There is no tenant concentration in “Resident fees and services” because these agreements are with individual residents.
Summary of NHC Percentage Rent	The following table summarizes the percentage rent income from NHC ( $ in thousands ): Three Months Ended March 31, 2024 2023 Current year $ 1,379 $ 965 Prior year final certification 1 1,656 630 Total percentage rent income $ 3,035 $ 1,595 1 For purposes of the percentage rent calculation described in the master lease agreement, NHC’s annual revenue by facility for a given year is certified to NHI by March 31st of the following year.
Schedule of Cash Rents Received	Cash rents received for the three months ended March 31, 2024 and 2023 were as follows ( $ in thousands ): Three Months Ended March 31, 2024 2023 Bickford 1 $ 9,364 $ 7,807 All others 2,401 4,199 Total rental income from cash basis operators $ 11,765 $ 12,006 1 Excludes $2.5 million of rental income related to the reduction of pandemic-related rent deferrals recognized in connection with the acquisition of an ALF from Bickford in 2023.
Schedule of Future Minimum Base Rent	Future minimum lease payments to be received by us under our operating leases at March 31, 2024, were as follows ( $ in thousands ): Remainder of 2024 $ 175,434 2025 237,719 2026 245,066 2027 197,770 2028 191,509 2029 174,278 Thereafter 525,045 $ 1,746,821
Schedule of Fixed and Variable Lease Payments	The table below indicates the rental income recognized as a result of fixed and variable lease escalators ( $ in thousands ): Three Months Ended March 31, 2024 2023 Lease payments based on fixed escalators $ 56,592 $ 58,937 Lease payments based on variable escalators 3,893 1,945 Straight-line rent, net of write-offs (308) 2,097 Escrow funds received from tenants for property operating expenses 2,733 2,619 Amortization of lease incentives (723) (299) Rental income $ 62,187 $ 65,299

Mortgage And Other Notes Rece_2

Mortgage And Other Notes Receivable (Tables)	3 Months Ended
Mortgage And Other Notes Receivable (Tables)	Mar. 31, 2024
Accounts, Notes, Loans and Financing Receivable, Gross, Allowance, and Net [Abstract]
Schedule of Financing Receivable Credit Quality Indicators	The credit quality indicator as of March 31, 2024 is presented below for the amortized cost, net by year of origination ( $ in thousands ): 2024 2023 2022 2021 2020 Prior Total Mortgages more than 1.5x $ — $ — $ 70,278 $ — $ 22,367 $ 35,232 $ 127,877 between 1.0x and 1.5x 14,855 930 — — — 6,423 22,208 less than 1.0x — 620 — — — 14,700 15,320 14,855 1,550 70,278 — 22,367 56,355 165,405 Mezzanine more than 1.5x — 506 — 14,520 — — 15,026 between 1.0x and 1.5x — — — 23,924 — — 23,924 less than 1.0x — 221 — — — 25,000 25,221 — 727 — 38,444 — 25,000 64,171 Non-performing between 1.0x and 1.5x — — — — — 24,500 24,500 less than 1.0x — — — — 2,047 — 2,047 — — — — 2,047 — 26,547 Revolver more than 1.5x 15,500 between 1.0x and 1.5x 2,726 18,226 Credit loss reserve (15,475) $ 258,874
Schedule of Financing Receivable, Allowance for Credit Loss	The allowance for expected credit losses is presented in the following table for the three months ended March 31, 2024 ( $ in thousands ): Beginning balance at January 1, 2024 $ 15,476 Provision for expected credit losses (1) Balance at March 31, 2024 $ 15,475

Other Assets (Tables)

Other Assets (Tables)	3 Months Ended
Other Assets (Tables)	Mar. 31, 2024
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]
Schedule of Other Assets	Other assets, net consist of the following ( $ in thousands ): March 31, 2024 December 31, 2023 SHOP accounts receivable, net of allowance of $375 and $343, and other assets $ 2,563 $ 1,620 Real estate investments accounts receivable and prepaid expenses 5,364 3,296 Lease incentive payments, net 9,946 10,669 Regulatory escrows 6,208 6,208 Restricted cash 1,972 2,270 $ 26,053 $ 24,063

Debt (Tables)

Debt (Tables)	3 Months Ended
Debt (Tables)	Mar. 31, 2024
Debt Instruments [Abstract]
Schedule of Debt	Debt consisted of the following ( $ in thousands ): March 31, 2024 December 31, 2023 Revolving credit facility - unsecured $ 248,500 $ 245,000 Bank term loans - unsecured 200,000 200,000 2031 Senior Notes - unsecured, net of discount of $2,198 and $2,278 397,802 397,722 Private placement notes - unsecured 225,000 225,000 Fannie Mae term loans - secured, non-recourse 76,136 76,241 Unamortized loan costs (8,172) (8,912) $ 1,139,266 $ 1,135,051
Schedule of Maturities of Long-term Debt	Aggregate principal maturities of debt as of March 31, 2024 were as follows ( $ in thousands ): Remainder of 2024 $ 75,425 2025 325,711 2026 248,500 2027 100,000 2028 — 2029 — Thereafter 400,000 1,149,636 Less: discount (2,198) Less: unamortized loan costs (8,172) $ 1,139,266
Schedule of Unsecured Term Loans	Our unsecured private placement notes as of March 31, 2024, payable interest-only, are summarized below ( $ in thousands ): Amount Inception Maturity Fixed Rate $ 75,000 September 2016 September 2024 3.93% 50,000 November 2015 November 2025 4.33% 100,000 January 2015 January 2027 4.51% $ 225,000
Schedule of Interest Expense	The following table summarizes interest expense ($ in thousands ): Three Months Ended March 31, 2024 2023 Interest expense on debt at contractual rates $ 14,087 $ 13,440 Capitalized interest (39) (19) Amortization of debt issuance costs, debt discount and other 821 606 Total interest expense $ 14,869 $ 14,027

Commitments. Contingencies an_2

Commitments. Contingencies and Uncertainties (Tables)	3 Months Ended
Commitments. Contingencies and Uncertainties (Tables)	Mar. 31, 2024
Commitments and Contingencies Disclosure [Abstract]
Schedule of Off Balance Sheet, Credit Loss, Liability, Roll Forward	The liability for expected credit losses on our unfunded loan commitments reflected in “ Accounts payable and accrued expenses ” on the Condensed Consolidated Balance Sheets as of March 31, 2024 and December 31, 2023 is presented in the following table for the three months ended March 31, 2024 ( $ in thousands ): Beginning balance January 1, 2024 $ 279 Provision for expected credit losses 10 Balance at March 31, 2024 $ 289

Redeemable Noncontrolling Int_2

Redeemable Noncontrolling Interest (Tables)	3 Months Ended
Redeemable Noncontrolling Interest (Tables)	Mar. 31, 2024
Noncontrolling Interest [Abstract]
Schedule of Redeemable Noncontrolling Interest	The following table presents the change in “ Redeemable noncontrolling interest” for the three months ended March 31, 2024 ( $ in thousands ): Three Months Ended March 31, 2024 Balance at January 1, $ 9,656 Net loss (225) Distributions (6) Balance at March 31, $ 9,425

Equity and Dividends (Tables)

Equity and Dividends (Tables)	3 Months Ended
Equity and Dividends (Tables)	Mar. 31, 2024
Equity [Abstract]
Schedule of Dividends Declared	The following table summarizes dividends declared by the Board of Directors or paid during the three months ended March 31, 2024 and 2023: Three Months Ended March 31, 2024 Date of Declaration Date of Record Date Paid/Payable Quarterly Dividend November 3, 2023 December 29, 2023 January 26, 2024 $0.90 February 16, 2024 March 28, 2024 May 3, 2024 $0.90 Three Months Ended March 31, 2023 Date of Declaration Date of Record Date Paid/Payable Quarterly Dividend November 6, 2022 December 30, 2022 January 27, 2023 $0.90 February 17, 2023 March 31, 2023 May 5, 2023 $0.90

