BROOKDALE SENIOR LIVING INC., 10-K filed on 2/21/2024
Annual Report
v3.24.0.1
Cover Page - USD ($)
$ in Billions
12 Months Ended
Dec. 31, 2023
Feb. 19, 2024
Jun. 30, 2023
Document Information [Line Items]      
Document Type 10-K    
Document Annual Report true    
Document Period End Date Dec. 31, 2023    
Current Fiscal Year End Date --12-31    
Document Transition Report false    
Entity File Number 001-32641    
Entity Registrant Name BROOKDALE SENIOR LIVING INC.    
Entity Incorporation, State or Country Code DE    
Entity Tax Identification Number 20-3068069    
Entity Address, Address Line One 111 Westwood Place,    
Entity Address, Address Line Two Suite 400,    
Entity Address, City or Town Brentwood,    
Entity Address, State or Province TN    
Entity Address, Postal Zip Code 37027    
City Area Code (615)    
Local Phone Number 221-2250    
Entity Well-known Seasoned Issuer Yes    
Entity Voluntary Filers No    
Entity Current Reporting Status Yes    
Entity Interactive Data Current Yes    
Entity Filer Category Large Accelerated Filer    
Entity Small Business false    
Entity Emerging Growth Company false    
ICFR Auditor Attestation Flag true    
Document Financial Statement Error Correction [Flag] false    
Entity Shell Company false    
Entity Public Float     $ 0.8
Entity Common Stock, Shares Outstanding   189,339,428  
Documents Incorporated by Reference
Certain sections of the registrant's Definitive Proxy Statement relating to its 2024 Annual Meeting of Stockholders to be filed with the SEC within 120 days of December 31, 2023, are incorporated by reference into Part III of this Annual Report on Form 10-K.
   
Entity Central Index Key 0001332349    
Document Fiscal Year Focus 2023    
Document Fiscal Period Focus FY    
Amendment Flag false    
Common Stock      
Document Information [Line Items]      
Title of 12(b) Security Common Stock, $0.01 Par Value Per Share    
Trading Symbol BKD    
Security Exchange Name NYSE    
Incremental shares issuable under purchase contracts      
Document Information [Line Items]      
Title of 12(b) Security 7.00% Tangible Equity Units    
Trading Symbol BKDT    
Security Exchange Name NYSE    
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Audit Information
12 Months Ended
Dec. 31, 2023
Audit Information [Abstract]  
Auditor Name Ernst & Young LLP
Auditor Firm ID 42
Auditor Location Chicago, Illinois
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CONSOLIDATED BALANCE SHEETS - USD ($)
$ in Thousands
Dec. 31, 2023
Dec. 31, 2022
Current assets    
Cash and cash equivalents $ 277,971 $ 398,850
Marketable securities 29,755 48,680
Restricted cash 41,341 27,735
Accounts receivable, net 48,393 55,761
Prepaid expenses and other current assets, net 80,908 106,067
Total current assets 478,368 637,093
Property, plant and equipment and leasehold intangibles, net 4,330,629 4,535,702
Operating lease right-of-use assets 670,907 597,130
Restricted cash 30,356 47,963
Investment in unconsolidated ventures 1,906 55,333
Goodwill 27,321 27,321
Deferred tax asset 0 1,604
Other assets, net 33,948 34,916
Total assets 5,573,435 5,937,062
Current liabilities    
Current portion of long-term debt 41,463 66,043
Current portion of financing lease obligations 1,075 24,059
Current portion of operating lease obligations 192,631 176,758
Trade accounts payable 66,526 71,000
Accrued expenses 242,668 237,148
Refundable fees and deferred revenue 55,753 66,197
Total current liabilities 600,116 641,205
Long-term debt, less current portion 3,655,850 3,784,099
Financing lease obligations, less current portion 150,774 224,801
Operating lease obligations, less current portion 683,876 616,973
Deferred tax liability 5,987 0
Other liabilities 71,679 85,831
Total liabilities 5,168,282 5,352,909
Preferred stock, $0.01 par value, 50,000,000 shares authorized at December 31, 2023 and 2022; no shares issued and outstanding 0 0
Common stock, $0.01 par value, 400,000,000 shares authorized at December 31, 2023 and 2022; 198,780,826 and 197,776,991 shares issued and 188,253,301 and 187,249,466 shares outstanding, respectively 1,988 1,978
Additional paid-in-capital 4,342,362 4,332,302
Treasury stock, at cost; 10,527,525 shares at December 31, 2023 and 2022 (102,774) (102,774)
Accumulated deficit (3,837,912) (3,648,901)
Total Brookdale Senior Living Inc. stockholders' equity 403,664 582,605
Noncontrolling interest 1,489 1,548
Total equity 405,153 584,153
Total liabilities and equity $ 5,573,435 $ 5,937,062
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CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares
Dec. 31, 2023
Dec. 31, 2022
Statement of Financial Position [Abstract]    
Preferred stock, par value (in dollars per share) $ 0.01 $ 0.01
Preferred stock, shares authorized (in shares) 50,000,000 50,000,000
Preferred stock, shares issued (in shares) 0 0
Preferred stock, shares outstanding (in shares) 0 0
Common stock, par value (in dollars per share) $ 0.01 $ 0.01
Common stock, shares authorized (in shares) 400,000,000 400,000,000
Common stock, shares issued (in shares) 198,780,826 197,776,991
Common stock, shares outstanding (in shares) 188,253,301 187,249,466
Treasury stock, shares (in shares) 10,527,525 10,527,525
v3.24.0.1
CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($)
shares in Thousands, $ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Revenue $ 3,015,829 $ 2,825,379 $ 2,758,259
Cost of Revenue [Abstract]      
General and administrative expense (including non-cash stock-based compensation expense of $11,985, $14,466, and $16,270, respectively) 178,894 168,594 184,916
Facility operating lease expense 202,410 165,294 174,358
Depreciation and amortization 342,712 347,444 337,613
Asset impairment 40,572 29,618 23,003
Loss (gain) on sale of communities, net (36,296) (73,850) 0
Loss (gain) on facility operating lease termination, net 0 0 (2,003)
Income (loss) from operations 18,412 (42,687) (216,936)
Interest income 23,146 6,935 1,349
Interest expense:      
Debt (209,772) (157,869) (141,409)
Financing lease obligations (21,950) (48,061) (46,282)
Amortization of deferred financing costs (7,696) (6,446) (7,297)
Change in fair value of derivatives 1,144 7,659 (152)
Gain (loss) on debt modification and extinguishment, net (2,702) (1,357) (1,932)
Equity in earnings (loss) of unconsolidated ventures (3,996) (10,782) 10,394
Non-operating gain (loss) on sale of assets, net 1,441 595 288,835
Other non-operating income (loss) 21,687 12,114 5,903
Income (loss) before income taxes (180,286) (239,899) (107,527)
Benefit (provision) for income taxes (8,784) 1,559 8,163
Net income (loss) (189,070) (238,340) (99,364)
Net (income) loss attributable to noncontrolling interest 59 (87) 74
Net income (loss) attributable to Brookdale Senior Living Inc. common stockholders $ (189,011) $ (238,427) $ (99,290)
Basic and diluted net income (loss) per share attributable to Brookdale Senior Living Inc. common stockholders      
Basic net income (loss) per share attributable to Brookdale Senior Living Inc. common stockholders (in dollars per share) $ (0.84) $ (1.25) $ (0.54)
Diluted net income (loss) per share attributable to Brookdale Senior Living Inc. common stockholders (in dollars per share) $ (0.84) $ (1.25) $ (0.54)
Weighted average shares used in computing basic and diluted net income (loss) per share      
Weighted average shares used in computing basic net income (loss) per share (in shares) 225,209 190,463 184,975
Weighted average shares used in computing diluted net income (loss) per share (in shares) 225,209 190,463 184,975
Resident fees      
Revenue $ 2,857,270 $ 2,585,529 $ 2,543,848
Management fees      
Revenue 10,161 12,020 20,598
Reimbursed costs incurred on behalf of managed communities      
Revenue 139,325 147,361 181,445
Cost of Revenue [Abstract]      
Costs incurred 139,325 147,361 181,445
Other operating income      
Revenue 9,073 80,469 12,368
Facility operating expense      
Cost of Revenue [Abstract]      
Costs incurred $ 2,129,800 $ 2,083,605 $ 2,075,863
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CONSOLIDATED STATEMENTS OF OPERATIONS (Parenthetical) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Income Statement [Abstract]      
Facility depreciation and amortization $ 317,581 $ 324,904 $ 313,830
Non-cash stock-based compensation expense $ 11,985 $ 14,466 $ 16,270
v3.24.0.1
CONSOLIDATED STATEMENTS OF EQUITY - USD ($)
$ in Thousands
Total
Common Stock
Additional Paid-In- Capital
Treasury Stock
Accumulated Deficit
Noncontrolling Interest
Balances at beginning of period at Dec. 31, 2020 $ 802,729 $ 1,983 $ 4,212,409 $ (102,774) $ (3,311,184) $ 2,295
Increase (Decrease) in Stockholders' Equity [Roll Forward]            
Compensation expense related to restricted stock grants     16,270      
Issuance of common stock under Associate Stock Purchase Plan     699      
Purchase of capped call transactions     (15,916)      
Restricted stock and restricted stock units, net   (1) 1      
Shares withheld for employee taxes   (7) (4,813)      
Other, net     25      
Net income (loss) (99,290)       (99,290)  
Net income (loss) attributable to noncontrolling interest (99,364)         (74)
Balances at end of period at Dec. 31, 2021 699,623 $ 1,975 4,208,675 (102,774) (3,410,474) 2,221
Balances at beginning of period (in shares) at Dec. 31, 2020   187,804,000        
Equity, Including Portion Attributable to Noncontrolling Interest [Abstract]            
Issuance of common stock under Associate Stock Purchase Plan (in shares)   124,000        
Restricted stock and restricted stock units, net (in shares)   (159,000)        
Shares withheld for employee taxes (in shares)   (811,000)        
Balances at end of period (in shares) at Dec. 31, 2021   186,958,000        
Increase (Decrease) in Stockholders' Equity [Roll Forward]            
Compensation expense related to restricted stock grants     14,466      
Issuance of tangible equity units, net of issuance costs     113,457      
Restricted stock and restricted stock units, net   $ 9 (9)      
Shares withheld for employee taxes   (6) (4,287)      
Net income (loss) (238,427)       (238,427)  
Net income (loss) attributable to noncontrolling interest (238,340)         87
Noncontrolling interest distribution           (760)
Balances at end of period at Dec. 31, 2022 $ 584,153 $ 1,978 4,332,302 (102,774) (3,648,901) 1,548
Equity, Including Portion Attributable to Noncontrolling Interest [Abstract]            
Restricted stock and restricted stock units, net (in shares)   911,000        
Shares withheld for employee taxes (in shares)   (620,000)        
Balances at end of period (in shares) at Dec. 31, 2022 187,249,466 187,249,000        
Increase (Decrease) in Stockholders' Equity [Roll Forward]            
Compensation expense related to restricted stock grants     11,985      
Restricted stock and restricted stock units, net   $ 16 (16)      
Shares withheld for employee taxes   (6) (1,909)      
Net income (loss) $ (189,011)       (189,011)  
Net income (loss) attributable to noncontrolling interest (189,070)         (59)
Balances at end of period at Dec. 31, 2023 $ 405,153 $ 1,988 $ 4,342,362 $ (102,774) $ (3,837,912) $ 1,489
Equity, Including Portion Attributable to Noncontrolling Interest [Abstract]            
Restricted stock and restricted stock units, net (in shares)   1,580,000        
Shares withheld for employee taxes (in shares)   (576,000)        
Balances at end of period (in shares) at Dec. 31, 2023 188,253,301 188,253,000        
v3.24.0.1
CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Cash Flows from Operating Activities      
Net income (loss) $ (189,070) $ (238,340) $ (99,364)
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:      
Loss (gain) on debt modification and extinguishment, net 2,702 1,357 1,932
Depreciation and amortization, net 350,408 353,890 344,910
Asset impairment 40,572 29,618 23,003
Equity in (earnings) loss of unconsolidated ventures 3,996 10,782 (10,394)
Distributions from unconsolidated ventures from cumulative share of net earnings 430 561 6,191
Amortization of entrance fees (732) (2,307) (1,758)
Proceeds from deferred entrance fee revenue 477 4,222 3,562
Deferred income tax (benefit) provision 7,590 (1,324) (9,837)
Operating lease expense adjustment (45,739) (34,896) (23,280)
Change in fair value of derivatives (1,144) (7,659) 152
Loss (gain) on sale of assets, net (37,737) (74,445) (288,835)
Loss (gain) on facility operating lease termination, net 0 0 (2,003)
Non-cash stock-based compensation expense 11,985 14,466 16,270
Property and casualty insurance income (18,920) (11,379) (4,689)
Other non-operating (income) loss (2,542) 0 0
Changes in operating assets and liabilities:      
Accounts receivable, net 7,380 (4,624) 502
Prepaid expenses and other assets, net 21,629 (21,240) (15,483)
Trade accounts payable and accrued expenses 2,448 (27,185) (54,032)
Refundable fees and deferred revenue (654) (1,934) (10,066)
Operating lease assets and liabilities for lessor capital expenditure reimbursements 9,844 13,718 30,965
Operating lease assets and liabilities for lease termination 0 0 (2,380)
Net cash provided by (used in) operating activities 162,923 3,281 (94,634)
Cash Flows from Investing Activities      
Purchase of marketable securities (174,476) (263,669) (362,257)
Sale and maturities of marketable securities 197,100 398,752 352,988
Capital expenditures, net of related payables (233,205) (196,924) (176,657)
Acquisition of assets, net of cash acquired (574) (6,004) 0
Investment in unconsolidated ventures (7,589) (218) (5,436)
Distributions received from unconsolidated ventures 0 966 37,113
Proceeds from sale of assets, net 83,526 4,653 334,006
Property and casualty insurance proceeds 24,704 0 0
Purchase of interest rate cap instruments (12,454) (1,632) 0
Proceeds from interest rate cap instruments 9,890 788 0
Other (286) (4,141) 1,700
Net cash provided by (used in) investing activities (113,364) (67,429) 181,457
Cash Flows from Financing Activities      
Proceeds from debt 205,549 254,259 352,962
Repayment of debt and financing lease obligations (367,242) (281,185) (441,571)
Proceeds from issuance of tangible equity units 0 139,438 0
Purchase of capped call transactions 0 0 (15,916)
Payment of financing costs, net of related payables (10,831) (7,077) (3,904)
Payments of employee taxes for withheld shares (1,915) (4,293) (4,820)
Other 0 (760) (408)
Net cash provided by (used in) financing activities (174,439) 100,382 (113,657)
Net increase (decrease) in cash, cash equivalents, and restricted cash (124,880) 36,234 (26,834)
Cash, cash equivalents, and restricted cash at beginning of period 474,548 438,314 465,148
Cash, cash equivalents, and restricted cash at end of period $ 349,668 $ 474,548 $ 438,314
v3.24.0.1
Description of Business
12 Months Ended
Dec. 31, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]  
Description of Business
1. Description of Business

Brookdale Senior Living Inc. together with its consolidated subsidiaries ("Brookdale" or the "Company") is an operator of 652 senior living communities throughout the United States. The Company is committed to its mission of enriching the lives of the people it serves with compassion, respect, excellence, and integrity. The Company operates and manages independent living, assisted living, memory care, and continuing care retirement communities ("CCRCs"). The Company's senior living communities and its comprehensive network help to provide seniors with care, connection, and services in an environment that feels like home. As of December 31, 2023, the Company owned 345 communities, representing a majority of the Company's community portfolio, leased 277 communities, and managed 30 communities.
v3.24.0.1
Summary of Significant Accounting Policies
12 Months Ended
Dec. 31, 2023
Accounting Policies [Abstract]  
Summary of Significant Accounting Policies
2. Summary of Significant Accounting Policies

The consolidated financial statements have been prepared in accordance with U.S. generally accepted accounting principles ("GAAP"). The significant accounting policies are summarized below:

Principles of Consolidation

The consolidated financial statements include the accounts of Brookdale and its consolidated subsidiaries. The ownership interest of consolidated entities not wholly-owned by the Company are presented as noncontrolling interests in the accompanying consolidated financial statements. Intercompany balances and transactions have been eliminated in consolidation, and net income (loss) is reduced by the portion of net income (loss) attributable to noncontrolling interests.

Use of Estimates

The preparation of the consolidated financial statements and related disclosures in conformity with GAAP requires management to make estimates and assumptions that affect the amounts reported in the consolidated financial statements and accompanying notes. Estimates are used for, but not limited to, revenue, asset impairments, self-insurance reserves, performance-based compensation, allowance for credit losses, depreciation and amortization, leasing transactions, income taxes, and other contingencies. Although these estimates are based on management's best knowledge of current events and actions that the Company may undertake in the future, actual results may differ from the original estimates.

Revenue Recognition

Resident Fees

Resident fee revenue is reported at the amount that reflects the consideration the Company expects to receive in exchange for the services provided. These amounts are due from residents or third-party payors and include variable consideration for retroactive adjustments from estimated reimbursements, if any, under reimbursement programs. Performance obligations are determined based on the nature of the services provided. Resident fee revenue is recognized as performance obligations are satisfied.

Under the Company's senior living residency agreements, which are generally for a contractual term of 30 days to one year, the Company provides senior living services to residents for a stated daily or monthly fee. The Company has elected the lessor practical expedient within ASC 842, Leases ("ASC 842") and recognizes, measures, presents, and discloses the revenue for services under the Company's senior living residency agreements based upon the predominant component, either the lease or nonlease component, of the contracts. The Company has determined that the services included under the Company's independent living, assisted living, and memory care residency agreements have the same timing and pattern of transfer and are performance obligations that are satisfied over time. The Company recognizes revenue under ASC 606, Revenue Recognition from Contracts with Customers ("ASC 606") for its independent living, assisted living, and memory care residency agreements for which it has estimated that the nonlease components of such residency agreements are the predominant component of the contract.

The Company receives payment for services under various third-party payor programs which include Medicare, Medicaid, and other third-party payors. Estimates for settlements with third-party payors for retroactive adjustments from estimated reimbursements due to audits, reviews, or investigations are included in the determination of the estimated transaction price for providing services. The Company estimates the transaction price based on the terms of the contract with the payor,
correspondence with the payor, and historical payment trends. Changes to these estimates for retroactive adjustments are recognized in the period the change or adjustment becomes known or when final settlements are determined.