Share-Based Compensation (Table

Share-Based Compensation (Tables)	3 Months Ended
Share-Based Compensation (Tables)	Mar. 31, 2024
Share-Based Payment Arrangement [Abstract]
Schedule of Share-based Payment Award, Stock Options, Valuation Assumptions	The fair value of each grant is estimated on the date of grant using the Black-Scholes option-pricing model with the following weighted average assumptions: 2024 2023 Dividend yield 6.4% 7.0% Expected volatility 26.1% 39.7% Expected lives 2.9 years 2.9 years Risk-free interest rate 4.49% 4.65%
Schedule of Stock Option Activity	The following table summarizes our outstanding stock options: Weighted Average Number Weighted Average Remaining of Shares Exercise Price Contractual Life (Years) Options outstanding, January 1, 2023 2,216,175 $70.97 Options granted 385,500 $54.73 Options forfeited (25,000) $74.67 Options expired (60,002) $64.33 Options outstanding, March 31, 2023 2,516,673 $68.61 Exercisable at March 31, 2023 2,132,828 $71.21 Options outstanding, January 1, 2024 2,447,171 $68.80 Options granted 431,000 $57.76 Options expired (301,837) $79.96 Options outstanding, March 31, 2024 2,576,334 $65.89 2.74 Exercisable at March 31, 2024 2,235,640 $66.99 2.45
Schedule of Disclosure of Share-Based Compensation Arrangements by Share-Based Payment Award	The following is a summary of share-based compensation expense, net of any forfeitures, included in “ General and administrative expenses ” in the Condensed Consolidated Statements of Income ( $ in thousands ): Three Months Ended March 31, 2024 2023 Share-based compensation components: Restricted stock expense $ 158 $ — Stock option expense 1,997 2,105 Total share-based compensation expense $ 2,155 $ 2,105

Earnings Per Common Share (Tabl

Earnings Per Common Share (Tables)	3 Months Ended
Earnings Per Common Share (Tables)	Mar. 31, 2024
Earnings Per Share [Abstract]
Schedule of Earnings Per Share, Basic and Diluted	The following table summarizes the average number of common shares and the net income used in the calculation of basic and diluted earnings per common share ($ in thousands, except share and per share amounts) : Three Months Ended March 31, 2024 2023 Net income $ 30,657 $ 34,183 Add: net loss attributable to noncontrolling interests 290 301 Net income attributable to stockholders 30,947 34,484 Less: net income attributable to unvested restricted stock awards (32) — Net income attributable to common stockholders - basic $ 30,915 $ 34,484 BASIC: Weighted average common shares outstanding 43,388,841 43,388,742 DILUTED: Weighted average common shares outstanding 43,388,841 43,388,742 Stock options 35,709 2,687 Weighted average dilutive common shares outstanding 43,424,550 43,391,429 Earnings per common share - basic $ 0.71 $ 0.79 Earnings per common share - diluted $ 0.71 $ 0.79 Incremental anti-dilutive shares excluded: Net share effect of stock options with an exercise price in excess of the average market price for our common shares 492,675 728,524 Regular dividends declared per common share $ 0.90 $ 0.90

Fair Value of Financial Instr_2

Fair Value of Financial Instruments (Tables)	3 Months Ended
Fair Value of Financial Instruments (Tables)	Mar. 31, 2024
Fair Value Disclosures [Abstract]
Schedule of Fair Value Measurements, Nonrecurring	Carrying amounts and fair values of financial instruments that are not carried at fair value at March 31, 2024 and December 31, 2023 in the Condensed Consolidated Balance Sheets are as follows ($ in thousands ): Carrying Amount Fair Value Measurement March 31, 2024 December 31, 2023 March 31, 2024 December 31, 2023 Level 2 Variable rate debt $ 443,758 $ 439,693 $ 448,500 $ 445,000 Fixed rate debt $ 695,508 $ 695,358 $ 614,295 $ 616,852 Level 3 Mortgage and other notes receivable, net $ 258,874 $ 245,271 $ 249,999 $ 237,646

Segment Reporting (Tables)

Segment Reporting (Tables)	3 Months Ended
Segment Reporting (Tables)	Mar. 31, 2024
Segment Reporting [Abstract]
Schedule of Segment Reporting Information, by Segment	Summary information for the reportable segments during the three months ended March 31, 2024 and 2023 is as follows ( $ in thousands ): For the three months ended March 31, 2024: Real Estate Investments SHOP Non-segment/Corporate Total Rental income $ 62,187 $ — $ — $ 62,187 Resident fees and services — 13,256 — 13,256 Interest income and other 5,942 — 128 6,070 Total revenues 68,129 13,256 128 81,513 Senior housing operating expenses — 10,314 — 10,314 Taxes and insurance on leased properties 2,733 — — 2,733 NOI 65,396 2,942 128 68,466 Depreciation 15,058 2,437 10 17,505 Interest 763 — 14,106 14,869 Legal — — 236 236 Franchise, excise and other taxes — — (187) (187) General and administrative — — 5,642 5,642 Loan and realty losses 10 — — 10 Gains on sales of real estate, net (100) — — (100) Gains from equity method investment (166) — — (166) Net income (loss) $ 49,831 $ 505 $ (19,679) $ 30,657 Total assets $ 2,202,511 $ 265,120 $ 10,494 $ 2,478,125 For the three months ended March 31, 2023: Real Estate Investments SHOP Non-segment/Corporate Total Rental income $ 65,299 $ — $ — $ 65,299 Resident fees and services — 11,700 — 11,700 Interest income and other 5,308 — 81 5,389 Total revenues 70,607 11,700 81 82,388 Senior housing operating expenses — 9,799 — 9,799 Taxes and insurance on leased properties 2,619 — — 2,619 NOI 67,988 1,901 81 69,970 Depreciation 15,376 2,227 14 17,617 Interest 759 — 13,268 14,027 Legal — — 122 122 Franchise, excise and other taxes — — 183 183 General and administrative — — 5,653 5,653 Loan and realty gains (418) — — (418) Gains on sales of real estate, net (1,397) — — (1,397) Net income (loss) $ 53,668 $ (326) $ (19,159) $ 34,183 Total assets $ 2,254,939 $ 270,085 $ 8,206 $ 2,533,230

Variable Interest Entities (Tab

Variable Interest Entities (Tables)	3 Months Ended
Variable Interest Entities (Tables)	Mar. 31, 2024
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Schedule of Variable Interest Entities	The Company’s unconsolidated VIEs are summarized below by date of initial involvement. For further discussion of the nature of the relationships, including the sources of exposure to these VIEs, see the notes to our condensed consolidated financial statements cross-referenced below ( $ in thousands ). Date Name Source of Exposure Carrying Amount Maximum Exposure to Loss Note Reference 2014 Senior Living Notes and straight-line receivable $ 87,964 $ 92,464 Notes 3, 4 2016 Senior Living Management Notes $ 24,500 $ 24,500 — 2018 Bickford Notes $ 16,861 $ 29,415 Notes 3, 4 2019 Encore Senior Living Various 1 $ 56,965 $ 57,639 — 2020 Timber Ridge OpCo Various 2 $ 689 $ 5,689 Notes 6, 7 2020 Watermark Retirement Notes and straight-line receivable $ 9,450 $ 11,723 — 2021 Montecito Medical Real Estate Notes and funding commitment $ 20,498 $ 50,243 Note 4 2021 Vizion Health Notes and straight-line receivable $ 16,173 $ 16,173 — 2021 Navion Senior Solutions Various 3 $ 7,990 $ 7,990 — 2023 Kindcare Senior Living Notes 4 $ 758 $ 758 — 1 Notes, straight-line rent receivable, and lease receivables 2 Loan commitment, equity method investment, straight-line rent receivable and unamortized lease incentive 3 Development commitments, straight-line rent receivable, and unamortized lease incentive 4 Represents two mezzanine loans originated from the sales of real estate

Organization and Nature of Bu_2

Organization and Nature of Business (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2024 USD ($) segment	Mar. 31, 2024 property	Mar. 31, 2024 state	Mar. 31, 2024 tenant	Mar. 31, 2024 mortgage	Mar. 31, 2024 unit	Mar. 31, 2024 jointVenture	Dec. 31, 2023 USD ($)
Real Estate Properties [Line Items]
Number of reportable segments \| segment	2
Number of properties		1
Number of health care properties related to mortgage notes receivables		17			9
Loans and leases receivable, gross \| $	$ 274,349
Credit loss reserve \| $	(15,475)							$ (15,476)
Real Estate Investments
Real Estate Properties [Line Items]
Real estate investment property, portfolio assets \| $	2,400,000
Properties		163
Number of states in which entity operates \| state			31
Number of lessees \| tenant				25
Senior Housing Community \| Real Estate Investments
Real Estate Properties [Line Items]
Properties		97
Skilled Nursing Facility
Real Estate Properties [Line Items]
Properties		32
Skilled Nursing Facility \| Real Estate Investments
Real Estate Properties [Line Items]
Properties		65
Hospital \| Real Estate Investments
Real Estate Properties [Line Items]
Properties		1
Independent Living Facility
Real Estate Properties [Line Items]
Properties		3
Number of states in which entity operates \| state			8
Number of joint ventures \| jointVenture							2
Independent Living Facility \| SHOP
Real Estate Properties [Line Items]
Real estate investment property, portfolio assets \| $	$ 348,700
Properties		15
Number of units in real estate property \| unit						1,732

Basis of Presentation and Sig_4

Basis of Presentation and Significant Accounting Policies (Narrative) (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2024 USD ($) property mortgage segment realEstatePartnership operator jointVenture
Property, Plant and Equipment [Line Items]
Number of real estate partnerships \| realEstatePartnership	2
Loans and leases receivable, gross \| $	$ (274,349)
Number of reportable segments \| segment	2
Non-performing
Property, Plant and Equipment [Line Items]
Mortgage note receivables \| mortgage	2
Number of operators/borrowers \| operator	2
Non-performing \| Mortgage Receivable And Mezzanine Loan
Property, Plant and Equipment [Line Items]
Loans and leases receivable, gross \| $	$ (26,500)
Minimum
Property, Plant and Equipment [Line Items]
Residency agreement, term	30 days
Maximum
Property, Plant and Equipment [Line Items]
Residency agreement, term	1 year
Independent Living Facility
Property, Plant and Equipment [Line Items]
Number of joint ventures \| jointVenture	2
Properties \| property	3
Independent Living Facility \| SHOP
Property, Plant and Equipment [Line Items]
Properties \| property	15

Basis of Presentation and Sig_5

Basis of Presentation and Significant Accounting Policies (Schedule of Cash and Cash Equivalents and Restricted Cash) (Details) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023	Mar. 31, 2023	Dec. 31, 2022
Accounting Policies [Abstract]
Cash and cash equivalents	$ 11,357	$ 22,347	$ 13,875	$ 19,291
Restricted cash (included in Other assets, net)	1,972	2,270	1,652	2,225
Cash, cash equivalents, and restricted cash	$ 13,329	$ 24,617	$ 15,527	$ 21,516

Investment Activity (Tenant Con

Investment Activity (Tenant Concentration Narrative) (Details) $ in Thousands		1 Months Ended	3 Months Ended
	Apr. 01, 2024 USD ($)	May 06, 2024 USD ($)	Mar. 31, 2024 USD ($) property leaseAgreement state boardMember facility	Mar. 31, 2023 USD ($)	Dec. 31, 2023 USD ($)
Real Estate [Line Items]
Cost of corporate office			$ 2,600	$ 2,600
Credit loss reserve			(15,475)		$ (15,476)
Straight-line rent, net of write-offs			$ (308)	2,097
Number of board of directors \| boardMember			2
Rental income			$ 62,187	65,299
Bickford Senior Living Acquisition
Real Estate [Line Items]
Asset acquisition, rent deferral deduction			2,500
Lease Extended Until 2026 \| Subsequent Event
Real Estate [Line Items]
Lease escalator minimum	2%
Annual lease cap	3%
Senior Living Communities, LLC (“Senior Living”)
Real Estate [Line Items]
Straight-line rent, net of write-offs			700	300
Rental income			12,815	12,833
National HealthCare Corporation (“NHC”)
Real Estate [Line Items]
Straight-line rent, net of write-offs			100	300
Rental income			$ 11,246	9,807
National HealthCare Corporation (“NHC”) \| NHC - 1991 Lease
Real Estate [Line Items]
Percentage rent rate			4%
Bickford
Real Estate [Line Items]
Properties \| facility			39
Number of leases \| leaseAgreement			4
Rent deferral			$ 16,500
Rental income			10,054	11,162
Bickford \| Subsequent Event
Real Estate [Line Items]
Maximum capital improvements commitment	$ 8,000	$ 8,000
Annual rent increase	8%	8%
Bickford \| Bickford Senior Living Acquisition
Real Estate [Line Items]
Payments for rent			$ 1,500	$ 200
Bickford \| Lease Extended Until 2026 \| Subsequent Event
Real Estate [Line Items]
Rental income	$ 34,500
NHC - 1991 Lease \| Senior Living Communities, LLC (“Senior Living”)
Real Estate [Line Items]
Properties \| property			10
Revenue as % of Total, Exceeds 10%
Real Estate [Line Items]
Number of states in which entity operates \| state			2
Geographic Concentration Risk \| South Carolina \| Investment Consideration Benchmark
Real Estate [Line Items]
Concentration risk percentage			12.10%
Geographic Concentration Risk \| Texas \| Investment Consideration Benchmark
Real Estate [Line Items]
Concentration risk percentage			10.70%
Independent Living Facility
Real Estate [Line Items]
Number of states in which entity operates \| state			8
Properties \| property			3
Independent Living Facility \| SHOP
Real Estate [Line Items]
Real estate investment property, portfolio assets			$ 348,700
Properties \| property			15
Skilled Nursing Facility
Real Estate [Line Items]
Properties \| property			32
Skilled Nursing Facility \| National HealthCare Corporation (“NHC”) \| Subleased Facilities
Real Estate [Line Items]
Properties \| property			4

Investment Activity (Schedule o

Investment Activity (Schedule of Tenant Concentrations) (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023	Dec. 31, 2023
Tenant Concentration [Line Items]
Gross Real Estate	$ 2,783,370		$ 2,780,358
Total Gross Real Estate	2,444,078
Total notes receivable	274,349
Revenues	62,187	$ 65,299
Escrow funds received from tenants for property operating expenses	2,733	2,619
Resident fees and services	13,256	11,700
Total revenues	$ 81,513	$ 82,388
Percentage of continuing revenue	16%	14%
Senior Living Communities, LLC (“Senior Living”)
Tenant Concentration [Line Items]
Gross Real Estate	$ 573,631
Notes Receivable	48,200
Revenues	$ 12,815	$ 12,833
Percentage of continuing revenue	16%	16%
National HealthCare Corporation (“NHC”)
Tenant Concentration [Line Items]
Gross Real Estate	$ 133,770
Notes Receivable	0
Revenues	$ 11,246	$ 9,807
Percentage of continuing revenue	14%	12%
Bickford
Tenant Concentration [Line Items]
Gross Real Estate	$ 429,043
Notes Receivable	16,747
Revenues	$ 10,054	$ 11,162
Percentage of continuing revenue	12%	14%
All others, net
Tenant Concentration [Line Items]
Gross Real Estate	$ 1,307,634
Notes Receivable	209,402
Revenues	$ 31,409	$ 34,267
Percentage of continuing revenue	39%	41%
Tenants With Escrow Funds
Tenant Concentration [Line Items]
Percentage of continuing revenue	3%	3%
More than 10% Operators
Tenant Concentration [Line Items]
Revenues	$ 68,257	$ 70,688