Billings for services under third-party payor programs are recorded net of estimated retroactive adjustments, if any. Retroactive adjustments are accrued on an estimated basis in the period the related services are rendered and adjusted in future periods or as final settlements are determined. Contractual or cost related adjustments from Medicare or Medicaid are accrued when assessed (without regard to when the assessment is paid or withheld). Subsequent adjustments to these accrued amounts are recorded in net revenues when known.

Management Services

The Company manages certain communities under contracts which provide periodic management fee payments to the Company and reimbursement for costs and expense related to such communities. Management fees are generally determined by an agreed upon percentage of gross revenues (as defined in the management agreement). Certain management contracts also provide for an annual incentive fee to be paid to the Company upon achievement of certain metrics identified in the contract. The Company has determined that all community management activities are a single performance obligation, which is satisfied over time as the services are rendered. The Company estimates the amount of incentive fee revenue expected to be earned, if any, during the annual contract period and revenue is recognized as services are provided. The Company's estimate of the transaction price for management services also includes the amount of reimbursement due from the owners of the communities for services provided and related costs incurred. Such revenue is included in reimbursed costs incurred on behalf of managed communities on the consolidated statements of operations. The related costs are included in costs incurred on behalf of managed communities on the consolidated statements of operations.

Government Grants

The Company recognizes income for government grants on a systematic and rational basis over the periods in which the Company recognizes the related expenses or loss of revenue for which the grants are intended to compensate when there is reasonable assurance that the Company will comply with the applicable terms and conditions of the grant and there is reasonable assurance that the grant will be received.

Lease Accounting

The Company, as lessee, recognizes a right-of-use asset and a lease liability on the Company's consolidated balance sheet for its long-term leases. As of the commencement date of a lease, a lease liability and corresponding right-of-use asset is established on the Company's consolidated balance sheet at the estimated present value of future minimum lease payments. The Company's community leases generally contain fixed annual rent escalators or annual rent escalators based on an index, such as the consumer price index. The future minimum lease payments recognized on the consolidated balance sheet include fixed payments (including in-substance fixed payments) and variable payments estimated utilizing the index or rate on the lease commencement date. The Company recognizes lease expense as incurred for additional variable payments. For the Company's leases for which the rate implicit in the lease is not readily determinable, the Company utilizes its estimated incremental borrowing rate to determine the present value of lease payments based on information available at commencement of the lease. The Company's estimated incremental borrowing rate reflects the fixed rate at which the Company could borrow a similar amount for the same term on a collateralized basis. For accounting purposes, renewal or extension options are included in the lease term at lease inception or modification when it is reasonably certain that the Company will exercise the option. The Company elected the short-term lease exception policy which permits leases with an initial term of 12 months or less to not be recorded on the Company's consolidated balance sheet.

The Company, as lessee, makes a determination with respect to each of its leases as to whether each should be accounted for as an operating lease or financing lease. The classification criteria is based on estimates regarding the fair value of the leased asset, minimum lease payments, effective cost of funds, economic life of the asset, and certain other terms in the lease agreements.

Lease right-of-use assets are reviewed for impairment whenever changes in circumstances indicate that the carrying amount of an asset group may not be recoverable. Recoverability of right-of-use assets are assessed by a comparison of the carrying amount of the asset group to the estimated future undiscounted net cash flows expected to be generated by the asset group, calculated utilizing the lowest level of identifiable cash flows. If estimated future undiscounted net cash flows are less than the carrying amount of the asset group then the fair value of the asset is estimated. The impairment loss is determined by comparing the estimated fair value of the asset to its carrying amount, with any amount in excess of fair value recognized as an impairment loss in the current period. Undiscounted cash flow projections and estimates of fair value amounts are based on a number of assumptions such as revenue and expense growth rates and estimated lease coverage ratios (Level 3).
Operating Leases

The Company recognizes operating lease expense for actual rent paid, generally plus or minus a straight-line adjustment for estimated minimum lease escalators if applicable. The right-of-use asset is generally reduced each period by an amount equal to the difference between the operating lease expense and the amount of expense on the lease liability utilizing the effective interest method. Subsequent to the impairment of an operating lease right-of-use asset, the Company recognizes operating lease expense consisting of the reduction of the right-of-use asset on a straight-line basis over the remaining lease term and the amount of expense on the lease liability utilizing the effective interest method.

Financing Leases

Financing lease right-of-use assets are recognized within property, plant and equipment and leasehold intangibles, net on the Company's consolidated balance sheets. The Company recognizes interest expense on the financing lease liabilities utilizing the effective interest method. The right-of-use asset is generally amortized to depreciation and amortization expense on a straight-line basis over the lease term unless the lease contains an option to purchase the underlying asset that the Company is reasonably certain to exercise. If the Company is reasonably certain to exercise the purchase option, the asset is amortized over the useful life.

Sale-Leaseback Transactions

For transactions in which an owned community is sold and leased back from the buyer (sale-leaseback transactions), the Company recognizes an asset sale and lease accounting is applied if the Company has transferred control of the community. For such transactions, the Company removes the transferred assets from the consolidated balance sheet and a gain or loss on the sale is recognized for the difference between the carrying amount of the asset and the transaction price for the sale transaction.

For sale‑leaseback transactions in which the Company has not transferred control of the underlying asset, the Company does not recognize an asset sale or derecognize the underlying asset until control is transferred. For such transactions, the Company recognizes the underlying assets within assets under financing leases as a component of property, plant and equipment and leasehold intangibles, net on the consolidated balance sheets and continues to depreciate the assets over their useful lives. Additionally, the Company accounts for any amounts received as a financing lease liability and the Company recognizes interest expense on the financing lease liability utilizing the effective interest method with the interest expense limited to an amount that is not greater than the cash payments on the financing lease liability over the term of the lease. The Company reviews for sale accounting whenever events or changes in circumstances indicate that control may have been transferred and the Company recognizes an asset sale and lease accounting is applied if the Company has transferred control of the underlying asset. When an asset sale is recognized for such transactions, the Company removes the transferred assets and financing lease liability from the consolidated balance sheet and a gain or loss on the sale is recognized for the difference between the carrying amount of the asset and the financing lease liability.

Gain (Loss) on Sale of Assets

The Company regularly enters into real estate transactions which may include the disposition of certain communities, including the associated real estate. The Company recognizes a gain or loss from real estate sales when the transfer of control is complete.

The Company recognizes a gain or loss from the sale of equity method investments when the transfer of control is complete and the Company has no continuing involvement with the transferred financial assets.

Purchase Accounting

For the acquisition of assets that do not meet the definition of a business, the Company accounts for the transaction as an asset acquisition at the purchase price, including acquisition costs, allocated among the acquired assets and assumed liabilities, including identified intangible assets and liabilities, based upon the relative fair values using Level 3 inputs at the date of acquisition.

For acquisitions of a business, the Company accounts for the transaction as a business combination pursuant to the acquisition method and assets acquired and liabilities assumed, including identified intangible assets and liabilities, are recorded at fair value. In determining the allocation of the purchase price of companies and communities to net tangible and identified intangible assets acquired and liabilities assumed, the Company makes estimates of fair value using information obtained as a result of pre-acquisition due diligence, marketing, leasing activities, and/or independent appraisals. In connection with a business combination, the excess of the fair value of liabilities assumed and common stock issued and cash paid over the fair
value of identifiable assets acquired is allocated to goodwill. Transaction costs associated with business combinations are expensed as incurred.

Deferred Financing Costs

Costs and fees incurred with third parties that directly relate to obtaining new long-term debt (excluding the Company's line-of-credit) are recorded as a direct adjustment to the carrying amount of long-term debt. The Company presents deferred financing costs related to line-of-credit facilities in other assets, net on the consolidated balance sheet. The Company amortizes deferred financing costs on a straight-line basis, which approximates the effective yield method over the term of the related debt arrangements.

Stock-Based Compensation

Measurement of the cost of employee services received in exchange for stock-based compensation is based on the grant-date fair value of the employee stock awards, which is based on the quoted price of the Company's common shares on the grant date for the majority of the Company's awards. The Company evaluates if grant-date fair value adjustments are necessary based on whether the Company is in possession of material non-public information at the grant date and the changes in the Company’s stock price subsequent to the release of such information and no adjustments were made. The Company recognizes forfeitures of stock-based awards as they occur and any previously recognized compensation expense is reversed for forfeited awards. Stock-based awards that vest over a requisite service period, other than those with performance or market conditions, generally vest ratably in annual installments over a period of three to four years. Incremental compensation costs arising from subsequent modifications of awards after the grant date are recognized when incurred.

Certain of the Company's employee stock-based awards vest only upon the achievement of performance conditions. The Company recognizes compensation cost only when achievement of performance conditions is considered probable. Consequently, the Company’s determination of the amount of stock-based compensation expense requires judgment in estimating the probability of achievement of these performance conditions. Performance conditioned awards that vest dependent upon attainment of various levels of performance that equal or exceed threshold levels generally vest based upon performance at the end of a three-year performance period. The number of shares that ultimately vest can range from 0% to 150% of the stock-based awards granted depending on the level of achievement of the performance criteria.

Certain of the Company's employee stock-based awards vest only upon the achievement of a market condition where the measurement period is three years and vesting of the awards is based on the Company's level of attainment of a specified total stockholder return relative to the percentage appreciation of a specified index of companies for the respective three-year measurement period. Compensation expense for awards with market conditions is recognized over the service period, which is generally four years, and the actual achievement of the market condition does not impact expense recognition. The Company uses a Monte Carlo valuation model to estimate the grant date fair value of such awards. Depending on the results achieved during the three-year measurement period, the number of shares that ultimately vest may range from 0% to 150% of the stock-based awards granted. The expected volatility of the Company's common stock at the date of grant is estimated based on a historical average volatility rate for the approximate three-year performance period and the estimated expected weighted average volatility was 83.3% and 76.0% for awards granted in 2023 and 2022, respectively. The risk-free interest rate assumption is based on observed interest rates consistent with the approximate three-year measurement period and the estimated weighted average risk free interest rate was 4.4% and 1.8% for awards granted in 2023 and 2022, respectively.

For all share-based awards with graded vesting other than performance conditioned awards, the Company records compensation expense for the entire award on a straight-line basis (or, if applicable, on the accelerated method) over the requisite service period. For performance conditioned awards, total compensation expense is recognized over the requisite service period for each separately vesting tranche of the award as if the award is, in substance, multiple awards once the performance condition is deemed probable of achievement. Performance conditions are evaluated quarterly. If such conditions are not ultimately met or it is not probable the conditions will be achieved, no compensation expense for performance conditioned awards is recognized and any previously recognized compensation expense is reversed.

Income Taxes

The Company accounts for income taxes under the asset and liability approach which requires recognition of deferred tax assets and liabilities for the differences between the financial reporting and tax basis of assets and liabilities using the tax rates in effect for the year in which the differences are expected to affect taxable income. A valuation allowance reduces deferred tax assets when it is more likely than not that some portion or all of the deferred tax assets will not be realized. When it is determined that it is more likely than not that the Company will be able to realize deferred tax assets in the future in excess of
the net recorded amount, an adjustment to the deferred tax asset is made and reflected in income. This determination is made by considering various factors, including the reversal and timing of existing temporary differences, tax planning strategies, and estimates of future taxable income exclusive of the reversal of temporary differences.

Fair Value of Financial Instruments

Fair value measurements are based on a three-level valuation hierarchy for disclosure of fair value measurements. The valuation hierarchy is based upon the transparency of inputs to the valuation of an asset or liability as of the measurement date. Categorization within the valuation hierarchy is based upon the lowest level of input that is significant to the fair value measurement. The three levels are defined as follows.

Level 1 – quoted prices (unadjusted) for identical assets or liabilities in active markets;

Level 2 – quoted prices for similar assets and liabilities in active markets; quoted prices for identical or similar instruments in markets that are not active; and model-derived valuations in which significant inputs and significant value drivers are observable in active markets; and

Level 3 – fair value measurements derived from valuation techniques in which one or more significant inputs or significant value drivers are unobservable.

Marketable Securities

Marketable securities are investments in commercial paper and short-term corporate bond instruments with maturities of greater than 90 days as of their acquisition date by the Company.

Accounts Receivable, Net

Accounts receivable are reported net of an allowance for credit losses to represent the Company's estimate of expected losses at the balance sheet date. The adequacy of the Company's allowance for credit losses is reviewed on an ongoing basis, using historical payment trends, write-off experience, analyses of receivable portfolios by payor source and aging of receivables, a review of specific accounts, as well as expected future economic conditions and market trends, and adjustments are made to the allowance as necessary.

Property, Plant and Equipment and Leasehold Intangibles, Net

Property, plant and equipment and leasehold intangibles, net are recorded at cost. Depreciation and amortization is computed using the straight-line method over the estimated useful lives of the assets, which are as follows.

Asset CategoryEstimated
Useful Life
(in years)
Buildings and improvements 
40
Furniture and equipment 
3 – 10
Resident in-place lease intangibles 
1 – 3

Expenditures for ordinary maintenance and repairs are expensed to operations as incurred. Renovations and improvements, which improve and/or extend the useful life of the asset, are capitalized and depreciated over the estimated useful life of the renovations or improvements. For communities subject to operating or financing leases, leasehold improvements are depreciated over the shorter of the estimated useful life of the assets or the term of the lease. For financing leases that have a purchase option the Company is reasonably certain to exercise, the leasehold improvements are depreciated over their estimated useful life. Facility operating expense excludes facility depreciation and amortization.

Long-lived assets are reviewed for impairment whenever events or changes in circumstances indicate the carrying amount of an asset group may not be recoverable. Recoverability of an asset group is assessed by comparing its carrying amount to the estimated future undiscounted net cash flows expected to be generated by the asset group through operation or disposition, calculated utilizing the lowest level of identifiable cash flows. If this comparison indicates that the carrying amount of an asset group is not recoverable, the Company is required to recognize an impairment loss. The impairment loss is measured by the amount by which the carrying amount of the asset exceeds its estimated fair value, with any amount in excess of fair value
recognized as an expense in the current period. Undiscounted cash flow projections and estimates of fair value amounts are based on a number of assumptions such as revenue and expense growth rates, estimated holding periods, and estimated capitalization rates (Level 3).

Investment in Unconsolidated Ventures

The Company reports investments in unconsolidated entities over whose operating and financial policies it has the ability to exercise significant influence under the equity method of accounting. The initial carrying amount of investment in unconsolidated ventures is based on the amount paid to purchase the investment or its fair value in the case of a retained noncontrolling interest upon deconsolidation of a former subsidiary. The Company's reported share of earnings of an unconsolidated venture is adjusted for the impact, if any, of basis differences between its carrying amount of the equity investment and its share of the venture's underlying assets. Distributions received from an investee are recognized as a reduction in the carrying amount of the investment.

The Company evaluates realization of its investment in ventures accounted for using the equity method if circumstances indicate that the Company's investment is other than temporarily impaired. A current fair value of an investment that is less than its carrying amount may indicate a loss in value of the investment. If the Company determines that an equity method investment is other than temporarily impaired, it is recorded at its fair value with an impairment charge recognized in asset impairment expense for the difference between its carrying amount and fair value.

Goodwill

The Company tests goodwill for impairment annually during the fourth quarter or more frequently if indicators of impairment arise. Factors the Company considers important in its analysis of whether an indicator of impairment exists include a significant decline in the Company's stock price or market capitalization for a sustained period since the last testing date, significant underperformance relative to historical or projected future operating results, and significant negative industry or economic trends. The Company first assesses qualitative factors to determine if it is more likely than not that the fair value of a reporting unit is less than its carrying amount. If so, the Company performs a quantitative goodwill impairment test based upon a comparison of the estimated fair value of the reporting unit to which the goodwill has been assigned with the reporting unit's carrying amount. The fair values used in the quantitative goodwill impairment test are estimated using Level 3 inputs based upon discounted future cash flow projections for the reporting unit. These cash flow projections are based upon a number of estimates and assumptions such as revenue and expense growth rates, capitalization rates, and discount rates. The Company also considers market-based measures such as earnings multiples in its analysis of estimated fair values of its reporting units. If the quantitative goodwill impairment test results in a reporting unit's carrying amount exceeding its estimated fair value, an impairment charge will be recorded based on the difference, with the impairment charge limited to the amount of goodwill allocated to the reporting unit.

Self-Insurance Liability Accruals

The Company is subject to various legal proceedings and claims that arise in the ordinary course of its business. Although the Company maintains general liability and professional liability insurance policies for its owned, leased, and managed communities under a master insurance program, the Company's current policies provide for deductibles for each claim and contain various exclusions from coverage. The Company uses its wholly-owned captive insurance company for the purpose of insuring certain portions of its risk retention under its general and professional liability insurance programs. Accordingly, the Company is, in effect, self-insured for claims that are less than the deductible amounts, for claims that exceed the funding level of the Company’s wholly-owned captive insurance company, and for claims or portions of claims that are not covered by such policies and/or exceed the policy limits. In addition, the Company maintains a high deductible workers' compensation program and a self-insured employee medical program.

The Company reviews the adequacy of its accruals related to these liabilities on an ongoing basis using historical claims, actuarial valuations, third-party administrator estimates, consultants, advice from legal counsel, and industry data, and adjusts accruals periodically. Estimated costs related to these self-insurance programs are accrued based on known claims and projected claims incurred but not yet reported. Subsequent changes in actual experience are monitored, and estimates are updated as information becomes available.

Treasury Stock

The Company accounts for treasury stock under the cost method and includes treasury stock as a component of stockholders' equity.
Reclassifications

Certain prior period amounts have been reclassified to conform to the current financial statement presentation, with no effect on the Company's consolidated financial position or results of operations.
v3.24.0.1
Acquisitions, Dispositions, and Other Significant Leasing Transactions
12 Months Ended
Dec. 31, 2023
Business Combination and Asset Acquisition [Abstract]  
Acquisitions, Dispositions, and Other Significant Leasing Transactions
3. Acquisitions, Dispositions, and Other Significant Leasing Transactions

Welltower Lease Amendments

During the three months ended June 30, 2023, the Company entered into amendments to its existing lease arrangements with Welltower Inc. ("Welltower") pursuant to which the Company continues to lease 74 communities. In connection with the amendments, the Company extended the maturity of one lease involving 39 communities from December 31, 2026 until June 30, 2032. As a result, the Company's amended lease arrangements provide that the current term for 69 of the communities will expire on June 30, 2032 and the current term for five of the communities will expire on December 31, 2024. The amendments did not change the amount of required lease payments over the previous term of the leases or the annual lease escalators. In addition, Welltower agreed to make available a pool in the aggregate amount of up to $17.0 million to fund costs associated with certain capital expenditure projects for 69 of the communities. Upon reimbursement of such expenditures, the annual minimum rent under the lease will prospectively increase by the amount of the reimbursement multiplied by the sum of the then current Secured Overnight Financing Rate ("SOFR") (subject to a floor of 3.0%) and a margin of 4.0%, and such amount will escalate annually consistent with the minimum rent escalation provisions of the 39 community lease.