Investment Activity (Summary of

Investment Activity (Summary of NHC Percentage Rent) (Details) - National HealthCare Corporation (“NHC”) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Real Estate [Line Items]
Rent income from NHC	$ 3,035	$ 1,595
Current year
Real Estate [Line Items]
Rent income from NHC	1,379	965
Prior year final certification
Real Estate [Line Items]
Rent income (loss) from NHC	$ 1,656	$ 630

Investment Activity (Assets Hel

Investment Activity (Assets Held for Sale and Long-Lived Assets Narrative) (Details) $ in Thousands	1 Months Ended	3 Months Ended
	Mar. 31, 2024 USD ($) property	Mar. 31, 2024 USD ($) property	Mar. 31, 2023 USD ($) property	Dec. 31, 2023 USD ($) property
Real Estate [Line Items]
Number of properties \| property	1	1
Rental income		$ 62,187	$ 65,299
Real Estate Investments
Real Estate [Line Items]
Impairment of real estate			$ 300
Number of real estate properties, impaired, sold or classified as held for sale \| property			3
Disposal Group, Held-for-sale, Not Discontinued Operations
Real Estate [Line Items]
Rental income		300	$ 500
Disposal Group, Held-for-sale, Not Discontinued Operations \| Senior Living Campuses \| 2024 Disposal Group
Real Estate [Line Items]
Purchase price	$ 38,500	38,500
Lease income, annual rent	2,900
Net real estate balance	$ 19,600	$ 19,600
Disposal Group, Held-for-sale, Not Discontinued Operations \| Real Estate Investments
Real Estate [Line Items]
Number of properties \| property	1	1		1
Held for sale, net real estate balance	$ 5,000	$ 5,000		$ 5,000

Investment Activity (Cash Basis

Investment Activity (Cash Basis Operators Narrative) (Details)	3 Months Ended
	Mar. 31, 2024 operator
Cash Basis Lessees
Real Estate [Line Items]
Number of cash basis operators	3

Investment Activity (Schedule_2

Investment Activity (Schedule of Cash Rents Received) (Details) - USD ($) $ in Thousands	3 Months Ended		12 Months Ended
	Mar. 31, 2024	Mar. 31, 2023	Dec. 31, 2023
Real Estate [Line Items]
Total rental income from cash basis operators	$ 62,187	$ 65,299
Cash Basis Lessees
Real Estate [Line Items]
Total rental income from cash basis operators	11,765	12,006
Cash Basis Lessees \| Bickford
Real Estate [Line Items]
Total rental income from cash basis operators	9,364	7,807
Asset acquisition, rent deferral deduction			$ 2,500
Cash Basis Lessees \| All others
Real Estate [Line Items]
Total rental income from cash basis operators	$ 2,401	$ 4,199

Investment Activity (Tenant Tra

Investment Activity (Tenant Transition Narrative) (Details) $ in Millions	3 Months Ended
	Mar. 31, 2024 USD ($)
Skilled Nursing Facilities
Real Estate [Line Items]
Straight-line rent receivable	$ (0.8)

Investment Activity (Second Qua

Investment Activity (Second Quarter 2024 Dispositions Narrative) (Details) $ in Thousands	1 Months Ended	3 Months Ended
	May 06, 2024 USD ($) tenant property	Mar. 31, 2024 USD ($)	Mar. 31, 2023 USD ($)
Real Estate [Line Items]
Gains on sales of real estate, net		$ 100	$ 1,397
Assisted Living Facilities \| Disposal Group, Disposed of by Sale, Not Discontinued Operations \| Subsequent Event
Real Estate [Line Items]
Properties \| property	2
Number of tenants leased on cash basis \| tenant	1
Amount of real estate sold in cash consideration	$ 4,600
Gains on sales of real estate, net	$ 1,300

Investment Activity (Tenant Pur

Investment Activity (Tenant Purchase Options Narrative) (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2024 USD ($) property	Mar. 31, 2023 USD ($)	Dec. 31, 2023 USD ($)
Real Estate [Line Items]
Real estate properties, net	$ 2,092,580		$ 2,107,082
Rental income	$ 62,187	$ 65,299
Lease Option
Real Estate [Line Items]
Properties \| property	3
Lease Option, Between 2027 and 2028
Real Estate [Line Items]
Real estate properties, net	$ 58,000
Rental income	$ 1,800	$ 1,800

Investment Activity (Schedule_3

Investment Activity (Schedule of Future Minimum Lease Payments) (Details) $ in Thousands	Mar. 31, 2024 USD ($)
Real Estate [Abstract]
Remainder of 2024	$ 175,434
2025	237,719
2026	245,066
2027	197,770
2028	191,509
2029	174,278
Thereafter	525,045
Future minimum lease payments	$ 1,746,821

Investment Activity (Schedule_4

Investment Activity (Schedule of Fixed and Variable Lease Payments) (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Fixed and Variable Lease Payments [Line Items]
Rental income	$ 62,187	$ 65,299
Straight-line rent adjustments	308	(2,097)
Lease payments based on fixed escalators
Fixed and Variable Lease Payments [Line Items]
Rental income	56,592	58,937
Lease payments based on variable escalators
Fixed and Variable Lease Payments [Line Items]
Rental income	3,893	1,945
Straight-line rent, net of write-offs
Fixed and Variable Lease Payments [Line Items]
Straight-line rent adjustments	308	(2,097)
Escrow funds received from tenants for property operating expenses
Fixed and Variable Lease Payments [Line Items]
Rental income	2,733	2,619
Amortization of lease incentives
Fixed and Variable Lease Payments [Line Items]
Amortization of lease incentives	$ (723)	$ (299)

Mortgage And Other Notes Rece_3

Mortgage And Other Notes Receivable (Narrative) (Details) $ in Thousands

1 Months Ended

3 Months Ended

12 Months Ended

Feb. 29, 2024 USD ($) extensionOption

Mar. 31, 2024 USD ($) extensionTerm property

Mar. 31, 2023 USD ($)

Dec. 31, 2023 USD ($)

Mar. 31, 2024 property

Mar. 31, 2024 mortgage

Mar. 31, 2024 unit

Mar. 31, 2024 operator

Mar. 31, 2024 facility

Mar. 31, 2024

Mar. 31, 2024 loan

Dec. 31, 2021 property

Accounts, Notes, Loans and Financing Receivable [Line Items]

Number of health care properties related to mortgage notes receivables

Credit loss reserve

$ (15,475)

$ (15,476)

Financing receivable, excluding accrued interest, after allowance for credit loss

(258,874)

(245,271)

Loans and leases agreement

132,700

Interest income and other

6,070

$ 5,389

Increase rate in the amount of loss from a default

20%

Effective adjustment rate

44%

Carriage Crossing Senior Living

Accounts, Notes, Loans and Financing Receivable [Line Items]

Loans and leases agreement

$ 15,000

Contingent incentive payments

$ 2,000

Term of loan agreement

5 years

Financing receivable, stated interest rate

8.75%

Number of loan extensions | extensionOption

Financing receivable, renewal term

1 year

Montecito Medical Real Estate

Accounts, Notes, Loans and Financing Receivable [Line Items]

Mortgage and other notes receivable, net

20,300

Interest income and other

500

400

Loans and leases agreement

50,000

Bickford

Accounts, Notes, Loans and Financing Receivable [Line Items]

Mortgage and other notes receivable, net

16,747

Properties | facility

Interest income and other

300

Repayments of term loan

100

Senior Living Communities, LLC (“Senior Living”)

Accounts, Notes, Loans and Financing Receivable [Line Items]

Mortgage and other notes receivable, net

$ 48,200

Financing receivable, renewal term

1 year

Revolving amount line of credit

$ 20,000

Revolving note receivable amount outstanding

$ (15,500)

Loans receivable facility bears interest rate

Number of renewal term | extensionTerm

Purchase option at a stated minimum price

$ 38,300

Mezzanine

Accounts, Notes, Loans and Financing Receivable [Line Items]

Credit loss reserve

(10,000)

Non-performing

Accounts, Notes, Loans and Financing Receivable [Line Items]

Mortgage notes receivable, designated as nonperforming

2,000

$ 2,100

Number of operators/borrowers | operator

Interest income and other

500

$ 500

Non-performing | Mezzanine

Accounts, Notes, Loans and Financing Receivable [Line Items]

Financing receivable, excluding accrued interest, after allowance for credit loss

(14,500)

Number of operators/borrowers | operator

Secured By Real Estate

Accounts, Notes, Loans and Financing Receivable [Line Items]

Mortgage and other notes receivable, net

177,400

Not Secured By Real Estate

Accounts, Notes, Loans and Financing Receivable [Line Items]

Mortgage and other notes receivable, net

$ 96,900

Property Held by Fund | Montecito Medical Real Estate

Accounts, Notes, Loans and Financing Receivable [Line Items]

Number of medical office buildings | property

Combined purchase price of medical office buildings

$ 86,700

Fully Funded | Bickford

Accounts, Notes, Loans and Financing Receivable [Line Items]

Loans and leases agreement

14,700

Number of construction loans | loan

Disposal Group, Disposed of by Sale, Not Discontinued Operations | Bickford

Accounts, Notes, Loans and Financing Receivable [Line Items]

Note receivable interest rate

10%

Disposal Group, Disposed of by Sale, Not Discontinued Operations | Bickford Note Investment | Unlikely to be Collected Financing Receivable

Accounts, Notes, Loans and Financing Receivable [Line Items]

Increase in notes receivable from sales of real estate

(12,600)

Negotiations to sale | Bickford

Accounts, Notes, Loans and Financing Receivable [Line Items]

Properties | property

After 2021 | Senior Living Communities, LLC (“Senior Living”)

Accounts, Notes, Loans and Financing Receivable [Line Items]

Revolving amount line of credit

15,000

July 2019 Transaction | Senior Living Communities, LLC (“Senior Living”)

Accounts, Notes, Loans and Financing Receivable [Line Items]

Loans and leases agreement

$ 32,700

Loan agreement term

5 years

Annual interest rate from master credit agreement

7.25%

June 2019 Transaction | Senior Living Communities, LLC (“Senior Living”)

Accounts, Notes, Loans and Financing Receivable [Line Items]

Number of units in real estate property | unit

248

Mortgage And Other Notes Rece_4

Mortgage And Other Notes Receivable (Schedule of Financing Receivables By Credit Quality Indicator) (Details) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Financing Receivable, Credit Quality Indicator [Line Items]
Credit loss reserve	$ (15,475)	$ (15,476)
Financing receivable, after allowance for credit loss	258,874	$ 245,271
Mortgages
Financing Receivable, Credit Quality Indicator [Line Items]
2024	14,855
2023	1,550
2022	70,278
2021	0
2020	22,367
Prior	56,355
Total	165,405
Mezzanine
Financing Receivable, Credit Quality Indicator [Line Items]
2024	0
2023	727
2022	0
2021	38,444
2020	0
Prior	25,000
Total	64,171
Non-performing
Financing Receivable, Credit Quality Indicator [Line Items]
2024	0
2023	0
2022	0
2021	0
2020	2,047
Prior	0
Total	26,547
Revolver
Financing Receivable, Credit Quality Indicator [Line Items]
Total	18,226
more than 1.5x \| Mortgages
Financing Receivable, Credit Quality Indicator [Line Items]
2024	0
2023	0
2022	70,278
2021	0
2020	22,367
Prior	35,232
Total	127,877
more than 1.5x \| Mezzanine
Financing Receivable, Credit Quality Indicator [Line Items]
2024	0
2023	506
2022	0
2021	14,520
2020	0
Prior	0
Total	15,026
more than 1.5x \| Revolver
Financing Receivable, Credit Quality Indicator [Line Items]
Total	15,500
between 1.0x and 1.5x \| Mortgages
Financing Receivable, Credit Quality Indicator [Line Items]
2024	14,855
2023	930
2022	0
2021	0
2020	0
Prior	6,423
Total	22,208
between 1.0x and 1.5x \| Mezzanine
Financing Receivable, Credit Quality Indicator [Line Items]
2024	0
2023	0
2022	0
2021	23,924
2020	0
Prior	0
Total	23,924
between 1.0x and 1.5x \| Non-performing
Financing Receivable, Credit Quality Indicator [Line Items]
2024	0
2023	0
2022	0
2021	0
2020	0
Prior	24,500
Total	24,500
between 1.0x and 1.5x \| Revolver
Financing Receivable, Credit Quality Indicator [Line Items]
Total	2,726
less than 1.0x \| Mortgages
Financing Receivable, Credit Quality Indicator [Line Items]
2024	0
2023	620
2022	0
2021	0
2020	0
Prior	14,700
Total	15,320
less than 1.0x \| Mezzanine
Financing Receivable, Credit Quality Indicator [Line Items]
2024	0
2023	221
2022	0
2021	0
2020	0
Prior	25,000
Total	25,221
EBITDARM Coverage less than 1.0x \| Non-performing
Financing Receivable, Credit Quality Indicator [Line Items]
2024	0
2023	0
2022	0
2021	0
2020	2,047
Prior	0
Total	$ 2,047

Mortgage And Other Notes Rece_5

Mortgage And Other Notes Receivable (Schedule of Financing Receivables By Allowance for Credit Loss) (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2024 USD ($)
Financing Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance at January 1, 2024	$ 15,476
Provision for expected credit losses	(1)
Balance at March 31, 2024	$ 15,475

Senior Housing Operating Port_2

Senior Housing Operating Portfolio Structure (Details)	3 Months Ended
Senior Housing Operating Portfolio Structure (Details)	Mar. 31, 2024 USD ($) property jointVenture
Minimum
Senior Housing Operating Portfolio Formation Activities [Line Items]
Management fee multiplier \| $	$ 1,000
Merrill Gardens Managed Portfolio
Senior Housing Operating Portfolio Formation Activities [Line Items]
Interest in joint venture percentage	20%
Management fee	5%
Real estate services fee	5%
Discovery Managed Portfolio
Senior Housing Operating Portfolio Formation Activities [Line Items]
Management fee	5%
Common equity interest in venture	2%
SHOP \| New Venture
Senior Housing Operating Portfolio Formation Activities [Line Items]
Ownership percentage	100%
Independent Living Facility
Senior Housing Operating Portfolio Formation Activities [Line Items]
Number of joint ventures \| jointVenture	2
Properties	3
Independent Living Facility \| Merrill Gardens Managed Portfolio
Senior Housing Operating Portfolio Formation Activities [Line Items]
Properties	6
Independent Living Facility \| Discovery Managed Portfolio
Senior Housing Operating Portfolio Formation Activities [Line Items]
Properties	9
Independent Living Facility \| SHOP
Senior Housing Operating Portfolio Formation Activities [Line Items]
Properties	15