The amended leases for 35 of such communities were prospectively classified as operating leases subsequent to the amendment. For 2023, the classification of such lease costs as operating lease expense resulted in a $19.3 million increase in cash lease payments for operating leases and an offsetting decrease in cash lease payments for financing leases. The amendment to the lease arrangements increased the right-of-use assets and lease obligations recognized on the Company's consolidated balance sheet each by $122.3 million.

The amendments replaced the net worth covenant provisions requiring the Company to maintain at least $400.0 million of stockholders' equity with a consolidated tangible net worth covenant requiring the Company to maintain at least $2.0 billion of tangible net worth, generally calculated as stockholders' equity plus accumulated depreciation and amortization less intangible assets and further adjusted for certain other items. Such calculation is generally similar to the tangible net worth covenants within certain of the Company’s long-term debt documents. So long as it maintains tangible net worth as defined in the leases of at least $1.5 billion, the Company will also be able to cure any breach by posting collateral with Welltower.

Community Transactions

During the year ended December 31, 2023, the Company completed the sale of two owned CCRCs for cash proceeds of $25.6 million, net of $29.6 million in mortgage debt repaid and transaction costs, and recognized a net gain on sale of communities of $36.3 million. During the year ended December 31, 2022, the Company completed the sale of two owned communities for cash proceeds of $4.4 million, net of transaction costs. During the year ended December 31, 2021, the Company completed the sale of three owned communities for cash proceeds of $16.5 million, net of transaction costs.

The Company's triple-net lease obligations on 24 communities were terminated from 2021 to 2023 (2 in 2021, 4 in 2022, and 18 in 2023), including through the acquisition of one formerly leased community in 2022. Additionally, the Company acquired the remaining 50% equity interest in one community during 2023.

Sale of Health Care Services

On July 1, 2021, the Company completed the sale of 80% of its equity in its Health Care Services segment to affiliates of HCA Healthcare, Inc. ("HCA Healthcare") for a purchase price of $400.0 million in cash, subject to certain adjustments set forth in the Securities Purchase Agreement (the "Purchase Agreement") dated February 24, 2021, including a reduction for the remaining outstanding balance as of the closing of Medicare advance payments and deferred payroll tax payments related to the Health Care Services segment (the "HCS Sale"). The Company received net cash proceeds of $312.6 million, including $305.8 million at closing on July 1, 2021 and $6.8 million upon completion of the post-closing net working capital adjustment in October 2021. The Purchase Agreement also contained certain agreed upon indemnities for the benefit of the purchaser. At closing of the transaction, the Company retained a 20% equity interest in the Health Care Services venture (the "HCS Venture").
The accompanying consolidated financial statements include the results of operations and cash flows of the Health Care Services segment through June 30, 2021. The results and financial position of the Health Care Services segment were deconsolidated from its consolidated financial statements as of July 1, 2021 and its 20% equity interest in the HCS Venture was accounted for under the equity method of accounting subsequent to that date. As of July 1, 2021, the Company recognized a $100.0 million asset within investment in unconsolidated ventures on its consolidated balance sheet for the estimated fair value of its retained 20% noncontrolling interest in the HCS Venture. The Company recognized a $286.5 million gain on sale, net of transaction costs, within its consolidated statement of operations for the year ended December 31, 2021 for the HCS Sale. Refer to Note 20 for selected financial data for the Health Care Services segment through June 30, 2021.

On November 1, 2021, the HCS Venture sold certain home health, hospice, and outpatient therapy agencies in areas not served by HCA Healthcare to LHC Group Inc. Upon the completion of the sale, the Company received $35.0 million of cash distributions from the HCS Venture from the net sale proceeds, which decreased its investment in unconsolidated ventures.

During the three months ended September 30, 2023, the Company contributed $7.5 million to the HCS Venture. During the three months ended December 31, 2023, the Company recognized a non-cash impairment charge of $26.0 million on its investment in the HCS Venture as a result of the Company's decision to sell its equity interest prior to the recovery of its market value. In December 2023, the Company completed the sale of its 20% equity interest in the HCS Venture to HCA Healthcare for cash proceeds of $27.4 million.

Master Lease Amendment

In the three months ended December 31, 2022, the Company and a lessor entered into an amendment to the Company’s existing master lease pursuant to which the Company continues to lease 24 communities. The amendment removed certain asset repurchase clauses and adjusted the extension option provisions. The amendment did not change the amount of required lease payments or the initial term of the lease. The leases for 16 of these communities were previously accounted for as failed sale-leaseback transactions as the Company had not previously transferred control of the underlying assets for accounting purposes. The Company determined that the adjustment of the extension option provisions and the removal of the asset repurchase clauses in December 2022 resulted in the transfer of control of the assets of the 16 communities for accounting purposes and resulted in qualification as a sale. The Company recognized a $73.9 million non-cash gain on sale of communities for the transaction in the three months ended December 31, 2022. In addition, the amended leases for such communities are prospectively classified as operating leases as of December 31, 2022, the effective date of the amendment. For 2023, the reclassification of such lease costs as operating lease expense resulted in a $22.2 million increase in cash lease payments for operating leases and an offsetting decrease in cash lease payments for financing leases. See Note 18 for more information regarding the impact to the Company’s consolidated balance sheet as a result of this transaction.
v3.24.0.1
Fair Value Measurements
12 Months Ended
Dec. 31, 2023
Fair Value Disclosures [Abstract]  
Fair Value Measurements
4. Fair Value Measurements

Cash, Cash Equivalents, and Restricted Cash

Cash, cash equivalents, and restricted cash are reflected in the accompanying consolidated balance sheets at amounts considered by management to reasonably approximate fair value due to their short maturity of 90 days or less.

Marketable Securities

As of December 31, 2023 and 2022, marketable securities of $29.8 million and $48.7 million, respectively, are stated at fair value based on valuations provided by third-party pricing services and are classified within Level 2 of the valuation hierarchy.

Interest Rate Derivatives

The Company's derivative assets include interest rate cap and swap instruments that effectively manage the risk above certain interest rates for a portion of the Company's long-term variable rate debt. The Company has not designated the interest rate cap and swap instruments as hedging instruments and as such, changes in the fair value of the instruments are recognized in earnings in the period of the change. The interest rate derivative positions are valued using models developed by the respective counterparty that use as their basis readily available observable market parameters (such as forward yield curves) and are classified within Level 2 of the valuation hierarchy. The Company considers the credit risk of its counterparties when evaluating the fair value of its derivatives.
The following table summarizes the Company's SOFR interest rate cap instruments as of December 31, 2023.

($ in thousands)
Current notional balance$1,231,920 
Weighted average fixed cap rate4.07 %
Earliest maturity date2024 
Latest maturity date2025 
Weighted average remaining term0.8 years
Estimated asset fair value (included in other assets, net) at December 31, 2023$13,268 
Estimated asset fair value (included in other assets, net) at December 31, 2022$10,599 

The following table summarizes the Company's SOFR interest rate swap instrument as of December 31, 2023.

($ in thousands)
Current notional balance$220,000 
Fixed interest rate3.00 %
Remaining term0.3 years
Estimated asset fair value (included in other assets, net) at December 31, 2023$1,611 
Estimated asset fair value (included in other assets, net) at December 31, 2022$4,834 

Long-Term Debt

The Company estimates the fair value of its debt primarily using a discounted cash flow analysis based upon the Company's current borrowing rate for debt with similar maturities and collateral securing the indebtedness. The Company estimates the fair value of its convertible senior notes based on valuations provided by third-party pricing services. The Company had outstanding long-term debt with a carrying amount of approximately $3.7 billion and $3.9 billion as of December 31, 2023 and 2022, respectively. Fair value of the long-term debt is approximately $3.4 billion as of both December 31, 2023 and 2022. The Company's fair value of long-term debt disclosure is classified within Level 2 of the valuation hierarchy.

Asset Impairment Expense

The following is a summary of asset impairment expense.

For the Years Ended December 31,
(in millions)202320222021
Operating lease right-of-use assets$8.3 $13.7 $16.6 
Property, plant and equipment and leasehold intangibles, net6.3 15.9 6.4 
Investment in unconsolidated ventures26.0 — — 
Asset impairment$40.6 $29.6 $23.0 

Long-lived assets are reviewed for impairment whenever events or changes in circumstances indicate the carrying amount of an asset group may not be recoverable. In estimating the recoverability of asset groups for purposes of the Company’s long-lived asset impairment testing, the Company utilizes future cash flow projections that are developed internally. Any estimates of future cash flow projections necessarily involve predicting unknown future circumstances and events and require significant management judgments and estimates. In arriving at the cash flow projections, the Company considers its historic operating results, approved budgets and business plans, future demographic factors, expected revenue and expense growth rates, estimated asset holding periods, estimated capitalization rates, and other factors. Future events may indicate differences from management's current judgments and estimates which could, in turn, result in future impairments.
Operating Lease Right-of-Use Assets

During the years ended December 31, 2023, 2022, and 2021, the Company evaluated operating lease right-of-use assets for impairment and identified communities with a carrying amount of the assets in excess of the estimated future undiscounted net cash flows expected to be generated by the assets. The Company compared the estimated fair value of the assets to their carrying amount for these identified communities and recorded an impairment charge for the excess of carrying amount over fair value. During the year ended December 31, 2023, the Company recognized the right-of-use assets for the operating leases for 12 communities on the consolidated balance sheet at the estimated fair value of $16.4 million. During the year ended December 31, 2022, the Company recognized the right-of-use assets for the operating leases for eight communities on the consolidated balance sheet at the estimated fair value of $30.9 million. During the year ended December 31, 2021, the Company recognized the right-of-use assets for the operating leases for 11 communities on the consolidated balance sheet at the estimated fair value of $31.0 million. In the aggregate, the Company recorded a non-cash impairment charge of $8.3 million, $13.7 million, and $16.6 million for the years ended December 31, 2023, 2022, and 2021, respectively, to operating lease right-of-use assets. These impairment charges are primarily due to decreased occupancy and future cash flow estimates at certain leased communities, including as a result of the impacts of the COVID-19 pandemic, and reflect the amount by which the carrying amounts of the assets exceeded their estimated fair value.

The fair values of the operating lease right-of-use assets were estimated utilizing a discounted cash flow approach based upon projected community cash flows and market data, including management fees and a market supported lease coverage ratio, all of which are considered Level 3 inputs within the valuation hierarchy. The estimated future cash flows were discounted at a rate that is consistent with a weighted average cost of capital from a market participant perspective.

Property, Plant and Equipment and Leasehold Intangibles, Net

During the years ended December 31, 2023, 2022, and 2021, the Company evaluated property, plant and equipment and leasehold intangibles for impairment and identified properties with a carrying amount of the assets in excess of the estimated future undiscounted net cash flows expected to be generated by the assets. The Company compared the estimated fair value of the assets to their carrying amount for these identified properties and recorded an impairment charge for the excess of carrying amount over fair value.

The Company recorded property, plant and equipment and leasehold intangibles non-cash impairment charges in its operating results of $6.3 million, $15.9 million, and $6.4 million for the years ended December 31, 2023, 2022, and 2021, respectively. These impairment charges are primarily due to property damage sustained at certain communities, decreased occupancy and future cash flow estimates at certain communities, including as a result of the impacts of the COVID-19 pandemic, and/or the completed or potential disposition of underperforming communities and reflect the amount by which the carrying amounts of the assets exceeded their estimated fair value.

Investment in Unconsolidated Ventures

As of July 1, 2021, the Company recognized a $100.0 million asset within investment in unconsolidated ventures on its consolidated balance sheet for the estimated fair value of its retained 20% noncontrolling interest in the HCS Venture. The initial recognized amount of the Company’s 20% equity interest in the HCS Venture was determined based upon a pro-rata share of the total enterprise value of the HCS Venture considering the $400.0 million purchase price paid by HCA Healthcare, as the Company's 20% interest shared ratably in all of the benefits and losses expected to be generated by the HCS Venture. The fair value measurement is classified within Level 2 of the valuation hierarchy.

The Company evaluates realization of its investment in unconsolidated ventures accounted for using the equity method if circumstances indicate the Company's investment is other than temporarily impaired. During the three months ended December 31, 2023, the Company recognized a non-cash impairment charge of $26.0 million on its investment in the HCS Venture as a result of the Company's decision to sell its equity interest prior to the recovery of its market value. The Company determined the $27.4 million fair value of its investment based primarily on the sale agreements with the purchasers. The fair value measurement is classified within Level 2 of the valuation hierarchy.
v3.24.0.1
Revenue
12 Months Ended
Dec. 31, 2023
Revenue from Contract with Customer [Abstract]  
Revenue
5. Revenue

Resident fee revenue by payor source is as follows.

For the Years Ended December 31,
202320222021
Private pay93.7 %93.5 %86.8 %
Government reimbursement4.8 %5.1 %10.3 %
Other third-party payor programs1.5 %1.4 %2.9 %

The sale of 80% of the Company's equity in its Health Care Services segment on July 1, 2021 reduced its revenue from government reimbursement programs. Government reimbursements represented 16.9%, 18.0%, and 18.8% of resident fee revenue for the CCRCs segment for the years ended December 31, 2023, 2022, and 2021, respectively. Refer to Note 20 for disaggregation of revenue by reportable segment.

The payment terms and conditions within the Company's revenue-generating contracts vary by contract type and payor source, although terms generally include payment to be made within 30 days. Resident fee revenue for recurring and routine monthly services is generally billed monthly in advance under the Company's independent living, assisted living, and memory care residency agreements. Resident fee revenue for standalone or certain healthcare services is generally billed monthly in arrears. Additionally, certain of the Company's revenue-generating contracts include non-refundable fees that are generally billed and collected in advance or upon move-in of a resident under the Company's independent living, assisted living, and memory care residency agreements. Amounts of revenue that are collected from residents in advance are recognized as deferred revenue until the performance obligations are satisfied.

The Company had total deferred revenue (included within refundable fees and deferred revenue, and other liabilities within the consolidated balance sheets) of $48.3 million and $67.3 million, including $24.1 million and $25.2 million of monthly resident fees billed and received in advance, as of December 31, 2023 and 2022, respectively. For the years ended December 31, 2023, 2022, and 2021 the Company recognized $50.2 million, $54.5 million, and $60.2 million respectively, of revenue that was included in the deferred revenue balance as of January 1, 2023, 2022, and 2021, respectively. The Company applies the practical expedient in ASC 606-10-50-14 and does not disclose amounts for remaining performance obligations that have original expected durations of one year or less.

The following table presents the changes in allowance for credit losses on accounts receivable for the periods indicated.

For the Years Ended December 31,
(in millions)202320222021
Balance at beginning of period$12.8 $13.3 $9.8 
Provision within facility operating expense22.6 20.0 21.6 
Write-offs(22.5)(22.2)(19.2)
Recoveries and other1.2 1.7 1.1 
Balance at end of period$14.1 $12.8 $13.3 
v3.24.0.1
Property, Plant and Equipment and Leasehold Intangibles, Net
12 Months Ended
Dec. 31, 2023
Property, Plant and Equipment [Abstract]  
Property, Plant and Equipment and Leasehold Intangibles, Net
6. Property, Plant and Equipment and Leasehold Intangibles, Net

As of December 31, 2023 and 2022, net property, plant and equipment and leasehold intangibles, which include assets under financing leases, consisted of the following.

As of December 31,
(in thousands)20232022
Land$500,649 $506,968 
Buildings and improvements5,348,133 5,323,736 
Furniture and equipment1,111,408 1,055,304 
Resident in-place lease intangibles282,411 286,122 
Construction in progress33,905 41,778 
Assets under financing leases and leasehold improvements1,070,900 1,375,521 
Property, plant and equipment and leasehold intangibles8,347,406 8,589,429 
Accumulated depreciation and amortization(4,016,777)(4,053,727)
Property, plant and equipment and leasehold intangibles, net$4,330,629 $4,535,702 

Long-lived assets with definite useful lives are depreciated or amortized on a straight-line basis over their estimated useful lives (or, in certain cases, the shorter of their estimated useful lives or the lease term) and are tested for impairment whenever indicators of impairment arise. Refer to Note 4 for information on impairment expense for property, plant and equipment and leasehold intangibles.

For the years ended December 31, 2023, 2022, and 2021, the Company recognized depreciation and amortization expense on its property, plant and equipment and leasehold intangibles of $342.7 million, $347.4 million, and $337.6 million, respectively.
v3.24.0.1
Debt
12 Months Ended
Dec. 31, 2023
Debt Disclosure [Abstract]  
Debt
7. Debt

Long-term debt consists of the following.

December 31,
(in thousands)20232022
Fixed mortgage notes payable due 2025 through 2047; weighted average interest rate of 4.26% and 4.14%, as of December 31, 2023 and 2022, respectively.
$1,953,414 $2,055,867 
Variable mortgage notes payable due 2025 through 2030; weighted average interest rate of 7.74% and 6.68% as of December 31, 2023 and 2022, respectively.
1,524,907 1,568,555 
Convertible notes payable due October 2026; interest rate of 2.00% as of both December 31, 2023 and 2022.
230,000 230,000 
Tangible equity units senior amortizing notes due November 2025; interest rate of 10.25% as of both December 31, 2023 and 2022.
17,990 25,586 
Deferred financing costs, net(28,998)(29,866)
Total long-term debt3,697,313 3,850,142 
Current portion41,463 66,043 
Total long-term debt, less current portion$3,655,850 $3,784,099 

As of December 31, 2023, 91.9%, or $3.4 billion of the Company's total debt obligations represented non-recourse property-level mortgage financings.
The annual aggregate scheduled maturities (including recurring principal payments) of long-term debt outstanding as of December 31, 2023 are as follows (in thousands).



Year Ending December 31,
Long-term
Debt
Weighted Rate
2024$49,485 6.46 %
2025 (1)
573,035 7.30 %
2026305,614 2.71 %
2027960,971 6.00 %
2028563,548 5.79 %
Thereafter1,273,658 5.03 %
Total obligations3,726,311 5.58 %
Less amount representing deferred financing costs, net(28,998)
Total$3,697,313 

(1)    Includes the initial maturity of $320.0 million of mortgage debt for which the Company has the option to extend the maturity for two additional terms of one year each subject to the satisfaction of certain conditions.