Equity Method Investment (Detai

Equity Method Investment (Details) $ in Thousands	1 Months Ended		3 Months Ended
Equity Method Investment (Details) $ in Thousands	Feb. 28, 2023 USD ($)	Jan. 31, 2020 USD ($)	Mar. 31, 2024 USD ($) extensionOption	Mar. 31, 2023 USD ($)
Schedule of Equity Method Investments [Line Items]
Cumulative unrecognized equity method losses			$ (5,000)
Unrecognized equity method losses			(600)	$ (600)
Gains from equity method investment			$ 166	$ 0
Operating lease term			7 years
Number of renewal options \| extensionOption			2
Balance secured by the deed and indenture			$ 11,800
Timber Ridge OpCo
Schedule of Equity Method Investments [Line Items]
Financing receivable of revolving credit facility			5,000
Amortization and write-off of lease incentives	$ 2,500
Maximum exposure to loss			5,000
Timber Ridge OpCo
Schedule of Equity Method Investments [Line Items]
Mortgage and other notes receivable, net			0
Gains from equity method investment			200
Timber Ridge OpCo \| Cumulative Amount
Schedule of Equity Method Investments [Line Items]
Cumulative unrecognized equity method losses			$ (9,900)
Timber Ridge OpCo \| Noncontrolling Interests \| Real Estate Operating Company
Schedule of Equity Method Investments [Line Items]
Investments in affiliates		$ 900
LCS Timber Ridge \| Real Estate Operating Company
Schedule of Equity Method Investments [Line Items]
Equity interest in affiliates		25%

Other Assets (Details)

Other Assets (Details) - USD ($) $ in Thousands	1 Months Ended	3 Months Ended
Other Assets (Details) - USD ($) $ in Thousands	Feb. 28, 2023	Mar. 31, 2024	Mar. 31, 2023	Dec. 31, 2023	Dec. 31, 2022
Segment Reporting Information [Line Items]
Lease incentive payments, net		$ 9,946		$ 10,669
Regulatory escrows		6,208		6,208
Restricted cash		1,972	$ 1,652	2,270	$ 2,225
Other assets		26,053		24,063
Payment of lease incentive		0	$ 10,000
Timber Ridge OpCo
Segment Reporting Information [Line Items]
Payment of lease incentive	$ 10,000
SHOP
Segment Reporting Information [Line Items]
Accounts receivable and prepaid expenses		2,563		1,620
Allowance		375		343
Real Estate Investments
Segment Reporting Information [Line Items]
Accounts receivable and prepaid expenses		$ 5,364		$ 3,296

Debt (Schedule of Debt) (Detail

Debt (Schedule of Debt) (Details) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Debt Instrument [Line Items]
Revolving credit facility - unsecured	$ 248,500	$ 245,000
Unamortized loan costs	(8,172)	(8,912)
Debt	1,139,266	1,135,051
Debt instrument, unamortized discount	(2,198)
Bank term loans - unsecured
Debt Instrument [Line Items]
Bank term loans - unsecured	200,000	200,000
2031 Senior Notes
Debt Instrument [Line Items]
Bank term loans - unsecured	397,802	397,722
Debt instrument, unamortized discount	(2,198)	(2,278)
Private placement notes - unsecured
Debt Instrument [Line Items]
Bank term loans - unsecured	225,000	225,000
Fannie Mae term loans - secured, non-recourse
Debt Instrument [Line Items]
Fannie Mae term loans - secured, non-recourse	$ 76,136	$ 76,241

Debt (Schedule of Maturities of

Debt (Schedule of Maturities of Long-term Debt) (Details) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Debt Instruments [Abstract]
Remainder of 2024	$ 75,425
2025	325,711
2026	248,500
2027	100,000
2028	0
2029	0
Thereafter	400,000
Long-term debt, gross	1,149,636
Less: discount	(2,198)
Less: unamortized loan costs	(8,172)	$ (8,912)
Debt	$ 1,139,266	$ 1,135,051

Debt (Narrative) (Details)

Debt (Narrative) (Details) $ in Millions	1 Months Ended	3 Months Ended
Debt (Narrative) (Details) $ in Millions	Jan. 31, 2021 USD ($)	Mar. 31, 2024 USD ($) property extensionOption
Debt Instrument [Line Items]
Debt leverage limit		50%
Fannie Mae term loans - secured, non-recourse
Debt Instrument [Line Items]
Interest rate		3.79%
Long-term debt		$ 60.1
Term of debt		10 years
Net book value		$ 100
Debt Instrument, Name, Fannie Mae Term Loans
Debt Instrument [Line Items]
Properties \| property		11
FNMA Berkadia Note
Debt Instrument [Line Items]
Interest rate		4.60%
Long-term debt		$ 16
Secured Overnight Financing Rate (SOFR)
Debt Instrument [Line Items]
Basis spread on variable rate		1%
Fed Funds Effective Rate Overnight Index Swap Rate
Debt Instrument [Line Items]
Basis spread on variable rate		0.50%
Minimum
Debt Instrument [Line Items]
Facility fee percentage		0.125%
Maximum
Debt Instrument [Line Items]
Facility fee percentage		0.30%
Secured Debt \| 2025 Term Loan
Debt Instrument [Line Items]
Aggregate principle amount issued		$ 200
Secured Debt \| Secured Overnight Financing Rate (SOFR) \| 2025 Term Loan
Debt Instrument [Line Items]
Basis spread on variable rate		0.10%
Senior Notes \| 2031 Senior Notes
Debt Instrument [Line Items]
Aggregate principle amount issued	$ 400
Interest rate	3%
Percentage of issue price on face value	99.196%
Proceeds from issuance of senior notes	$ 392.3
Revolving Credit Facility \| Minimum \| Secured Overnight Financing Rate (SOFR)
Debt Instrument [Line Items]
Basis spread on variable rate		0.725%
Revolving Credit Facility \| Minimum \| Base Rate
Debt Instrument [Line Items]
Basis spread on variable rate		0%
Revolving Credit Facility \| Maximum \| Secured Overnight Financing Rate (SOFR)
Debt Instrument [Line Items]
Basis spread on variable rate		1.40%
Revolving Credit Facility \| Maximum \| Base Rate
Debt Instrument [Line Items]
Basis spread on variable rate		0.40%
Revolving Credit Facility \| Unsecured Debt
Debt Instrument [Line Items]
Unsecured revolving credit facility		$ 700
Debt instrument, number of extension options \| extensionOption		2
Debt instrument, extension period		6 months
Unused balance of the unsecured revolving credit facility		$ 451.5

Debt (Schedule of Unsecured Ter

Debt (Schedule of Unsecured Term Loans) (Details) $ in Thousands	Mar. 31, 2024 USD ($)
September 2024
Unsecured Term Loans [Line Items]
Amount	$ 75,000
Fixed Rate	3.93%
November 2025
Unsecured Term Loans [Line Items]
Amount	$ 50,000
Fixed Rate	4.33%
January 2027
Unsecured Term Loans [Line Items]
Amount	$ 100,000
Fixed Rate	4.51%

Debt (Schedule of Interest Expe

Debt (Schedule of Interest Expense) (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Debt Instruments [Abstract]
Interest expense on debt at contractual rates	$ 14,087	$ 13,440
Capitalized interest	(39)	(19)
Amortization of debt issuance costs, debt discount and other	821	606
Total interest expense	$ 14,869	$ 14,027

Commitments. Contingencies an_3

Commitments. Contingencies and Uncertainties (Narrative) (Details) $ in Thousands		1 Months Ended	3 Months Ended
	Apr. 01, 2024 USD ($)	May 06, 2024 USD ($)	Mar. 31, 2024 USD ($) operator leaseAgreement property
Commitment and Contingencies [Line Items]
Loans and leases agreement			$ 132,700
Development commitments for construction and renovation			15,500
Amount funded toward the development commitments			12,600
Amount funded on real estate investments			1,000
Contingent lease inducement commitments and contingent consideration of acquisitions			8,900
Discovery PropCo
Commitment and Contingencies [Line Items]
Development commitments for construction and renovation			2,000
Bickford
Commitment and Contingencies [Line Items]
Mortgage and other notes receivable, net			$ 16,747
Number of leases \| leaseAgreement			4
Bickford \| Subsequent Event
Commitment and Contingencies [Line Items]
Maximum capital improvements commitment	$ 8,000	$ 8,000
Annual rent increase	8%	8%
Senior Living \| Subsequent Event
Commitment and Contingencies [Line Items]
Maximum capital improvements commitment		$ 10,000
Loans Receivable
Commitment and Contingencies [Line Items]
Number of operators/tenants \| operator			6
Notes Receivable Remain Unfunded
Commitment and Contingencies [Line Items]
Mortgage and other notes receivable, net			$ 88,500
Development Commitment
Commitment and Contingencies [Line Items]
Number of operators/tenants \| property			4
Lease Inducement
Commitment and Contingencies [Line Items]
Number of leases \| leaseAgreement			4