The Company's remaining variable rate mortgage notes payable arrangements indexed to London Interbank Offered Rate ("LIBOR") were modified to reference SOFR rather than LIBOR prospectively after the discontinuance of LIBOR in July 2023. The Company applied the optional expedient provided by Accounting Standards Codification 848, Reference Rate Reform, for debt contract modifications related to the discontinuation of reference rates to ease the potential burden in accounting for reference rate reform.

Convertible Debt Offering

On October 1, 2021, the Company issued $230.0 million principal amount of 2.00% convertible senior notes due 2026 (the "Notes"). The Company received net proceeds of $224.3 million at closing after the deduction of the initial purchasers' discount. The Company used $15.9 million of the net proceeds to pay the Company’s cost of the capped call transactions described below. Additionally, the Company used the remaining net proceeds together with cash on hand to repay $284.4 million of mortgage debt and a $45.0 million note payable.

The Notes were issued pursuant to, and are governed by, the Indenture dated as of October 1, 2021 by and between the Company and American Stock Transfer & Trust Company, LLC, as trustee. The Notes are the Company’s senior unsecured obligations and rank senior in right of payment to any of the Company’s indebtedness that is expressly subordinated in right of payment to the Notes, and equal in right of payment to any of the Company’s indebtedness that is not so subordinated. The Notes are effectively junior in right of payment to any of the Company’s secured indebtedness to the extent of the value of the assets securing such indebtedness; and structurally junior to all indebtedness and other liabilities (including trade payables) and any preferred equity of current or future subsidiaries of the Company.

The Notes bear interest at 2.00% per year, payable semi-annually in arrears in cash on April 15 and October 15 of each year. The Notes will mature on October 15, 2026, unless earlier converted, redeemed, or repurchased in accordance with their terms. Holders of the Notes may convert all or any portion of their Notes at their option at any time prior to the close of business on the business day immediately preceding July 15, 2026, only under the following circumstances: (1) during any calendar quarter commencing after the calendar quarter ending on December 31, 2021 (and only during such calendar quarter), if the last reported sale price of the common stock of the Company for at least 20 trading days (whether or not consecutive) during a period of 30 consecutive trading days ending on, and including, the last trading day of the immediately preceding calendar quarter is greater than or equal to 130% of the conversion price on each applicable trading day; (2) during the five business day period after any ten consecutive trading day period (the "measurement period") in which the trading price per $1,000 principal amount of Notes for each trading day of the measurement period was less than 98% of the product of the last reported sale price of the common stock of the Company and the conversion rate for the Notes on each such trading day; (3) if the Company calls any or all of the Notes for redemption, at any time prior to the close of business on the second scheduled trading day immediately preceding the redemption date, but only with respect to the Notes called (or deemed called) for redemption; or (4) upon the occurrence of specified corporate events. On or after July 15, 2026, holders may convert all or any portion of their Notes at any time prior to the close of business on the second scheduled trading day immediately preceding the maturity date regardless of the foregoing conditions. Upon conversion, the Company will satisfy its conversion obligation by paying or
delivering, as the case may be, cash, shares of the Company’s common stock or a combination of cash and shares of the Company’s common stock at the Company’s election.

The conversion rate for the Notes is initially 123.4568 shares of the Company’s common stock per $1,000 principal amount of Notes (equivalent to an initial conversion price of approximately $8.10 per share of common stock). The conversion rate will be subject to adjustment in some events but will not be adjusted for any accrued and unpaid interest. In addition, following certain corporate events that occur prior to the maturity date or following the issuance of a notice of redemption, the Company will increase the conversion rate for a holder who elects to convert its Notes in connection with such a corporate event or who elects to convert any Notes called (or deemed called) for redemption during the related redemption period in certain circumstances.

The Company may not redeem the Notes prior to October 21, 2024. The Company may redeem for cash all or (subject to certain limitations) any portion of the Notes, at the Company's option, on or after October 21, 2024 and prior to the 51st scheduled trading day immediately preceding the maturity date if the last reported sale price of the Company's common stock has been at least 130% of the conversion price then in effect for at least 20 trading days (whether or not consecutive) during any 30 consecutive trading day period (including the last trading day of such period) ending on, and including, the trading day immediately preceding the date on which the Company provides notice of redemption at a redemption price equal to 100% of the principal amount of the Notes to be redeemed, plus accrued and unpaid interest to, but excluding, the redemption date. No sinking fund is provided for the Notes.

The Company has recognized the Notes in their entirety as a liability on the consolidated balance sheet and no portion of the proceeds from the issuance of the convertible debt instrument was accounted for separately as an embedded conversion feature within stockholders’ equity. The Notes were initially recognized at $223.3 million, which reflects $230.0 million principal amount less the $5.7 million initial purchasers' discount and $1.0 million of debt issuance costs.

Capped Call Transactions

In connection with the offering of the Notes, the Company entered into privately negotiated capped call transactions ("Capped Call Transactions") with each of Bank of America, N.A., Royal Bank of Canada, Wells Fargo Bank, National Association or their respective affiliates (the "Capped Call Counterparties"). The Capped Call Transactions initially cover, subject to customary anti-dilution adjustments, the number of shares of the Company’s common stock that initially underlie the Notes and initially have an exercise price of $8.10 per share of common stock. The cap price of the Capped Call Transactions is initially approximately $9.90 per share of the Company’s common stock, representing a premium of 65% above the last reported sale price of $6.00 per share of the Company’s common stock on September 28, 2021, and is subject to certain adjustments under the terms of the Capped Call Transactions. The Capped Call Transactions are expected generally to reduce or offset potential dilution to holders of the Company’s common stock upon conversion of the Notes and/or offset the potential cash payments that the Company could be required to make in excess of the principal amount of any converted Notes upon conversion thereof, with such reduction and/or offset subject to a cap based on the cap price.

The Capped Call Transactions are separate transactions entered into by the Company with the Capped Call Counterparties and are not part of the terms of the Notes. The Capped Call Transactions had a cost of $15.9 million, which was paid on October 1, 2021 from the proceeds of the Notes. The Company accounted for the Capped Call Transactions separately from the Notes and recognized the $15.9 million cost as a reduction of additional paid-in capital in the year ended December 31, 2021 as the Capped Call Transactions are indexed to the Company’s common stock.

Credit Facilities

In December 2023, the Company amended its revolving credit agreement with Capital One, National Association, as administrative agent and lender and the other lenders from time to time parties thereto. The amended agreement provides an expanded commitment amount of up to $100.0 million which can be drawn in cash or as letters of credit. The credit facility matures in January 2027, and the Company has the option to extend the facility for two additional terms of approximately one year each subject to the satisfaction of certain conditions. Amounts drawn under the facility will bear interest at SOFR plus an applicable margin which was 3.00% as of December 31, 2023. Additionally, a quarterly commitment fee of 0.25% per annum was applicable on the unused portion of the facility as of December 31, 2023. The revolving credit facility is currently secured by first priority mortgages and negative pledges on certain of the Company’s communities. Available capacity under the facility will vary from time to time based upon certain calculations related to the appraised value and performance of the communities securing the credit facility and the variable interest rate of the credit facility.
As of December 31, 2023, $63.6 million of letters of credit and no cash borrowings were outstanding under the Company's $100.0 million secured credit facility. The Company also had a separate secured letter of credit facility providing up to $15.0 million of letters of credit as of December 31, 2023 under which $14.5 million had been issued as of that date.

2024 Financing

On February 9, 2024, the Company obtained $50.0 million of debt secured by first priority mortgages on 11 communities. The loan bears interest at a variable rate equal to SOFR plus a margin of 350 basis points. The debt matures in February 2027 with two one-year renewal options, exercisable subject to certain performance criteria.

2023 Financing

In December 2023, the Company obtained $179.5 million of debt secured by non-recourse first mortgages on 47 communities, which also continue to secure $580.4 million of additional outstanding mortgages with a later maturity. The $179.5 million loan bears interest at a fixed rate of 5.97%, and matures in January 2031. The mortgage facility includes certain provisions allowing for the Company to obtain additional funding based on the performance of the underlying communities. At the closing, the Company repaid $260.1 million of debt under the mortgage facility, which was scheduled to mature in 2024, using proceeds from the $179.5 million loan and cash on hand.

2022 Financing

In October 2022, the Company obtained $220.0 million of debt secured by first priority mortgages on 24 communities. The loan bears interest at a variable rate equal to SOFR plus a margin of 245 basis points and is interest only for the first three years. The debt matures in October 2025 with two one-year renewal options, exercisable by the Company subject to the satisfaction of certain conditions. The debt documents contain a requirement for the Company to maintain liquidity of at least $130.0 million and 25% of the loan amount is subject to a guaranty by the Company. The proceeds from the financing were primarily utilized to repay $199.6 million of outstanding mortgage debt previously scheduled to mature in 2023 and to purchase a SOFR interest rate swap instrument for $6.1 million. The interest rate swap instrument has a $220.0 million notional amount, a fixed interest rate of 3.0%, and a term of eighteen months.

Financial Covenants

Certain of the Company's debt documents contain restrictions and financial covenants, such as those requiring the Company to maintain prescribed minimum liquidity, net worth, and stockholders' equity levels and debt service ratios, and requiring the Company not to exceed prescribed leverage ratios, in each case on a consolidated, portfolio-wide, multi-community, single-community, and/or entity basis. In addition, the Company's debt documents generally contain non-financial covenants, such as those requiring the Company to comply with Medicare or Medicaid provider requirements and maintain insurance coverage.

The Company's failure to comply with applicable covenants could constitute an event of default under the applicable debt documents. Many of the Company's debt documents contain cross-default provisions so that a default under one of these instruments could cause a default under other debt and lease documents (including documents with other lenders and lessors). Furthermore, the Company's mortgage debt is secured by its communities and, in certain cases, a guaranty by the Company and/or one or more of its subsidiaries.

As of December 31, 2023, the Company is in compliance with the financial covenants of its debt agreements.
v3.24.0.1
Leases
12 Months Ended
Dec. 31, 2023
Leases [Abstract]  
Leases
8. Leases

As of December 31, 2023, the Company operated 277 communities under long-term leases (263 operating leases and 14 financing leases). The substantial majority of the Company's lease arrangements are structured as master leases. Under a master lease, numerous communities are leased through an indivisible lease. In certain cases, the Company guarantees the performance and lease payment obligations of its subsidiary lessees under the master leases. An event of default related to an individual property or limited number of properties within a master lease portfolio may result in a default on the entire master lease portfolio.

The leases relating to these communities are generally fixed rate leases with annual escalators that are either fixed or based upon changes in the consumer price index or the leased property revenue. The Company is responsible for all operating costs, including repairs, property taxes, and insurance. As of December 31, 2023, the weighted average remaining lease term of the Company's operating and financing leases was 5.7 and 2.3 years, respectively. The leases generally provide for renewal or
extension options from 5 to 20 years and in some instances, purchase options. As of December 31, 2023, none of the Company's renewal or extension option periods are included in the lease term for accounting purposes.

The community leases contain other customary terms, which may include assignment and change of control restrictions, maintenance and capital expenditure obligations, termination provisions, and financial covenants, such as those requiring the Company to maintain prescribed minimum liquidity, net worth, and stockholders' equity levels and lease coverage ratios, in each case on a consolidated, portfolio-wide, multi-community, single-community and/or entity basis. In addition, the Company's lease documents generally contain non-financial covenants, such as those requiring the Company to comply with Medicare or Medicaid provider requirements and maintain insurance coverage.

The Company's failure to comply with applicable covenants could constitute an event of default under the applicable lease documents. Many of the Company's debt and lease documents contain cross-default provisions so that a default under one of these instruments could cause a default under other debt and lease documents (including documents with other lenders and lessors). Certain leases contain cure provisions, which generally allow the Company to post an additional lease security deposit if the required covenant is not met. Furthermore, the Company's leases are secured by its communities and, in certain cases, a guaranty by the Company and/or one or more of its subsidiaries.

As of December 31, 2023, the Company is in compliance with the financial covenants of its long-term leases.

A summary of operating and financing lease expense (including the respective presentation on the consolidated statements of operations) and net cash outflows from leases is as follows.

Years Ended December 31,
Operating Leases (in thousands)
202320222021
Facility operating expense$7,105 $6,329 $12,606 
Facility lease expense202,410 165,294 174,358 
Operating lease expense209,515 171,623 186,964 
Operating lease expense adjustment (1)
45,739 34,896 23,280 
Changes in operating lease assets and liabilities for lessor capital expenditure reimbursements(9,844)(13,718)(30,965)
Operating net cash outflows from operating leases$245,410 $192,801 $179,279 

(1) Represents the difference between the amount of cash operating lease payments and the amount of operating lease expense.

Years Ended December 31,
Financing Leases (in thousands)
202320222021
Depreciation and amortization $16,444 $38,126 $37,921 
Interest expense: financing lease obligations21,950 48,061 46,282 
Financing lease expense$38,394 $86,187 $84,203 
Operating cash outflows from financing leases$21,950 $48,061 $46,282 
Financing cash outflows from financing leases8,473 22,221 19,874 
Changes in financing lease assets and liabilities for lessor capital expenditure reimbursement(475)(11,932)(11,135)
Total net cash outflows from financing leases$29,948 $58,350 $55,021 

As of December 31, 2023, the weighted average discount rate of the Company's operating and financing leases was 8.4% and 10.3%, respectively.
The aggregate amounts of future minimum lease payments, including community, office, and equipment leases, recognized on the consolidated balance sheet as of December 31, 2023 are as follows (in thousands).

Year Ending December 31,Operating LeasesFinancing Leases
2024$260,694 $20,266 
2025260,501 6,849 
2026145,832 6,833 
2027147,660 6,082 
202884,767 5,917 
Thereafter251,579 20,625 
Total lease payments1,151,033 66,572 
Purchase option liability and non-cash gain on future sale of property— 145,136 
Imputed interest and variable lease payments(274,526)(59,859)
Total lease obligations$876,507 $151,849 
Leases
8. Leases

As of December 31, 2023, the Company operated 277 communities under long-term leases (263 operating leases and 14 financing leases). The substantial majority of the Company's lease arrangements are structured as master leases. Under a master lease, numerous communities are leased through an indivisible lease. In certain cases, the Company guarantees the performance and lease payment obligations of its subsidiary lessees under the master leases. An event of default related to an individual property or limited number of properties within a master lease portfolio may result in a default on the entire master lease portfolio.

The leases relating to these communities are generally fixed rate leases with annual escalators that are either fixed or based upon changes in the consumer price index or the leased property revenue. The Company is responsible for all operating costs, including repairs, property taxes, and insurance. As of December 31, 2023, the weighted average remaining lease term of the Company's operating and financing leases was 5.7 and 2.3 years, respectively. The leases generally provide for renewal or
extension options from 5 to 20 years and in some instances, purchase options. As of December 31, 2023, none of the Company's renewal or extension option periods are included in the lease term for accounting purposes.

The community leases contain other customary terms, which may include assignment and change of control restrictions, maintenance and capital expenditure obligations, termination provisions, and financial covenants, such as those requiring the Company to maintain prescribed minimum liquidity, net worth, and stockholders' equity levels and lease coverage ratios, in each case on a consolidated, portfolio-wide, multi-community, single-community and/or entity basis. In addition, the Company's lease documents generally contain non-financial covenants, such as those requiring the Company to comply with Medicare or Medicaid provider requirements and maintain insurance coverage.

The Company's failure to comply with applicable covenants could constitute an event of default under the applicable lease documents. Many of the Company's debt and lease documents contain cross-default provisions so that a default under one of these instruments could cause a default under other debt and lease documents (including documents with other lenders and lessors). Certain leases contain cure provisions, which generally allow the Company to post an additional lease security deposit if the required covenant is not met. Furthermore, the Company's leases are secured by its communities and, in certain cases, a guaranty by the Company and/or one or more of its subsidiaries.

As of December 31, 2023, the Company is in compliance with the financial covenants of its long-term leases.

A summary of operating and financing lease expense (including the respective presentation on the consolidated statements of operations) and net cash outflows from leases is as follows.

Years Ended December 31,
Operating Leases (in thousands)
202320222021
Facility operating expense$7,105 $6,329 $12,606 
Facility lease expense202,410 165,294 174,358 
Operating lease expense209,515 171,623 186,964 
Operating lease expense adjustment (1)
45,739 34,896 23,280 
Changes in operating lease assets and liabilities for lessor capital expenditure reimbursements(9,844)(13,718)(30,965)
Operating net cash outflows from operating leases$245,410 $192,801 $179,279 

(1) Represents the difference between the amount of cash operating lease payments and the amount of operating lease expense.

Years Ended December 31,
Financing Leases (in thousands)
202320222021
Depreciation and amortization $16,444 $38,126 $37,921 
Interest expense: financing lease obligations21,950 48,061 46,282 
Financing lease expense$38,394 $86,187 $84,203 
Operating cash outflows from financing leases$21,950 $48,061 $46,282 
Financing cash outflows from financing leases8,473 22,221 19,874 
Changes in financing lease assets and liabilities for lessor capital expenditure reimbursement(475)(11,932)(11,135)
Total net cash outflows from financing leases$29,948 $58,350 $55,021 

As of December 31, 2023, the weighted average discount rate of the Company's operating and financing leases was 8.4% and 10.3%, respectively.
The aggregate amounts of future minimum lease payments, including community, office, and equipment leases, recognized on the consolidated balance sheet as of December 31, 2023 are as follows (in thousands).

Year Ending December 31,Operating LeasesFinancing Leases
2024$260,694 $20,266 
2025260,501 6,849 
2026145,832 6,833 
2027147,660 6,082 
202884,767 5,917 
Thereafter251,579 20,625 
Total lease payments1,151,033 66,572 
Purchase option liability and non-cash gain on future sale of property— 145,136 
Imputed interest and variable lease payments(274,526)(59,859)
Total lease obligations$876,507 $151,849 
v3.24.0.1
Tangible Equity Units
12 Months Ended
Dec. 31, 2023
Equity [Abstract]  
Tangible Equity Units
9. Tangible Equity Units

During 2022, the Company issued 2,875,000 of its 7.00% tangible equity units (the “Units”) at a public offering price of $50.00 per Unit for an aggregate offering of $143.8 million. The Company received proceeds of $139.4 million after the deduction of the underwriters’ discount. Each Unit is comprised of a prepaid stock purchase contract and a senior amortizing note with an initial principal amount of $8.8996. Under each purchase contract, the Company is obligated to deliver to the holder on November 15, 2025 a minimum of 12.9341, and a maximum of 15.1976, shares of the Company’s common stock depending on the daily volume-weighted average price ("VWAPs") of its common stock for the 20 trading days preceding the settlement date. Each amortizing note bears interest at the rate of 10.25% per annum, requires quarterly installment payments of principal and interest, and has a final installment payment date of November 15, 2025. The cash installment payments will be equivalent to 7.00% per year with respect to each $50.00 stated amount of Unit. The Units, purchase contracts, and amortizing notes are subject to the terms and conditions set forth in the Purchase Contract Agreement dated November 21, 2022 between the Company and American Stock Transfer & Trust Company, LLC ("AST") as purchase contract agent, and the Indenture and First Supplemental Indenture, each dated November 21, 2022, between the Company and AST as trustee, including certain early settlement, repurchase, and adjustment events as set forth therein.

Subsequent to issuance, each Unit may be legally separated into the two components, both of which are freestanding instruments and separate units of account. The Company allocated the proceeds from the issuance of the Units to the purchase contracts and amortizing notes based on the relative fair values of the respective components, determined as of the date of issuance of the Units. The Company recognized the issuance of the purchase contract portion of the Units, net of issuance costs, as additional paid-in-capital on the consolidated balance sheet. The Company separately recognized the amortizing notes portion of the Units, net of issuance costs, as long-term debt on the consolidated balance sheet.

The proceeds from the issuance of the Units were allocated to equity and debt based on the relative fair value of the respective components of each Unit as follows:

(in thousands, except value per unit)Equity ComponentDebt ComponentTotal
Value per unit$41.10 $8.90 $50.00 
Gross proceeds$118,164 $25,586 $143,750 
Less: underwriters' discount(3,544)(768)(4,312)
Proceeds from issuance of Units$114,620 $24,818 $139,438 
Less: issuance costs(1,163)(252)(1,415)
Net proceeds$113,457 $24,566 $138,023 
Unless settled early in accordance with the terms of the instruments, each prepaid stock purchase contract will automatically settle on November 15, 2025 (the mandatory settlement date) for a number of shares of the Company’s common stock based on the arithmetic average of the VWAPs of the Company’s common stock on each of the 20 consecutive trading days beginning on, and including, the 21st scheduled trading day immediately preceding November 15, 2025 (applicable market value) with reference to the following settlement rates:

Applicable Market ValueCommon Stock Issued
Equal to or greater than the threshold appreciation price
12.9341 shares (minimum settlement rate)
Less than the threshold appreciation price, but greater than the reference price
$50 divided by applicable market value
Less than or equal to the reference price
15.1976 shares (maximum settlement rate)
The threshold appreciation price is initially approximately equal to $3.87 and the reference price is initially approximately equal to $3.29.
v3.24.0.1
Accrued Expenses
12 Months Ended
Dec. 31, 2023
Accounts Payable and Accrued Liabilities, Current [Abstract]  
Accrued Expenses
10. Accrued Expenses

Accrued expenses reflected within current liabilities on the Company’s consolidated balance sheets consist of the following.

As of December 31,
(in thousands)20232022
Employee compensation$104,322 $85,610 
Insurance reserves54,834 65,757 
Real estate taxes26,988 26,661 
Interest17,838 17,569 
Utilities8,444 8,533 
Income taxes payable2,071 2,081 
Other28,171 30,937 
Total$242,668 $237,148 
v3.24.0.1
Commitments and Contingencies
12 Months Ended
Dec. 31, 2023
Commitments and Contingencies Disclosure [Abstract]  
Commitments and Contingencies
11. Commitments and Contingencies

Litigation

The Company has been and is currently involved in litigation and claims incidental to the conduct of its business, which it believes are generally comparable to other companies in the senior living and healthcare industries, including, but not limited to, putative class action claims from time to time regarding staffing at the Company’s communities and compliance with consumer protection laws and the Americans with Disabilities Act. Certain claims and lawsuits allege large damage amounts and may require significant costs to defend and resolve. As a result, the Company maintains general liability, professional liability, and other insurance policies in amounts and with coverage and deductibles the Company believes are appropriate, based on the nature and risks of its business, historical experience, availability, and industry standards. The Company's current policies provide for deductibles for each claim and contain various exclusions from coverage. The Company uses its wholly-owned captive insurance company for the purpose of insuring certain portions of its risk retention under its general and professional liability insurance programs. Accordingly, the Company is, in effect, self-insured for claims that are less than the deductible amounts, for claims that exceed the funding level of the Company's wholly-owned captive insurance company, and for claims or portions of claims that are not covered by such policies and/or exceed the policy limits.

The senior living and healthcare industries are continuously subject to scrutiny by governmental regulators, which could result in reviews, audits, investigations, enforcement actions, or litigation related to regulatory compliance matters. In addition, the Company is subject to various government reviews, audits, and investigations to verify compliance with Medicare and Medicaid programs and other applicable laws and regulations. The Centers for Medicare & Medicaid Services ("CMS") has engaged third-party firms to review claims data to evaluate appropriateness of billings. In addition to identifying overpayments, audit contractors can refer suspected violations to government authorities. In addition, states' Attorneys General vigorously enforce consumer protection laws as those laws relate to the senior living industry. An adverse outcome of government scrutiny may result in citations, sanctions, other criminal or civil fines and penalties, the refund of overpayments, payment suspensions,
termination of participation in Medicare and Medicaid programs, and damage to the Company’s business reputation. The Company’s costs to respond to and defend any such audits, reviews, and investigations may be significant.

In June 2020, the Company and several current and former executive officers were named as defendants in a putative class action lawsuit alleging violations of the federal securities laws filed in the federal court for the Middle District of Tennessee. The lawsuit asserted that the defendants made material misstatements and omissions concerning the Company's business, operational and compliance policies, compliance with applicable regulations and statutes, and staffing practices that caused the Company's stock price to be artificially inflated between August 2016 and April 2020. The district court dismissed the lawsuit and entered judgment in favor of the defendants in September 2021, and the plaintiffs did not file an appeal. Between October 2020 and June 2021, alleged stockholders of the Company filed several stockholder derivative lawsuits in the federal courts for the Middle District of Tennessee and the District of Delaware, which were subsequently transferred to the Middle District of Tennessee and consolidated into two lawsuits. In January 2024, the court dismissed one of the two derivative lawsuits. Plaintiffs have appealed the dismissal to the United States Court of Appeals for the Sixth Circuit. The other derivative lawsuit remains pending with the Middle District of Tennessee and asserts claims on behalf of the Company against certain current and former officers and directors for alleged breaches of duties owed to the Company. The complaint incorporates substantively similar allegations to the securities lawsuit previously described.

Other
The Company has employment or letter agreements with certain officers of the Company and has adopted policies to which certain officers of the Company are eligible to participate, which grant these employees the right to receive a portion or multiple of their base salary, pro-rata bonus, bonus, and/or continuation of certain benefits, for a defined period of time, in the event of certain terminations of the officers' employment, as described in those agreements and policies.
v3.24.0.1
Self-Insurance
12 Months Ended
Dec. 31, 2023
Self Insurance Reserves [Abstract]  
Self-Insurance
12. Self-Insurance

The Company obtains various insurance coverages, including general and professional liability and workers' compensation programs, from commercial carriers at stated amounts as defined in the applicable policy. The Company's current general and professional liability policies provide for deductibles for each claim and contain various exclusions from coverage. The Company uses its wholly-owned captive insurance company for the purpose of insuring certain portions of its risk retention under its general and professional liability insurance programs. Accordingly, the Company is, in effect, self-insured for claims that are less than the deductible amounts, for claims that exceed the funding level of the Company’s wholly-owned captive insurance company, and for claims or portions of claims that are not covered by such policies and/or exceed the policy limits. Losses related to self-insured amounts are accrued based on the Company's estimate of expected losses for known claims and projected claims incurred but not yet reported.

As of December 31, 2023 and 2022, the Company accrued reserves of $122.6 million and $135.9 million, respectively, under the Company's insurance programs, of which $67.8 million and $70.2 million is classified as other liabilities as of December 31, 2023 and 2022, respectively. As of December 31, 2023 and 2022, the Company accrued $4.3 million and $9.9 million, respectively, of estimated amounts receivable from the insurance companies under these insurance programs.
The Company has secured self-insured retention risk under its primary workers' compensation programs with restricted cash deposits and other deposits of $8.3 million and $14.5 million and letters of credit of $57.2 million and $62.1 million as of December 31, 2023 and 2022, respectively. Additionally, the Company’s wholly-owned captive insurance company had restricted cash and other deposits of $10.3 million and $6.0 million as of December 31, 2023 and 2022, respectively.
v3.24.0.1
Stock-Based Compensation
12 Months Ended
Dec. 31, 2023
Share-Based Payment Arrangement [Abstract]  
Stock-Based Compensation
13. Stock-Based Compensation

The following table sets forth information about the Company's restricted stock units and stock awards.

(in thousands, except for weighted average amounts)Number of Restricted Stock Units and Stock AwardsWeighted
Average
Grant Date Fair Value
Outstanding on January 1, 20218,505 $7.68 
Granted1,998 5.12 
Vested(2,641)8.40 
Cancelled/forfeited(2,851)6.77 
Outstanding on December 31, 20215,011 6.80 
Granted2,921 5.58 
Vested(2,039)7.15 
Cancelled/forfeited(520)6.88 
Outstanding on December 31, 20225,373 6.00 
Granted3,992 2.98 
Vested(2,001)5.87 
Cancelled/forfeited(961)5.90 
Outstanding on December 31, 20236,403 4.17 

As of December 31, 2023, there was $15.8 million of total unrecognized compensation cost related to outstanding, unvested share-based compensation. That cost is expected to be recognized over a weighted average period of 2.3 years and is based on grant date fair value.

As of December 31, 2022, the Company's outstanding shares included 422,542 unvested restricted shares. The Company did not have any unvested restricted shares as of December 31, 2023.

During 2023, grants of restricted stock units and stock awards under the Company's 2014 Omnibus Incentive Plan were as follows.

(in thousands, except for weighted average amounts)Restricted Stock Unit and Stock Award GrantsWeighted Average Grant Date Fair ValueTotal Grant Date Fair Value
Three months ended March 31, 20233,959 $2.97 $11,778 
Three months ended June 30, 202310 $2.95 $29 
Three months ended September 30, 202316 $4.01 $65 
Three months ended December 31, 2023$4.14 $29 
v3.24.0.1
Earnings Per Share
12 Months Ended
Dec. 31, 2023
Earnings Per Share [Abstract]  
Earnings Per Share
14. Earnings Per Share

Potentially dilutive common stock equivalents for the Company include convertible senior notes, warrants, unvested restricted stock, restricted stock units, and prepaid stock purchase contracts.

As of December 31, 2023, the maximum number of shares issuable upon settlement of the Notes is 38.3 million (after giving effect to additional shares that would be issuable upon conversion in connection with the occurrence of certain corporate or other events).

On July 26, 2020, the Company issued to Ventas, Inc. ("Ventas") a warrant (the "Warrant") to purchase 16.3 million shares of the Company’s common stock, $0.01 par value per share, at a price per share of $3.00. The Warrant is exercisable at Ventas' option at any time and from time to time, in whole or in part, until December 31, 2025. The exercise price and the number of shares issuable on exercise of the Warrant are subject to certain anti-dilution adjustments, including for cash dividends, stock
dividends, stock splits, reclassifications, non-cash distributions, certain repurchases of common stock, and business combination transactions.

As of December 31, 2023, the maximum number of shares issuable upon settlement of the Units' prepaid stock purchase contracts is 43.7 million.

Basic earnings per share ("EPS") is calculated by dividing net income (loss) by the weighted average number of shares of common stock outstanding, after giving effect to the minimum number of shares issuable upon settlement of the prepaid stock purchase contract component of the Units. For both the years ended December 31, 2023 and 2022, 37.2 million shares are included in weighted average basic shares outstanding for the minimum number of shares issuable upon settlement of the Units' prepaid stock purchase contracts.

Years Ended December 31,
(in thousands)202320222021
Weighted average common shares outstanding188,023 186,574 184,975 
Weighted average minimum shares issuable under purchase contracts37,186 3,889 — 
Weighted average shares outstanding - basic225,209 190,463 184,975 

Diluted EPS includes the components of basic EPS and also gives effect to dilutive common stock equivalents. Diluted EPS reflects the potential dilution that could occur if securities or other instruments that are convertible into common stock were exercised or could result in the issuance of common stock. For the purposes of computing diluted EPS, weighted average shares outstanding do not include potentially dilutive securities that are anti-dilutive under the treasury stock method or if-converted method, and performance-based equity awards are included based on the attainment of the applicable performance metrics as of the end of the reporting period. The Company has the following potentially outstanding shares of common stock, which were excluded from the computation of diluted net income (loss) per share attributable to common stockholders in all periods as a result of the net loss.

As of December 31,
(in millions)202320222021
Convertible senior notes38.338.3 38.3 
Warrants16.316.3 16.3 
Restricted stock and restricted stock units6.45.4 5.0 
Incremental shares issuable under purchase contracts6.56.5 — 
Total67.566.559.6

Refer to Notes 7 and 9 for more information on the Notes and the Units, respectively.
v3.24.0.1
Share Repurchase Program
12 Months Ended
Dec. 31, 2023
Equity [Abstract]  
Share Repurchase Program
15. Share Repurchase Program

In 2016, the Company's Board of Directors approved a share repurchase program that authorizes the Company to purchase up to $100.0 million in the aggregate of the Company's common stock. The share repurchase program is intended to be implemented through purchases made from time to time using a variety of methods, which may include open market purchases, privately negotiated transactions, or block trades, or by any combination of these methods, in accordance with applicable insider trading and other securities laws and regulations.

The size, scope, and timing of any purchases will be based on business, market, and other conditions and factors, including price, regulatory, and contractual requirements or consents, and capital availability. The repurchase program does not obligate the Company to acquire any particular amount of common stock and the program may be suspended, modified, or discontinued at any time at the Company's discretion without prior notice. Shares of stock repurchased under the program will be held as treasury shares. The Company temporarily suspended purchases under the share repurchase plan in March 2020.
For the years ended December 31, 2023, 2022, and 2021, there were no repurchases under the share repurchase program. As of December 31, 2023, approximately $44.0 million remains available under the share repurchase program.
v3.24.0.1
Retirement Plans
12 Months Ended
Dec. 31, 2023
Retirement Benefits [Abstract]  
Retirement Plans
16. Retirement Plans
The Company maintains a 401(k) retirement savings plan for all employees that meet minimum employment criteria. Such plan provides that the participants may defer eligible compensation subject to certain Internal Revenue Code maximum amounts. The Company makes matching contributions in amounts equal to 25.0% of the employee's contribution to such plan, for contributions up to a maximum of 4.0% of eligible compensation. An additional matching contribution of 12.5%, subject to the same limit on eligible compensation, may be made at the discretion of the Company based upon the Company's performance. For the years ended December 31, 2023, 2022, and 2021, the Company's expense for such plan was $4.8 million, $4.1 million, and $4.6 million, respectively.
v3.24.0.1
Income Taxes
12 Months Ended
Dec. 31, 2023
Income Tax Disclosure [Abstract]  
Income Taxes
17. Income Taxes

The benefit (provision) for income taxes is comprised of the following.

For the Years Ended December 31,
(in thousands)202320222021
Federal:
Current$(183)$(17)$161 
Deferred(7,590)1,325 9,837 
Total federal(7,773)1,308 9,998 
State:
Current(1,011)251 (1,835)
Deferred (included in federal above)— — — 
Total state(1,011)251 (1,835)
Total$(8,784)$1,559 $8,163 

A reconciliation of the benefit (provision) for income taxes to the amount computed at the U.S. Federal statutory rate of 21% is as follows.

For the Years Ended December 31,
(in thousands)202320222021
Tax benefit (provision) at U.S. statutory rate$37,848 $50,397 $22,565 
State taxes, net of federal income tax5,766 10,811 7,673 
Valuation allowance(49,109)(57,080)13,027 
Goodwill derecognition— — (31,829)
Stock compensation(1,312)(181)(1,856)
Other(1,977)(2,388)(1,417)
Total$(8,784)$1,559 $8,163 
Significant components of the Company's deferred tax assets and liabilities are as follows.

As of December 31,
(in thousands)20232022
Deferred income tax assets:
Operating loss carryforwards$392,577 $361,160 
Operating lease obligations220,003 199,226 
Tax credits50,415 50,415 
Accrued expenses46,814 42,828 
Intangible assets26,816 39,360 
Financing lease obligations— 12,749 
Capital loss carryforward2,102 2,140 
Other3,268 3,091 
Total gross deferred income tax asset741,995 710,969 
Valuation allowance(474,152)(425,043)
Net deferred income tax assets267,843 285,926 
Deferred income tax liabilities:
Operating lease right-of-use assets(168,398)(149,881)
Property, plant and equipment(92,580)(122,377)
Investment in unconsolidated ventures— (12,064)
Financing lease obligations(10,273)— 
Other(2,579)— 
Total gross deferred income tax liability(273,830)(284,322)
Net deferred tax asset (liability)$(5,987)$1,604 
A reconciliation of the beginning and ending amounts of the deferred tax valuation allowance is as follows:

Year EndedBalance at beginning of periodCharged to deferred income tax (benefit) provisionBalance at end of period
December 31, 2021$380,990 $(13,027)(1)$367,963 
December 31, 2022$367,963 $57,080 (2)$425,043 
December 31, 2023$425,043 $49,109 (2)$474,152 

(1) Reduction of valuation allowance for federal and state net operating losses and credits.
(2) Increase to valuation allowance for federal and state net operating losses and credits.

As of December 31, 2023 and 2022, the Company had federal net operating loss carryforwards generated in 2017 and prior of approximately $790.8 million and $802.2 million, respectively, which are available to offset future taxable income from 2024 through 2034. Additionally, as of December 31, 2023 and 2022, the Company had federal net operating loss carryforwards generated after 2017 of $799.3 million and $659.7 million, respectively, which have an indefinite life, but with usage limited to 80% of taxable income in any given year. The Company had state capital loss carryforwards of $2.1 million as of both December 31, 2023 and 2022, which are available to offset future capital gains through 2024, and are fully offset by a valuation allowance. The Company determined that a valuation allowance was required after consideration of the Company's estimated future reversal of existing timing differences as of December 31, 2023 and 2022. The Company does not consider estimates of future taxable income in its determination due to the existence of cumulative historical operating losses. The Company's valuation allowance as of December 31, 2023 and 2022 was $474.2 million and $425.0 million, respectively.