Commitments. Contingencies an_4

Commitments. Contingencies and Uncertainties (Off Balance Sheet Credit Loss Liability Roll Forward Schedule) (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2024 USD ($)
Off Balance Sheet, Credit Loss [Roll Forward]
Provision for expected credit losses	$ 10
Ending balance	289
Accounting Standards Update 2016-13
Off Balance Sheet, Credit Loss [Roll Forward]
Beginning balance	$ 279

Redeemable Noncontrolling Int_3

Redeemable Noncontrolling Interest (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Redeemable Noncontrolling Interests [Roll Forward]
Beginning balance	$ 9,656
Net loss	225	$ 305
Distributions	(6)
Ending balance	$ 9,425

Equity and Dividends (Narrative

Equity and Dividends (Narrative) (Details) - USD ($) $ / shares in Units, $ in Millions			3 Months Ended
	May 03, 2024	Feb. 16, 2024	Mar. 31, 2024	Mar. 31, 2023	Dec. 31, 2023
Dividends Payable [Line Items]
Authorized repurchase amount		$ 160
Common stock, par value (in dollars per share)		$ 0.01	$ 0.01		$ 0.01
Effective period of stock repurchase plan		1 year
Common stock repurchased (in shares)			0	0
At-the market shelf registration, equity offering sales agreement, aggregate sales price			$ 500
Issuance of common stock (in shares)			0	0
Dividends to common stockholders (in dollars per share)			$ 0.90	$ 0.90
Subsequent Event
Dividends Payable [Line Items]
Dividends to common stockholders (in dollars per share)	$ 0.90

Equity and Dividends (Schedule

Equity and Dividends (Schedule of Dividends Declared) (Details) - $ / shares	Feb. 16, 2024	Nov. 03, 2023	Feb. 17, 2023	Nov. 06, 2022
Equity [Abstract]
Quarterly dividend (in dollars per share)	$ 0.90	$ 0.90	$ 0.90	$ 0.90

Share-Based Compensation (Narra

Share-Based Compensation (Narrative) (Details) $ / shares in Units, $ in Millions	1 Months Ended	3 Months Ended
	Feb. 29, 2024 $ / shares shares	Mar. 31, 2024 USD ($) plan $ / shares shares	Mar. 31, 2023 $ / shares shares	Dec. 31, 2023 USD ($)
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of incentive plans \| plan		2
Options granted (in shares) \| shares			385,500
Weighted average fair value of options granted (in US dollars per share) \| $ / shares		$ 7.36	$ 10.56
Aggregate intrinsic value of stock options outstanding		$ 11.1		$ 9.1
Unrecognized compensation cost		$ 3.7
2019 Stock Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options granted (in shares) \| shares		431,000
Restricted stock expense \| Executive Officer \| 2019 Stock Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares issued in period (in shares) \| shares	15,000
Shares issued in period (in dollars per shares) \| $ / shares	$ 57.76
Stock option plan, award vesting period	5 years
Restricted stock expense \| Executive Officer \| 2019 Stock Incentive Plan \| Tranche One
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting rights, percentage	20%
Restricted stock expense \| Executive Officer \| 2019 Stock Incentive Plan \| Tranche Two
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting rights, percentage	20%
Restricted stock expense \| Executive Officer \| 2019 Stock Incentive Plan \| Tranche Three
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting rights, percentage	20%
Restricted stock expense \| Executive Officer \| 2019 Stock Incentive Plan \| Tranche Four
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting rights, percentage	20%
Restricted stock expense \| Executive Officer \| 2019 Stock Incentive Plan \| Tranche Five
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting rights, percentage	20%
Expected To Be Recognized Remainder Of 2023
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation cost		$ 2
Expected To Be Recognized During 2024
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation cost		1.1
Expected To Be Recognized During 2025
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation cost		0.3
Expected To Be Recognized During 2026
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation cost		0.1
Expected To Be Recognized During Thereafter
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation cost		$ 0.1

Share-Based Compensation (Sched

Share-Based Compensation (Schedule of Stock Option Valuation Assumptions) (Details)	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Share-Based Payment Arrangement [Abstract]
Dividend yield	6.40%	7%
Expected volatility	26.10%	39.70%
Expected lives	2 years 10 months 24 days	2 years 10 months 24 days
Risk-free interest rate	4.49%	4.65%

Share-Based Compensation (Sch_2

Share-Based Compensation (Schedule Of Stock Option Activity) (Details) - $ / shares	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding [Roll Forward]
Options outstanding beginning balance (in shares)	2,447,171	2,216,175
Options granted (in shares)		385,500
Options forfeited (in shares)		(25,000)
Options expired (in shares)	(301,837)
Options outstanding, ending balance (in shares)	2,576,334	2,516,673
Stock Options Weighted Average Exercise Price
Options outstanding (in dollars per share)	$ 68.80	$ 70.97
Options granted (in dollars per share)		54.73
Options forfeited (in dollars per share)		74.67
Options expired (in dollars per share)	79.96
Options outstanding (in dollars per share)	$ 65.89	$ 68.61
Stock Options Additional Disclosures
Options exercisable (in shares)	2,235,640	2,132,828
Options exercisable (in dollars per share)	$ 66.99	$ 71.21
Options outstanding (in years)	2 years 8 months 26 days
Options exercisable (in years)	2 years 5 months 12 days
2019 Stock Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding [Roll Forward]
Options granted (in shares)	431,000
Options expired (in shares)		(60,002)
Stock Options Weighted Average Exercise Price
Options granted (in dollars per share)	$ 57.76
Options expired (in dollars per share)		$ 64.33

Share-Based Compensation (Sch_3

Share-Based Compensation (Schedule of Share-Based Payments) (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Non-cash share-based compensation	$ 2,155	$ 2,105
Restricted stock expense
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Non-cash share-based compensation	158	0
Stock option expense
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Non-cash share-based compensation	$ 1,997	$ 2,105

Earnings Per Common Share (Summ

Earnings Per Common Share (Summary Of Calculation Of Basic And Diluted Earnings Per Share) (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Earnings Per Share [Abstract]
Net income	$ 30,657	$ 34,183
Add: net loss attributable to noncontrolling interests	290	301
Net income attributable to stockholders	30,947	34,484
Less: net income attributable to unvested restricted stock awards	(32)	0
Net income attributable to common stockholders - basic	$ 30,915	$ 34,484
BASIC:
Weighted average common shares outstanding (in shares)	43,388,841	43,388,742
DILUTED:
Weighted average common shares outstanding (in shares)	43,388,841	43,388,742
Stock options (in shares)	35,709	2,687
Weighed average dilutive common shares outstanding (in shares)	43,424,550	43,391,429
Earnings per common share - basic (in dollars per share)	$ 0.71	$ 0.79
Earnings per common share - diluted (in dollars per share)	$ 0.71	$ 0.79
Incremental anti-dilutive shares excluded:
Net share effect of stock options with an exercise price in excess of the average market price for our common shares (in shares)	492,675	728,524
Regular dividends declared per common share (in dollars per share)	$ 0.90	$ 0.90