The Company has recorded valuation allowances of $421.6 million and $372.5 million against its federal and state net operating losses as of December 31, 2023 and 2022, respectively. The Company has recorded a valuation allowance against its state capital loss carryforward of $2.1 million as of both December 31, 2023 and 2022. The Company also recorded a valuation allowance against federal and state credits of $50.4 million as of both December 31, 2023 and 2022.
As of December 31, 2023 and 2022, the Company had gross tax affected unrecognized tax benefits of $18.2 million and $18.1 million, respectively, which, if recognized, would result in an income tax benefit recorded in the consolidated statement of operations. Interest and penalties related to these tax positions are classified as tax expense in the Company's consolidated financial statements. Total interest and penalties reserved is $0.2 million and $0.1 million as of December 31, 2023 and 2022, respectively. As of December 31, 2023, the Company's tax returns for years 2019 through 2022 are subject to future examination by tax authorities. In addition, the net operating losses from prior years are subject to adjustment under examination. The Company does not expect that unrecognized tax benefits for tax positions taken with respect to 2023 and prior years will significantly change in 2024.

A reconciliation of the unrecognized tax benefits is as follows.

For the Years Ended December 31,
(in thousands)20232022
Balance at beginning of period$18,088 $18,089 
Additions for tax positions related to prior years173 — 
Reductions for tax positions related to prior years(56)(1)
Balance at end of period$18,205 $18,088 
v3.24.0.1
Supplemental Disclosure of Cash Flow Information
12 Months Ended
Dec. 31, 2023
Supplemental Cash Flow Elements [Abstract]  
Supplemental Disclosure of Cash Flow Information
18. Supplemental Disclosure of Cash Flow Information

(in thousands)For the Years Ended December 31,
Supplemental Disclosure of Cash Flow Information:202320222021
Interest paid$231,786 $200,308 $188,791 
Income taxes paid, net of (refunds)$(1,429)$(330)$5,923 
Capital expenditures, net of related payables:
Capital expenditures - non-development, net$216,511 $168,166 $137,410 
Capital expenditures - development, net1,762 6,193 3,208 
Capital expenditures - non-development - reimbursable from lessor10,319 25,650 42,100 
Trade accounts payable4,613 (3,085)(6,061)
Net cash paid$233,205 $196,924 $176,657 
For the Years Ended December 31,
(in thousands)
2023
2022
2021
Acquisition of assets, net of cash acquired:
Prepaid expenses and other assets, net$23 $— $— 
Property, plant and equipment and leasehold intangibles, net6,872 — 
Investment in unconsolidated ventures(3,395)— — 
Financing lease obligations— 6,000 — 
Other liabilities(384)— — 
Other non-operating loss (income)(2,542)— — 
Net cash paid$574 $6,004 $— 
Proceeds from HCS Sale, net:
Accounts receivable, net$— $— $(57,582)
Property, plant and equipment and leasehold intangibles, net— — (1,806)
Operating lease right-of-use assets— — (8,145)
Investment in unconsolidated ventures— — 100,000 
Goodwill— — (126,810)
Prepaid expenses and other assets, net— — (32,963)
Trade accounts payable— — 1,387 
Accrued expenses— — 25,226 
Refundable fees and deferred revenue— — 57,314 
Operating lease obligations— — 8,145 
Other liabilities— — 9,165 
Non-operating loss (gain) on sale of assets, net— — (286,489)
Net cash received$— $— $(312,558)
Proceeds from sale of other assets, net:
Prepaid expenses and other assets, net$(1,889)$(1,308)$(1,983)
Assets held for sale— (3,668)(16,166)
Property, plant and equipment and leasehold intangibles, net(36,545)(107)(878)
Investment in unconsolidated ventures(27,392)— — 
Refundable fees and deferred revenue9,347 — — 
Other liabilities10,690 1,025 (75)
Non-operating loss (gain) on sale of assets, net(1,441)(595)(2,346)
Loss (gain) on sale of communities, net(36,296)— — 
Net cash received$(83,526)$(4,653)$(21,448)
Supplemental Schedule of Non-cash Operating, Investing and Financing Activities:
For the Years Ended December 31,
(in thousands)
2023
2022
2021
Gain on sale for master lease amendment:
Property, plant and equipment and leasehold intangibles, net$— $(220,477)$— 
Operating lease right-of-use assets— 91,641 — 
Financing lease obligations— 294,327 — 
Operating lease obligations— (91,641)— 
Loss (gain) on sale of communities, net— (73,850)— 
Net$— $— $— 
Other non-cash lease transactions, net:
Property, plant and equipment and leasehold intangibles, net$(51,518)$11,098 $4,056 
Operating lease right-of-use assets223,309 11,419 17,197 
Operating lease obligations(260,611)(16,179)(17,197)
Financing lease obligations88,820 (6,338)(4,056)
Net$— $— $— 

Restricted cash consists principally of escrow deposits for interest rate caps, real estate taxes, property insurance, capital expenditures, and debt service reserves required by certain lenders under mortgage debt agreements, deposits as security for self-insured retention risk under workers' compensation programs and property insurance programs, and regulatory reserves for certain CCRCs. The components of restricted cash are as follows.

 December 31,
(in thousands)20232022
Current:  
Interest rate cap escrows$17,843 $3,797 
Real estate tax and property insurance escrows16,061 15,722 
Replacement reserve escrows7,194 7,999 
Other243 217 
Subtotal41,341 27,735 
Long term:
Insurance deposits15,961 18,230 
CCRCs escrows10,813 15,847 
Debt service reserve3,472 13,779 
Letters of credit collateral110 107 
Subtotal30,356 47,963 
      Total$71,697 $75,698 

The following table provides a reconciliation of cash, cash equivalents, and restricted cash reported within the consolidated balance sheets that sums to the total of the same such amounts shown in the consolidated statements of cash flows.

December 31,
(in thousands)20232022
Reconciliation of cash, cash equivalents, and restricted cash:
Cash and cash equivalents$277,971 $398,850 
Restricted cash41,341 27,735 
Long-term restricted cash30,356 47,963 
Total cash, cash equivalents, and restricted cash$349,668 $474,548 
v3.24.0.1
COVID-19 Pandemic
12 Months Ended
Dec. 31, 2023
Unusual or Infrequent Items, or Both [Abstract]  
COVID-19 Pandemic
19. COVID-19 Pandemic

The COVID-19 pandemic has adversely impacted the Company's occupancy and resident fee revenue beginning in March 2020, resulted in incremental direct costs to respond to the pandemic, and for the year ended December, 31, 2021, resulted in net cash used in operating activities. While the Federal COVID-19 Public Health Emergency Declaration expired on May 11, 2023, the Company cannot predict with reasonable certainty the impacts that the COVID-19 pandemic and the continued recovery ultimately will have on the Company's business, results of operations, cash flow, and liquidity.

Government Provided Financial Relief. The Coronavirus Aid, Relief, and Economic Security Act of 2020 ("CARES Act"), signed into law on March 27, 2020, and Paycheck Protection Program and Health Care Enhancement Act, signed into law on April 24, 2020, provided liquidity and financial relief to certain businesses, among other things. Certain impacts of such programs are provided below.

During the years ended December 31, 2022 and 2021, the Company accepted $61.1 million and $0.8 million, respectively, of cash from grants from the Public Health and Social Services Emergency Fund ("Provider Relief Fund") administered by U.S. Department of Health and Human Services, under which grants have been made available to eligible healthcare providers for healthcare related expenses or lost revenues attributable to the COVID-19 pandemic.

During the year ended December 31, 2020, the Company received $87.5 million under the Accelerated and Advance Payment Program administered by CMS, $75.2 million of which related to its former Health Care Services segment and $12.3 million of which related to its CCRCs segment. During the years ended December 31, 2022 and 2021, $3.1 million and $20.8 million, respectively, of the advanced payments were recouped per the terms of the program. Pursuant to the sale of 80% of the Company's equity in its Health Care Services segment (as described in Note 3), $63.6 million of such obligations related to its former Health Care Services segment were retained by the unconsolidated HCS Venture. As of December 31, 2023, the Company has no remaining obligations under the program.

During the year ended December 31, 2020, the Company deferred payment of $72.7 million of the employer portion of social security payroll taxes incurred from March 27, 2020 through December 31, 2020 pursuant to the CARES Act. Pursuant to the sale of 80% of the Company's equity in its Health Care Services segment, $9.6 million of such obligations related to its former Health Care Services segment were retained by the unconsolidated HCS Venture. In both December 2021 and 2022, the Company paid $31.6 million of its retained deferred amount. As of December 31, 2023, the Company has no remaining obligations for the deferred payroll tax program.

The Company was eligible to claim the employee retention credit on wages paid from March 12, 2020 to December 31, 2021 for certain of its associates under the CARES Act and subsequent legislation. During the years ended December 31, 2022 and 2021, the Company recognized $9.4 million and $9.9 million, respectively, of employee retention credits on wages paid from March 12, 2020 to December 31, 2021 within other operating income. During the years ended December 31, 2023 and 2022, the Company received cash of $14.7 million and $4.6 million, respectively, for such employee retention credits. As of December 31, 2023, the Company has no remaining receivables under the program. The Company had a receivable for $14.7 million included within prepaid expenses and other current assets, net on the consolidated balance sheet as of December 31, 2022.

In addition to the grants previously described, during the years ended December 31, 2023, 2022, and 2021, the Company recognized $9.1 million, $10.0 million, and $1.7 million, respectively, of other operating income from grants from other government sources.
v3.24.0.1
Segment Information
12 Months Ended
Dec. 31, 2023
Segment Reporting [Abstract]  
Segment Information
20. Segment Information

The Company has three reportable segments: Independent Living; Assisted Living and Memory Care; and CCRCs. Operating segments are defined as components of an enterprise that engage in business activities from which it may earn revenues and incur expenses; for which separate financial information is available; and whose operating results are regularly reviewed by the chief operating decision maker to assess the performance of the individual segment and make decisions about resources to be allocated to the segment. Prior to July 1, 2021, the Company had an additional reportable segment, Health Care Services, as described in Note 3.

Independent Living. The Company's Independent Living segment includes owned or leased communities that are primarily designed for middle to upper income seniors who desire to live in a residential setting that feels like home, without the efforts of ownership. The majority of the Company's independent living communities consist of both independent and assisted living
units in a single community, which allows residents to age-in-place by providing them with a broad continuum of senior independent and assisted living services to accommodate their changing needs.

Assisted Living and Memory Care. The Company's Assisted Living and Memory Care segment includes owned or leased communities that offer housing and 24-hour assistance with activities of daily living for the Company's residents. The Company's assisted living and memory care communities include both freestanding, multi-story communities, as well as smaller, freestanding, single story communities. The Company also provides memory care services at freestanding memory care communities that are specially designed for residents with Alzheimer's disease and other dementias.

CCRCs. The Company's CCRCs segment includes large owned or leased communities that offer a variety of living arrangements and services to accommodate a broad spectrum of physical ability and healthcare needs. Most of the Company's CCRCs have independent living, assisted living, memory care, and skilled nursing available on one campus.

All Other. All Other includes communities operated by the Company pursuant to management agreements. Under the management agreements for these communities, the Company receives management fees as well as reimbursement of expenses it incurs on behalf of the owners.

Health Care Services. The Company's former Health Care Services segment included the home health, hospice, and outpatient therapy services provided to residents of many of its communities and to seniors living outside its communities. The Health Care Services segment did not include the skilled nursing and inpatient healthcare services provided in the Company's skilled nursing units, which are included in the Company's CCRCs segment.

The accounting policies of the Company's reportable segments are the same as those described in the summary of significant accounting policies in Note 2.

The following tables set forth selected segment financial data.

For the Years Ended December 31,
(in thousands)202320222021
Revenue and other operating income:
Independent Living (1)(2)
$564,499 $518,699 $477,050 
Assisted Living and Memory Care (1)(2)
1,968,440 1,815,722 1,595,684 
CCRCs (1)(2)
333,404 331,577 306,213 
All Other (3)
149,486 159,381 202,043 
Health Care Services (1)(2)
— — 177,269 
Total revenue and other operating income3,015,829 2,825,379 2,758,259 
Segment operating income:(4)
Independent Living184,645 158,950 146,108 
Assisted Living and Memory Care502,317 379,958 294,320 
CCRCs49,581 43,485 34,109 
All Other10,161 12,020 20,598 
Health Care Services— — 5,816 
Total segment operating income746,704 594,413 500,951 
For the Years Ended December 31,
(in thousands)202320222021
General and administrative expense (including non-cash stock-based compensation expense)178,894 168,594 184,916 
Facility operating lease expense:
Independent Living39,114 39,700 42,162 
Assisted Living and Memory Care146,166 106,961 111,117 
CCRCs12,943 13,883 15,932 
Corporate and All Other4,187 4,750 5,147 
Depreciation and amortization:
Independent Living83,637 79,521 74,922 
Assisted Living and Memory Care196,994 207,344 200,677 
CCRCs36,951 38,039 37,891 
Corporate and All Other25,130 22,540 23,783 
Health Care Services— — 340 
Asset impairment:
Independent Living1,647 10,893 3,483 
Assisted Living and Memory Care11,574 11,613 14,384 
CCRCs1,368 5,970 4,790 
Corporate and All Other25,983 1,142 346 
Loss (gain) on sale of communities, net(36,296)(73,850)— 
Loss (gain) on facility operating lease termination, net— — (2,003)
Income (loss) from operations$18,412 $(42,687)$(216,936)
Total interest expense:
Independent Living$61,624 $48,788 $45,209 
Assisted Living and Memory Care141,330 133,139 121,785 
CCRCs24,889 21,251 18,756 
Corporate and All Other10,431 1,539 9,390 
$238,274 $204,717 $195,140 
Total capital expenditures for property, plant and equipment, and leasehold intangibles:
Independent Living$51,188 $44,857 $36,992 
Assisted Living and Memory Care121,240 111,978 105,177 
CCRCs37,414 20,467 19,086 
Corporate and All Other18,750 22,707 21,463 
$228,592 $200,009 $182,718 
    
As of December 31,
(in thousands)20232022
Total assets:
Independent Living(5)
$1,206,021 $1,267,825 
Assisted Living and Memory Care3,315,921 3,329,516 
CCRCs612,521 664,502 
Corporate and All Other438,972 675,219 
Total assets$5,573,435 $5,937,062 

(1)All revenue and other operating income is earned from external third parties in the United States.
(2)Includes other operating income recognized for the credits or grants pursuant to the Provider Relief Fund, employee retention credit, and other government sources, as described in Note 19. Allocations to the applicable segment generally reflect the credits earned by the segment, the segment’s receipt and acceptance of the grant, or the segment’s proportional utilization of the grant. Other operating income by segment is as follows.

For the Years Ended December 31,
(in thousands)202320222021
Independent Living$487 $10,906 $1,512 
Assisted Living and Memory Care8,008 60,630 5,963 
CCRCs578 8,933 1,788 
Health Care Services— — 3,105 
Total other operating income$9,073 $80,469 $12,368 
(3)All Other revenue and other operating income includes management fees and reimbursements of costs incurred on behalf of managed communities. For the years ended December 31, 2023, 2022, and 2021, revenue and other operating income includes $0.9 million, $4.2 million, and $17.2 million of revenue earned from unconsolidated ventures in which the Company had or has an ownership interest.
(4)Segment operating income is defined as segment revenues and other operating income less segment facility operating expenses (excluding facility depreciation and amortization) and costs incurred on behalf of managed communities.
(5)The Company's total carrying amount of goodwill is included on the Independent Living segment and was $27.3 million as of December 31, 2023, 2022, and 2021.
v3.24.0.1
Pay vs Performance Disclosure - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Pay vs Performance Disclosure      
Net income (loss) $ (189,011) $ (238,427) $ (99,290)
v3.24.0.1
Insider Trading Arrangements
12 Months Ended
Dec. 31, 2023
Trading Arrangements, by Individual  
Rule 10b5-1 Arrangement Adopted false
Non-Rule 10b5-1 Arrangement Adopted false
Rule 10b5-1 Arrangement Terminated false
Non-Rule 10b5-1 Arrangement Terminated false
v3.24.0.1
Summary of Significant Accounting Policies (Policies)
12 Months Ended
Dec. 31, 2023
Accounting Policies [Abstract]  
Principles of Consolidation
Principles of Consolidation

The consolidated financial statements include the accounts of Brookdale and its consolidated subsidiaries. The ownership interest of consolidated entities not wholly-owned by the Company are presented as noncontrolling interests in the accompanying consolidated financial statements. Intercompany balances and transactions have been eliminated in consolidation, and net income (loss) is reduced by the portion of net income (loss) attributable to noncontrolling interests.
Use of Estimates
Use of Estimates

The preparation of the consolidated financial statements and related disclosures in conformity with GAAP requires management to make estimates and assumptions that affect the amounts reported in the consolidated financial statements and accompanying notes. Estimates are used for, but not limited to, revenue, asset impairments, self-insurance reserves, performance-based compensation, allowance for credit losses, depreciation and amortization, leasing transactions, income taxes, and other contingencies. Although these estimates are based on management's best knowledge of current events and actions that the Company may undertake in the future, actual results may differ from the original estimates.
Revenue Recognition and Government Grants
Revenue Recognition

Resident Fees

Resident fee revenue is reported at the amount that reflects the consideration the Company expects to receive in exchange for the services provided. These amounts are due from residents or third-party payors and include variable consideration for retroactive adjustments from estimated reimbursements, if any, under reimbursement programs. Performance obligations are determined based on the nature of the services provided. Resident fee revenue is recognized as performance obligations are satisfied.

Under the Company's senior living residency agreements, which are generally for a contractual term of 30 days to one year, the Company provides senior living services to residents for a stated daily or monthly fee. The Company has elected the lessor practical expedient within ASC 842, Leases ("ASC 842") and recognizes, measures, presents, and discloses the revenue for services under the Company's senior living residency agreements based upon the predominant component, either the lease or nonlease component, of the contracts. The Company has determined that the services included under the Company's independent living, assisted living, and memory care residency agreements have the same timing and pattern of transfer and are performance obligations that are satisfied over time. The Company recognizes revenue under ASC 606, Revenue Recognition from Contracts with Customers ("ASC 606") for its independent living, assisted living, and memory care residency agreements for which it has estimated that the nonlease components of such residency agreements are the predominant component of the contract.