Fair Value of Financial Instr_3

Fair Value of Financial Instruments (Fair Value Measurements, Nonrecurring) (Details) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Level 3 \| Carrying Amount
Fair Value of Financial Instruments [Line Items]
Mortgage and other notes receivable, net	$ 258,874	$ 245,271
Level 3 \| Fair Value Measurement
Fair Value of Financial Instruments [Line Items]
Mortgage and other notes receivable, net	249,999	237,646
Variable rate debt \| Level 2 \| Carrying Amount
Fair Value of Financial Instruments [Line Items]
Debt instrument, fair value disclosure	443,758	439,693
Variable rate debt \| Level 2 \| Fair Value Measurement
Fair Value of Financial Instruments [Line Items]
Debt instrument, fair value disclosure	448,500	445,000
Fixed rate debt \| Level 2 \| Carrying Amount
Fair Value of Financial Instruments [Line Items]
Debt instrument, fair value disclosure	695,508	695,358
Fixed rate debt \| Level 2 \| Fair Value Measurement
Fair Value of Financial Instruments [Line Items]
Debt instrument, fair value disclosure	$ 614,295	$ 616,852

Segment Reporting (Narrative) (

Segment Reporting (Narrative) (Details) $ in Millions	3 Months Ended
Segment Reporting (Narrative) (Details) $ in Millions	Mar. 31, 2024 USD ($) operatingSegment	Mar. 31, 2023 USD ($)
Segment Reporting Information [Line Items]
Number of operating segments \| operatingSegment	2
Real Estate Investments
Segment Reporting Information [Line Items]
Capital expenditures	$ 1.7	$ 55.8
SHOP
Segment Reporting Information [Line Items]
Capital expenditures	$ 1.3	$ 1.1

Segment Reporting (Schedule of

Segment Reporting (Schedule of Segment Reporting Information, by Segment) (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024		Mar. 31, 2023	Dec. 31, 2023	[1]
Segment Reporting Information [Line Items]
Rental income	$ 62,187		$ 65,299
Resident fees and services	13,256		11,700
Interest income and other	6,070		5,389
Total revenues	81,513		82,388
Senior housing operating expenses	10,314		9,799
Taxes and insurance on leased properties	2,733		2,619
NOI	68,466		69,970
Depreciation	17,505		17,617
Interest	14,869		14,027
Legal	236		122
Franchise, excise and other taxes	(187)		183
General and administrative	5,642		5,653
Loan and realty losses (gains)	10		(418)
Gains on sales of real estate, net	(100)		(1,397)
Gains from equity method investment	(166)		0
Net income	30,657		34,183
Total assets	2,478,125	[1]	2,533,230	$ 2,488,480
Operating Segments \| Real Estate Investments
Segment Reporting Information [Line Items]
Rental income	62,187		65,299
Resident fees and services	0		0
Interest income and other	5,942		5,308
Total revenues	68,129		70,607
Senior housing operating expenses	0		0
Taxes and insurance on leased properties	2,733		2,619
NOI	65,396		67,988
Depreciation	15,058		15,376
Interest	763		759
Legal	0		0
Franchise, excise and other taxes	0		0
General and administrative	0		0
Loan and realty losses (gains)	10		(418)
Gains on sales of real estate, net	(100)		(1,397)
Gains from equity method investment	(166)
Net income	49,831		53,668
Total assets	2,202,511		2,254,939
Operating Segments \| SHOP
Segment Reporting Information [Line Items]
Rental income	0		0
Resident fees and services	13,256		11,700
Interest income and other	0		0
Total revenues	13,256		11,700
Senior housing operating expenses	10,314		9,799
Taxes and insurance on leased properties	0		0
NOI	2,942		1,901
Depreciation	2,437		2,227
Interest	0		0
Legal	0		0
Franchise, excise and other taxes	0		0
General and administrative	0		0
Loan and realty losses (gains)	0		0
Gains on sales of real estate, net	0		0
Gains from equity method investment	0
Net income	505		(326)
Total assets	265,120		270,085
Non-segment/Corporate
Segment Reporting Information [Line Items]
Rental income	0		0
Resident fees and services	0		0
Interest income and other	128		81
Total revenues	128		81
Senior housing operating expenses	0		0
Taxes and insurance on leased properties	0		0
NOI	128		81
Depreciation	10		14
Interest	14,106		13,268
Legal	236		122
Franchise, excise and other taxes	(187)		183
General and administrative	5,642		5,653
Loan and realty losses (gains)	0		0
Gains on sales of real estate, net	0		0
Gains from equity method investment	0
Net income	(19,679)		(19,159)
Total assets	$ 10,494		$ 8,206

[1] The consolidated balance sheets include the following amounts related to our consolidated Variable Interest Entities (VIEs): $510.1 million and $513.2 million of Real estate properties, net; $5.4 million and $10.9 million of Cash and cash equivalents;$9.7 million and $9.7 million of Straight-line rent receivable; $9.8 million and $9.4 million of Other assets, net; and $2.6 million and $4.7 million of Accounts payable and accrued expenses, in each case as of March 31, 2024 and December 31, 2023, respectively.

Variable Interest Entities - Na

Variable Interest Entities - Narrative (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2024 USD ($) realEstatePartnership	Mar. 31, 2023 USD ($)	Dec. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)
Variable Interest Entity [Line Items]
Real estate properties, net	$ 2,092,580		$ 2,107,082
Cash and cash equivalents	$ 11,357	$ 13,875	22,347	$ 19,291
Number of real estate partnerships \| realEstatePartnership	2
Other assets, net	$ 26,053		24,063
Subsidiaries
Variable Interest Entity [Line Items]
Real estate properties, net	250,500		252,500
Cash and cash equivalents	2,500		3,200
Straight line receivables	9,700		9,700
Other assets, net	7,200		7,800
SHOP
Variable Interest Entity [Line Items]
Real estate properties, net	259,600		260,700
Cash and cash equivalents	2,900		7,700
Prepaid expense	2,600		$ 1,700
Credit liabilities of SHOP	$ (2,600)	$ (4,700)

Variable Interest Entities - Sc

Variable Interest Entities - Schedule of Variable Interest Entities (Details) $ in Thousands	Mar. 31, 2024 USD ($)
Senior Living \| Straight-Line Rent Receivable
Variable Interest Entity [Line Items]
Carrying Amount	$ 87,964
Maximum Exposure to Loss	92,464
Senior Living Management \| Straight-Line Rent Receivable
Variable Interest Entity [Line Items]
Carrying Amount	24,500
Maximum Exposure to Loss	24,500
Bickford \| Straight-Line Rent Receivable
Variable Interest Entity [Line Items]
Carrying Amount	16,861
Maximum Exposure to Loss	29,415
Encore Senior Living \| Notes Receivable
Variable Interest Entity [Line Items]
Carrying Amount	56,965
Maximum Exposure to Loss	57,639
Timber Ridge OpCo
Variable Interest Entity [Line Items]
Maximum Exposure to Loss	5,000
Timber Ridge OpCo \| Notes Receivable
Variable Interest Entity [Line Items]
Carrying Amount	689
Maximum Exposure to Loss	5,689
Watermark Retirement \| Notes Receivable
Variable Interest Entity [Line Items]
Carrying Amount	9,450
Maximum Exposure to Loss	11,723
Montecito Medical Real Estate \| Notes Receivable
Variable Interest Entity [Line Items]
Carrying Amount	20,498
Maximum Exposure to Loss	50,243
Vizion Health \| Notes Receivable
Variable Interest Entity [Line Items]
Carrying Amount	16,173
Maximum Exposure to Loss	16,173
Navion Senior Solutions \| Notes Receivable
Variable Interest Entity [Line Items]
Carrying Amount	7,990
Maximum Exposure to Loss	7,990
Kindcare Senior Living \| Notes Receivable
Variable Interest Entity [Line Items]
Carrying Amount	758
Maximum Exposure to Loss	$ 758