The Company receives payment for services under various third-party payor programs which include Medicare, Medicaid, and other third-party payors. Estimates for settlements with third-party payors for retroactive adjustments from estimated reimbursements due to audits, reviews, or investigations are included in the determination of the estimated transaction price for providing services. The Company estimates the transaction price based on the terms of the contract with the payor,
correspondence with the payor, and historical payment trends. Changes to these estimates for retroactive adjustments are recognized in the period the change or adjustment becomes known or when final settlements are determined.

Billings for services under third-party payor programs are recorded net of estimated retroactive adjustments, if any. Retroactive adjustments are accrued on an estimated basis in the period the related services are rendered and adjusted in future periods or as final settlements are determined. Contractual or cost related adjustments from Medicare or Medicaid are accrued when assessed (without regard to when the assessment is paid or withheld). Subsequent adjustments to these accrued amounts are recorded in net revenues when known.

Management Services

The Company manages certain communities under contracts which provide periodic management fee payments to the Company and reimbursement for costs and expense related to such communities. Management fees are generally determined by an agreed upon percentage of gross revenues (as defined in the management agreement). Certain management contracts also provide for an annual incentive fee to be paid to the Company upon achievement of certain metrics identified in the contract. The Company has determined that all community management activities are a single performance obligation, which is satisfied over time as the services are rendered. The Company estimates the amount of incentive fee revenue expected to be earned, if any, during the annual contract period and revenue is recognized as services are provided. The Company's estimate of the transaction price for management services also includes the amount of reimbursement due from the owners of the communities for services provided and related costs incurred. Such revenue is included in reimbursed costs incurred on behalf of managed communities on the consolidated statements of operations. The related costs are included in costs incurred on behalf of managed communities on the consolidated statements of operations.

Government Grants

The Company recognizes income for government grants on a systematic and rational basis over the periods in which the Company recognizes the related expenses or loss of revenue for which the grants are intended to compensate when there is reasonable assurance that the Company will comply with the applicable terms and conditions of the grant and there is reasonable assurance that the grant will be received.
Lease Accounting
Lease Accounting

The Company, as lessee, recognizes a right-of-use asset and a lease liability on the Company's consolidated balance sheet for its long-term leases. As of the commencement date of a lease, a lease liability and corresponding right-of-use asset is established on the Company's consolidated balance sheet at the estimated present value of future minimum lease payments. The Company's community leases generally contain fixed annual rent escalators or annual rent escalators based on an index, such as the consumer price index. The future minimum lease payments recognized on the consolidated balance sheet include fixed payments (including in-substance fixed payments) and variable payments estimated utilizing the index or rate on the lease commencement date. The Company recognizes lease expense as incurred for additional variable payments. For the Company's leases for which the rate implicit in the lease is not readily determinable, the Company utilizes its estimated incremental borrowing rate to determine the present value of lease payments based on information available at commencement of the lease. The Company's estimated incremental borrowing rate reflects the fixed rate at which the Company could borrow a similar amount for the same term on a collateralized basis. For accounting purposes, renewal or extension options are included in the lease term at lease inception or modification when it is reasonably certain that the Company will exercise the option. The Company elected the short-term lease exception policy which permits leases with an initial term of 12 months or less to not be recorded on the Company's consolidated balance sheet.

The Company, as lessee, makes a determination with respect to each of its leases as to whether each should be accounted for as an operating lease or financing lease. The classification criteria is based on estimates regarding the fair value of the leased asset, minimum lease payments, effective cost of funds, economic life of the asset, and certain other terms in the lease agreements.

Lease right-of-use assets are reviewed for impairment whenever changes in circumstances indicate that the carrying amount of an asset group may not be recoverable. Recoverability of right-of-use assets are assessed by a comparison of the carrying amount of the asset group to the estimated future undiscounted net cash flows expected to be generated by the asset group, calculated utilizing the lowest level of identifiable cash flows. If estimated future undiscounted net cash flows are less than the carrying amount of the asset group then the fair value of the asset is estimated. The impairment loss is determined by comparing the estimated fair value of the asset to its carrying amount, with any amount in excess of fair value recognized as an impairment loss in the current period. Undiscounted cash flow projections and estimates of fair value amounts are based on a number of assumptions such as revenue and expense growth rates and estimated lease coverage ratios (Level 3).
Operating Leases

The Company recognizes operating lease expense for actual rent paid, generally plus or minus a straight-line adjustment for estimated minimum lease escalators if applicable. The right-of-use asset is generally reduced each period by an amount equal to the difference between the operating lease expense and the amount of expense on the lease liability utilizing the effective interest method. Subsequent to the impairment of an operating lease right-of-use asset, the Company recognizes operating lease expense consisting of the reduction of the right-of-use asset on a straight-line basis over the remaining lease term and the amount of expense on the lease liability utilizing the effective interest method.

Financing Leases

Financing lease right-of-use assets are recognized within property, plant and equipment and leasehold intangibles, net on the Company's consolidated balance sheets. The Company recognizes interest expense on the financing lease liabilities utilizing the effective interest method. The right-of-use asset is generally amortized to depreciation and amortization expense on a straight-line basis over the lease term unless the lease contains an option to purchase the underlying asset that the Company is reasonably certain to exercise. If the Company is reasonably certain to exercise the purchase option, the asset is amortized over the useful life.

Sale-Leaseback Transactions

For transactions in which an owned community is sold and leased back from the buyer (sale-leaseback transactions), the Company recognizes an asset sale and lease accounting is applied if the Company has transferred control of the community. For such transactions, the Company removes the transferred assets from the consolidated balance sheet and a gain or loss on the sale is recognized for the difference between the carrying amount of the asset and the transaction price for the sale transaction.

For sale‑leaseback transactions in which the Company has not transferred control of the underlying asset, the Company does not recognize an asset sale or derecognize the underlying asset until control is transferred. For such transactions, the Company recognizes the underlying assets within assets under financing leases as a component of property, plant and equipment and leasehold intangibles, net on the consolidated balance sheets and continues to depreciate the assets over their useful lives. Additionally, the Company accounts for any amounts received as a financing lease liability and the Company recognizes interest expense on the financing lease liability utilizing the effective interest method with the interest expense limited to an amount that is not greater than the cash payments on the financing lease liability over the term of the lease. The Company reviews for sale accounting whenever events or changes in circumstances indicate that control may have been transferred and the Company recognizes an asset sale and lease accounting is applied if the Company has transferred control of the underlying asset. When an asset sale is recognized for such transactions, the Company removes the transferred assets and financing lease liability from the consolidated balance sheet and a gain or loss on the sale is recognized for the difference between the carrying amount of the asset and the financing lease liability.
Gain (Loss) on Sale of Assets
Gain (Loss) on Sale of Assets

The Company regularly enters into real estate transactions which may include the disposition of certain communities, including the associated real estate. The Company recognizes a gain or loss from real estate sales when the transfer of control is complete.

The Company recognizes a gain or loss from the sale of equity method investments when the transfer of control is complete and the Company has no continuing involvement with the transferred financial assets.
Purchase Accounting
Purchase Accounting

For the acquisition of assets that do not meet the definition of a business, the Company accounts for the transaction as an asset acquisition at the purchase price, including acquisition costs, allocated among the acquired assets and assumed liabilities, including identified intangible assets and liabilities, based upon the relative fair values using Level 3 inputs at the date of acquisition.

For acquisitions of a business, the Company accounts for the transaction as a business combination pursuant to the acquisition method and assets acquired and liabilities assumed, including identified intangible assets and liabilities, are recorded at fair value. In determining the allocation of the purchase price of companies and communities to net tangible and identified intangible assets acquired and liabilities assumed, the Company makes estimates of fair value using information obtained as a result of pre-acquisition due diligence, marketing, leasing activities, and/or independent appraisals. In connection with a business combination, the excess of the fair value of liabilities assumed and common stock issued and cash paid over the fair
value of identifiable assets acquired is allocated to goodwill. Transaction costs associated with business combinations are expensed as incurred.
Deferred Financing Costs
Deferred Financing Costs
Costs and fees incurred with third parties that directly relate to obtaining new long-term debt (excluding the Company's line-of-credit) are recorded as a direct adjustment to the carrying amount of long-term debt. The Company presents deferred financing costs related to line-of-credit facilities in other assets, net on the consolidated balance sheet. The Company amortizes deferred financing costs on a straight-line basis, which approximates the effective yield method over the term of the related debt arrangements.
Stock-Based Compensation
Stock-Based Compensation

Measurement of the cost of employee services received in exchange for stock-based compensation is based on the grant-date fair value of the employee stock awards, which is based on the quoted price of the Company's common shares on the grant date for the majority of the Company's awards. The Company evaluates if grant-date fair value adjustments are necessary based on whether the Company is in possession of material non-public information at the grant date and the changes in the Company’s stock price subsequent to the release of such information and no adjustments were made. The Company recognizes forfeitures of stock-based awards as they occur and any previously recognized compensation expense is reversed for forfeited awards. Stock-based awards that vest over a requisite service period, other than those with performance or market conditions, generally vest ratably in annual installments over a period of three to four years. Incremental compensation costs arising from subsequent modifications of awards after the grant date are recognized when incurred.

Certain of the Company's employee stock-based awards vest only upon the achievement of performance conditions. The Company recognizes compensation cost only when achievement of performance conditions is considered probable. Consequently, the Company’s determination of the amount of stock-based compensation expense requires judgment in estimating the probability of achievement of these performance conditions. Performance conditioned awards that vest dependent upon attainment of various levels of performance that equal or exceed threshold levels generally vest based upon performance at the end of a three-year performance period. The number of shares that ultimately vest can range from 0% to 150% of the stock-based awards granted depending on the level of achievement of the performance criteria.

Certain of the Company's employee stock-based awards vest only upon the achievement of a market condition where the measurement period is three years and vesting of the awards is based on the Company's level of attainment of a specified total stockholder return relative to the percentage appreciation of a specified index of companies for the respective three-year measurement period. Compensation expense for awards with market conditions is recognized over the service period, which is generally four years, and the actual achievement of the market condition does not impact expense recognition. The Company uses a Monte Carlo valuation model to estimate the grant date fair value of such awards. Depending on the results achieved during the three-year measurement period, the number of shares that ultimately vest may range from 0% to 150% of the stock-based awards granted. The expected volatility of the Company's common stock at the date of grant is estimated based on a historical average volatility rate for the approximate three-year performance period and the estimated expected weighted average volatility was 83.3% and 76.0% for awards granted in 2023 and 2022, respectively. The risk-free interest rate assumption is based on observed interest rates consistent with the approximate three-year measurement period and the estimated weighted average risk free interest rate was 4.4% and 1.8% for awards granted in 2023 and 2022, respectively.

For all share-based awards with graded vesting other than performance conditioned awards, the Company records compensation expense for the entire award on a straight-line basis (or, if applicable, on the accelerated method) over the requisite service period. For performance conditioned awards, total compensation expense is recognized over the requisite service period for each separately vesting tranche of the award as if the award is, in substance, multiple awards once the performance condition is deemed probable of achievement. Performance conditions are evaluated quarterly. If such conditions are not ultimately met or it is not probable the conditions will be achieved, no compensation expense for performance conditioned awards is recognized and any previously recognized compensation expense is reversed.
Income Taxes
Income Taxes

The Company accounts for income taxes under the asset and liability approach which requires recognition of deferred tax assets and liabilities for the differences between the financial reporting and tax basis of assets and liabilities using the tax rates in effect for the year in which the differences are expected to affect taxable income. A valuation allowance reduces deferred tax assets when it is more likely than not that some portion or all of the deferred tax assets will not be realized. When it is determined that it is more likely than not that the Company will be able to realize deferred tax assets in the future in excess of
the net recorded amount, an adjustment to the deferred tax asset is made and reflected in income. This determination is made by considering various factors, including the reversal and timing of existing temporary differences, tax planning strategies, and estimates of future taxable income exclusive of the reversal of temporary differences.
Fair Value of Financial Instruments
Fair Value of Financial Instruments

Fair value measurements are based on a three-level valuation hierarchy for disclosure of fair value measurements. The valuation hierarchy is based upon the transparency of inputs to the valuation of an asset or liability as of the measurement date. Categorization within the valuation hierarchy is based upon the lowest level of input that is significant to the fair value measurement. The three levels are defined as follows.

Level 1 – quoted prices (unadjusted) for identical assets or liabilities in active markets;

Level 2 – quoted prices for similar assets and liabilities in active markets; quoted prices for identical or similar instruments in markets that are not active; and model-derived valuations in which significant inputs and significant value drivers are observable in active markets; and

Level 3 – fair value measurements derived from valuation techniques in which one or more significant inputs or significant value drivers are unobservable.
Marketable Securities
Marketable Securities
Marketable securities are investments in commercial paper and short-term corporate bond instruments with maturities of greater than 90 days as of their acquisition date by the Company.
Accounts Receivable, Net
Accounts Receivable, Net

Accounts receivable are reported net of an allowance for credit losses to represent the Company's estimate of expected losses at the balance sheet date. The adequacy of the Company's allowance for credit losses is reviewed on an ongoing basis, using historical payment trends, write-off experience, analyses of receivable portfolios by payor source and aging of receivables, a review of specific accounts, as well as expected future economic conditions and market trends, and adjustments are made to the allowance as necessary.
Property, Plant and Equipment and Leasehold Intangibles, Net
Property, Plant and Equipment and Leasehold Intangibles, Net

Property, plant and equipment and leasehold intangibles, net are recorded at cost. Depreciation and amortization is computed using the straight-line method over the estimated useful lives of the assets, which are as follows.

Asset CategoryEstimated
Useful Life
(in years)
Buildings and improvements 
40
Furniture and equipment 
3 – 10
Resident in-place lease intangibles 
1 – 3

Expenditures for ordinary maintenance and repairs are expensed to operations as incurred. Renovations and improvements, which improve and/or extend the useful life of the asset, are capitalized and depreciated over the estimated useful life of the renovations or improvements. For communities subject to operating or financing leases, leasehold improvements are depreciated over the shorter of the estimated useful life of the assets or the term of the lease. For financing leases that have a purchase option the Company is reasonably certain to exercise, the leasehold improvements are depreciated over their estimated useful life. Facility operating expense excludes facility depreciation and amortization.

Long-lived assets are reviewed for impairment whenever events or changes in circumstances indicate the carrying amount of an asset group may not be recoverable. Recoverability of an asset group is assessed by comparing its carrying amount to the estimated future undiscounted net cash flows expected to be generated by the asset group through operation or disposition, calculated utilizing the lowest level of identifiable cash flows. If this comparison indicates that the carrying amount of an asset group is not recoverable, the Company is required to recognize an impairment loss. The impairment loss is measured by the amount by which the carrying amount of the asset exceeds its estimated fair value, with any amount in excess of fair value
recognized as an expense in the current period. Undiscounted cash flow projections and estimates of fair value amounts are based on a number of assumptions such as revenue and expense growth rates, estimated holding periods, and estimated capitalization rates (Level 3).
Investment in Unconsolidated Ventures
Investment in Unconsolidated Ventures

The Company reports investments in unconsolidated entities over whose operating and financial policies it has the ability to exercise significant influence under the equity method of accounting. The initial carrying amount of investment in unconsolidated ventures is based on the amount paid to purchase the investment or its fair value in the case of a retained noncontrolling interest upon deconsolidation of a former subsidiary. The Company's reported share of earnings of an unconsolidated venture is adjusted for the impact, if any, of basis differences between its carrying amount of the equity investment and its share of the venture's underlying assets. Distributions received from an investee are recognized as a reduction in the carrying amount of the investment.

The Company evaluates realization of its investment in ventures accounted for using the equity method if circumstances indicate that the Company's investment is other than temporarily impaired. A current fair value of an investment that is less than its carrying amount may indicate a loss in value of the investment. If the Company determines that an equity method investment is other than temporarily impaired, it is recorded at its fair value with an impairment charge recognized in asset impairment expense for the difference between its carrying amount and fair value.
Goodwill
Goodwill

The Company tests goodwill for impairment annually during the fourth quarter or more frequently if indicators of impairment arise. Factors the Company considers important in its analysis of whether an indicator of impairment exists include a significant decline in the Company's stock price or market capitalization for a sustained period since the last testing date, significant underperformance relative to historical or projected future operating results, and significant negative industry or economic trends. The Company first assesses qualitative factors to determine if it is more likely than not that the fair value of a reporting unit is less than its carrying amount. If so, the Company performs a quantitative goodwill impairment test based upon a comparison of the estimated fair value of the reporting unit to which the goodwill has been assigned with the reporting unit's carrying amount. The fair values used in the quantitative goodwill impairment test are estimated using Level 3 inputs based upon discounted future cash flow projections for the reporting unit. These cash flow projections are based upon a number of estimates and assumptions such as revenue and expense growth rates, capitalization rates, and discount rates. The Company also considers market-based measures such as earnings multiples in its analysis of estimated fair values of its reporting units. If the quantitative goodwill impairment test results in a reporting unit's carrying amount exceeding its estimated fair value, an impairment charge will be recorded based on the difference, with the impairment charge limited to the amount of goodwill allocated to the reporting unit.
Self-Insurance Liability Accruals
Self-Insurance Liability Accruals

The Company is subject to various legal proceedings and claims that arise in the ordinary course of its business. Although the Company maintains general liability and professional liability insurance policies for its owned, leased, and managed communities under a master insurance program, the Company's current policies provide for deductibles for each claim and contain various exclusions from coverage. The Company uses its wholly-owned captive insurance company for the purpose of insuring certain portions of its risk retention under its general and professional liability insurance programs. Accordingly, the Company is, in effect, self-insured for claims that are less than the deductible amounts, for claims that exceed the funding level of the Company’s wholly-owned captive insurance company, and for claims or portions of claims that are not covered by such policies and/or exceed the policy limits. In addition, the Company maintains a high deductible workers' compensation program and a self-insured employee medical program.

The Company reviews the adequacy of its accruals related to these liabilities on an ongoing basis using historical claims, actuarial valuations, third-party administrator estimates, consultants, advice from legal counsel, and industry data, and adjusts accruals periodically. Estimated costs related to these self-insurance programs are accrued based on known claims and projected claims incurred but not yet reported. Subsequent changes in actual experience are monitored, and estimates are updated as information becomes available.
Treasury Stock
Treasury Stock
The Company accounts for treasury stock under the cost method and includes treasury stock as a component of stockholders' equity.
Reclassifications
Reclassifications

Certain prior period amounts have been reclassified to conform to the current financial statement presentation, with no effect on the Company's consolidated financial position or results of operations.
v3.24.0.1
Summary of Significant Accounting Policies (Tables)
12 Months Ended
Dec. 31, 2023
Accounting Policies [Abstract]  
Schedule of Property, Plant and Equipment and Leasehold Intangibles, Net Depreciation and amortization is computed using the straight-line method over the estimated useful lives of the assets, which are as follows.
Asset CategoryEstimated
Useful Life
(in years)
Buildings and improvements 
40
Furniture and equipment 
3 – 10
Resident in-place lease intangibles 
1 – 3
As of December 31, 2023 and 2022, net property, plant and equipment and leasehold intangibles, which include assets under financing leases, consisted of the following.

As of December 31,
(in thousands)20232022
Land$500,649 $506,968 
Buildings and improvements5,348,133 5,323,736 
Furniture and equipment1,111,408 1,055,304 
Resident in-place lease intangibles282,411 286,122 
Construction in progress33,905 41,778 
Assets under financing leases and leasehold improvements1,070,900 1,375,521 
Property, plant and equipment and leasehold intangibles8,347,406 8,589,429 
Accumulated depreciation and amortization(4,016,777)(4,053,727)
Property, plant and equipment and leasehold intangibles, net$4,330,629 $4,535,702 
v3.24.0.1
Fair Value Measurements (Tables)
12 Months Ended
Dec. 31, 2023
Fair Value Disclosures [Abstract]  
Schedule of Interest Rate Caps
The following table summarizes the Company's SOFR interest rate cap instruments as of December 31, 2023.

($ in thousands)
Current notional balance$1,231,920 
Weighted average fixed cap rate4.07 %
Earliest maturity date2024 
Latest maturity date2025 
Weighted average remaining term0.8 years
Estimated asset fair value (included in other assets, net) at December 31, 2023$13,268 
Estimated asset fair value (included in other assets, net) at December 31, 2022$10,599 

The following table summarizes the Company's SOFR interest rate swap instrument as of December 31, 2023.

($ in thousands)
Current notional balance$220,000 
Fixed interest rate3.00 %
Remaining term0.3 years
Estimated asset fair value (included in other assets, net) at December 31, 2023$1,611 
Estimated asset fair value (included in other assets, net) at December 31, 2022$4,834 
Schedule of Asset Impairment Expense
The following is a summary of asset impairment expense.

For the Years Ended December 31,
(in millions)202320222021
Operating lease right-of-use assets$8.3 $13.7 $16.6 
Property, plant and equipment and leasehold intangibles, net6.3 15.9 6.4 
Investment in unconsolidated ventures26.0 — — 
Asset impairment$40.6 $29.6 $23.0 
v3.24.0.1
Revenue (Tables)
12 Months Ended
Dec. 31, 2023
Revenue from Contract with Customer [Abstract]  
Schedule of Disaggregation of Revenue
Resident fee revenue by payor source is as follows.

For the Years Ended December 31,
202320222021
Private pay93.7 %93.5 %86.8 %
Government reimbursement4.8 %5.1 %10.3 %
Other third-party payor programs1.5 %1.4 %2.9 %
Schedule of Accounts Receivable, Allowance for Credit Loss
The following table presents the changes in allowance for credit losses on accounts receivable for the periods indicated.

For the Years Ended December 31,
(in millions)202320222021
Balance at beginning of period$12.8 $13.3 $9.8 
Provision within facility operating expense22.6 20.0 21.6 
Write-offs(22.5)(22.2)(19.2)
Recoveries and other1.2 1.7 1.1 
Balance at end of period$14.1 $12.8 $13.3 
v3.24.0.1
Property, Plant and Equipment and Leasehold Intangibles, Net (Tables)
12 Months Ended
Dec. 31, 2023
Property, Plant and Equipment [Abstract]  
Schedule of Property, Plant and Equipment Depreciation and amortization is computed using the straight-line method over the estimated useful lives of the assets, which are as follows.
Asset CategoryEstimated
Useful Life
(in years)
Buildings and improvements 
40
Furniture and equipment 
3 – 10
Resident in-place lease intangibles 
1 – 3
As of December 31, 2023 and 2022, net property, plant and equipment and leasehold intangibles, which include assets under financing leases, consisted of the following.

As of December 31,
(in thousands)20232022
Land$500,649 $506,968 
Buildings and improvements5,348,133 5,323,736 
Furniture and equipment1,111,408 1,055,304 
Resident in-place lease intangibles282,411 286,122 
Construction in progress33,905 41,778 
Assets under financing leases and leasehold improvements1,070,900 1,375,521 
Property, plant and equipment and leasehold intangibles8,347,406 8,589,429 
Accumulated depreciation and amortization(4,016,777)(4,053,727)
Property, plant and equipment and leasehold intangibles, net$4,330,629 $4,535,702 
v3.24.0.1
Debt (Tables)
12 Months Ended
Dec. 31, 2023
Debt Disclosure [Abstract]  
Schedule of Debt
Long-term debt consists of the following.

December 31,
(in thousands)20232022
Fixed mortgage notes payable due 2025 through 2047; weighted average interest rate of 4.26% and 4.14%, as of December 31, 2023 and 2022, respectively.
$1,953,414 $2,055,867 
Variable mortgage notes payable due 2025 through 2030; weighted average interest rate of 7.74% and 6.68% as of December 31, 2023 and 2022, respectively.
1,524,907 1,568,555 
Convertible notes payable due October 2026; interest rate of 2.00% as of both December 31, 2023 and 2022.
230,000 230,000 
Tangible equity units senior amortizing notes due November 2025; interest rate of 10.25% as of both December 31, 2023 and 2022.
17,990 25,586 
Deferred financing costs, net(28,998)(29,866)
Total long-term debt3,697,313 3,850,142 
Current portion41,463 66,043 
Total long-term debt, less current portion$3,655,850 $3,784,099 
Schedule of Maturities
The annual aggregate scheduled maturities (including recurring principal payments) of long-term debt outstanding as of December 31, 2023 are as follows (in thousands).



Year Ending December 31,
Long-term
Debt
Weighted Rate
2024$49,485 6.46 %
2025 (1)
573,035 7.30 %
2026305,614 2.71 %
2027960,971 6.00 %
2028563,548 5.79 %
Thereafter1,273,658 5.03 %
Total obligations3,726,311 5.58 %
Less amount representing deferred financing costs, net(28,998)
Total$3,697,313 

(1)    Includes the initial maturity of $320.0 million of mortgage debt for which the Company has the option to extend the maturity for two additional terms of one year each subject to the satisfaction of certain conditions.
v3.24.0.1
Leases (Tables)
12 Months Ended
Dec. 31, 2023
Leases [Abstract]  
Schedule of Lease Cost
A summary of operating and financing lease expense (including the respective presentation on the consolidated statements of operations) and net cash outflows from leases is as follows.

Years Ended December 31,
Operating Leases (in thousands)
202320222021
Facility operating expense$7,105 $6,329 $12,606 
Facility lease expense202,410 165,294 174,358 
Operating lease expense209,515 171,623 186,964 
Operating lease expense adjustment (1)
45,739 34,896 23,280 
Changes in operating lease assets and liabilities for lessor capital expenditure reimbursements(9,844)(13,718)(30,965)
Operating net cash outflows from operating leases$245,410 $192,801 $179,279 

(1) Represents the difference between the amount of cash operating lease payments and the amount of operating lease expense.

Years Ended December 31,
Financing Leases (in thousands)
202320222021
Depreciation and amortization $16,444 $38,126 $37,921 
Interest expense: financing lease obligations21,950 48,061 46,282 
Financing lease expense$38,394 $86,187 $84,203 
Operating cash outflows from financing leases$21,950 $48,061 $46,282 
Financing cash outflows from financing leases8,473 22,221 19,874 
Changes in financing lease assets and liabilities for lessor capital expenditure reimbursement(475)(11,932)(11,135)
Total net cash outflows from financing leases$29,948 $58,350 $55,021 
Schedule of Lessee, Operating Lease, Liability, Maturity
The aggregate amounts of future minimum lease payments, including community, office, and equipment leases, recognized on the consolidated balance sheet as of December 31, 2023 are as follows (in thousands).

Year Ending December 31,Operating LeasesFinancing Leases
2024$260,694 $20,266 
2025260,501 6,849 
2026145,832 6,833 
2027147,660 6,082 
202884,767 5,917 
Thereafter251,579 20,625 
Total lease payments1,151,033 66,572 
Purchase option liability and non-cash gain on future sale of property— 145,136 
Imputed interest and variable lease payments(274,526)(59,859)
Total lease obligations$876,507 $151,849 
Schedule of Finance Lease, Liability, Maturity
The aggregate amounts of future minimum lease payments, including community, office, and equipment leases, recognized on the consolidated balance sheet as of December 31, 2023 are as follows (in thousands).

Year Ending December 31,Operating LeasesFinancing Leases
2024$260,694 $20,266 
2025260,501 6,849 
2026145,832 6,833 
2027147,660 6,082 
202884,767 5,917 
Thereafter251,579 20,625 
Total lease payments1,151,033 66,572 
Purchase option liability and non-cash gain on future sale of property— 145,136 
Imputed interest and variable lease payments(274,526)(59,859)
Total lease obligations$876,507 $151,849 
v3.24.0.1
Tangible Equity Units (Tables)
12 Months Ended
Dec. 31, 2023
Equity [Abstract]  
Schedule of Proceeds from Issuance Allocated to Equity and Debt Component
The proceeds from the issuance of the Units were allocated to equity and debt based on the relative fair value of the respective components of each Unit as follows:

(in thousands, except value per unit)Equity ComponentDebt ComponentTotal
Value per unit$41.10 $8.90 $50.00 
Gross proceeds$118,164 $25,586 $143,750 
Less: underwriters' discount(3,544)(768)(4,312)
Proceeds from issuance of Units$114,620 $24,818 $139,438 
Less: issuance costs(1,163)(252)(1,415)
Net proceeds$113,457 $24,566 $138,023 
Schedule of Debt Instrument Settlement Prepaid Stock Purchase Contract
Unless settled early in accordance with the terms of the instruments, each prepaid stock purchase contract will automatically settle on November 15, 2025 (the mandatory settlement date) for a number of shares of the Company’s common stock based on the arithmetic average of the VWAPs of the Company’s common stock on each of the 20 consecutive trading days beginning on, and including, the 21st scheduled trading day immediately preceding November 15, 2025 (applicable market value) with reference to the following settlement rates:

Applicable Market ValueCommon Stock Issued
Equal to or greater than the threshold appreciation price
12.9341 shares (minimum settlement rate)
Less than the threshold appreciation price, but greater than the reference price
$50 divided by applicable market value
Less than or equal to the reference price
15.1976 shares (maximum settlement rate)
v3.24.0.1
Accrued Expenses (Tables)
12 Months Ended
Dec. 31, 2023
Accounts Payable and Accrued Liabilities, Current [Abstract]  
Schedule of Accrued Expenses
Accrued expenses reflected within current liabilities on the Company’s consolidated balance sheets consist of the following.

As of December 31,
(in thousands)20232022
Employee compensation$104,322 $85,610 
Insurance reserves54,834 65,757 
Real estate taxes26,988 26,661 
Interest17,838 17,569 
Utilities8,444 8,533 
Income taxes payable2,071 2,081 
Other28,171 30,937 
Total$242,668 $237,148 
v3.24.0.1
Stock-Based Compensation (Tables)
12 Months Ended
Dec. 31, 2023
Share-Based Payment Arrangement [Abstract]  
Schedule of Restricted Stock Units and Stock Awards Activity
The following table sets forth information about the Company's restricted stock units and stock awards.

(in thousands, except for weighted average amounts)Number of Restricted Stock Units and Stock AwardsWeighted
Average
Grant Date Fair Value
Outstanding on January 1, 20218,505 $7.68 
Granted1,998 5.12 
Vested(2,641)8.40 
Cancelled/forfeited(2,851)6.77 
Outstanding on December 31, 20215,011 6.80 
Granted2,921 5.58 
Vested(2,039)7.15 
Cancelled/forfeited(520)6.88 
Outstanding on December 31, 20225,373 6.00 
Granted3,992 2.98 
Vested(2,001)5.87 
Cancelled/forfeited(961)5.90 
Outstanding on December 31, 20236,403 4.17 
Schedule of Restricted Stock Units and Stock Awards Grants
During 2023, grants of restricted stock units and stock awards under the Company's 2014 Omnibus Incentive Plan were as follows.

(in thousands, except for weighted average amounts)Restricted Stock Unit and Stock Award GrantsWeighted Average Grant Date Fair ValueTotal Grant Date Fair Value
Three months ended March 31, 20233,959 $2.97 $11,778 
Three months ended June 30, 202310 $2.95 $29 
Three months ended September 30, 202316 $4.01 $65 
Three months ended December 31, 2023$4.14 $29 
v3.24.0.1
Earnings Per Share (Tables)
12 Months Ended
Dec. 31, 2023
Earnings Per Share [Abstract]  
Schedule of Earnings Per Share, Basic and Diluted
Years Ended December 31,
(in thousands)202320222021
Weighted average common shares outstanding188,023 186,574 184,975 
Weighted average minimum shares issuable under purchase contracts37,186 3,889 — 
Weighted average shares outstanding - basic225,209 190,463 184,975 
Schedule of Potentially Dilutive Securities The Company has the following potentially outstanding shares of common stock, which were excluded from the computation of diluted net income (loss) per share attributable to common stockholders in all periods as a result of the net loss.
As of December 31,
(in millions)202320222021
Convertible senior notes38.338.3 38.3 
Warrants16.316.3 16.3 
Restricted stock and restricted stock units6.45.4 5.0 
Incremental shares issuable under purchase contracts6.56.5 — 
Total67.566.559.6
v3.24.0.1
Income Taxes (Tables)
12 Months Ended
Dec. 31, 2023
Income Tax Disclosure [Abstract]  
Schedule of Components of Income Tax Expense (Benefit)
The benefit (provision) for income taxes is comprised of the following.

For the Years Ended December 31,
(in thousands)202320222021
Federal:
Current$(183)$(17)$161 
Deferred(7,590)1,325 9,837 
Total federal(7,773)1,308 9,998 
State:
Current(1,011)251 (1,835)
Deferred (included in federal above)— — — 
Total state(1,011)251 (1,835)
Total$(8,784)$1,559 $8,163 
Schedule of Reconciliation of Income Tax Expense (Benefit)
A reconciliation of the benefit (provision) for income taxes to the amount computed at the U.S. Federal statutory rate of 21% is as follows.

For the Years Ended December 31,
(in thousands)202320222021
Tax benefit (provision) at U.S. statutory rate$37,848 $50,397 $22,565 
State taxes, net of federal income tax5,766 10,811 7,673 
Valuation allowance(49,109)(57,080)13,027 
Goodwill derecognition— — (31,829)
Stock compensation(1,312)(181)(1,856)
Other(1,977)(2,388)(1,417)
Total$(8,784)$1,559 $8,163 
Schedule of Deferred Tax Assets and Liabilities
Significant components of the Company's deferred tax assets and liabilities are as follows.

As of December 31,
(in thousands)20232022
Deferred income tax assets:
Operating loss carryforwards$392,577 $361,160 
Operating lease obligations220,003 199,226 
Tax credits50,415 50,415 
Accrued expenses46,814 42,828 
Intangible assets26,816 39,360 
Financing lease obligations— 12,749 
Capital loss carryforward2,102 2,140 
Other3,268 3,091 
Total gross deferred income tax asset741,995 710,969 
Valuation allowance(474,152)(425,043)
Net deferred income tax assets267,843 285,926 
Deferred income tax liabilities:
Operating lease right-of-use assets(168,398)(149,881)
Property, plant and equipment(92,580)(122,377)
Investment in unconsolidated ventures— (12,064)
Financing lease obligations(10,273)— 
Other(2,579)— 
Total gross deferred income tax liability(273,830)(284,322)
Net deferred tax asset (liability)$(5,987)$1,604 
A reconciliation of the beginning and ending amounts of the deferred tax valuation allowance is as follows:

Year EndedBalance at beginning of periodCharged to deferred income tax (benefit) provisionBalance at end of period
December 31, 2021$380,990 $(13,027)(1)$367,963 
December 31, 2022$367,963 $57,080 (2)$425,043 
December 31, 2023$425,043 $49,109 (2)$474,152 

(1) Reduction of valuation allowance for federal and state net operating losses and credits.
(2) Increase to valuation allowance for federal and state net operating losses and credits.
Schedule of Reconciliation of Unrecognized Tax Benefits
A reconciliation of the unrecognized tax benefits is as follows.

For the Years Ended December 31,
(in thousands)20232022
Balance at beginning of period$18,088 $18,089 
Additions for tax positions related to prior years173 — 
Reductions for tax positions related to prior years(56)(1)
Balance at end of period$18,205 $18,088 
v3.24.0.1
Supplemental Disclosure of Cash Flow Information (Tables)
12 Months Ended
Dec. 31, 2023
Supplemental Cash Flow Elements [Abstract]  
Schedule of Supplemental Disclosure of Cash Flow Information
(in thousands)For the Years Ended December 31,
Supplemental Disclosure of Cash Flow Information:202320222021
Interest paid$231,786 $200,308 $188,791 
Income taxes paid, net of (refunds)$(1,429)$(330)$5,923 
Capital expenditures, net of related payables:
Capital expenditures - non-development, net$216,511 $168,166 $137,410 
Capital expenditures - development, net1,762 6,193 3,208 
Capital expenditures - non-development - reimbursable from lessor10,319 25,650 42,100 
Trade accounts payable4,613 (3,085)(6,061)
Net cash paid$233,205 $196,924 $176,657 
For the Years Ended December 31,
(in thousands)
2023
2022
2021
Acquisition of assets, net of cash acquired:
Prepaid expenses and other assets, net$23 $— $— 
Property, plant and equipment and leasehold intangibles, net6,872 — 
Investment in unconsolidated ventures(3,395)— — 
Financing lease obligations— 6,000 — 
Other liabilities(384)— — 
Other non-operating loss (income)(2,542)— — 
Net cash paid$574 $6,004 $— 
Proceeds from HCS Sale, net:
Accounts receivable, net$— $— $(57,582)
Property, plant and equipment and leasehold intangibles, net— — (1,806)
Operating lease right-of-use assets— — (8,145)
Investment in unconsolidated ventures— — 100,000 
Goodwill— — (126,810)
Prepaid expenses and other assets, net— — (32,963)
Trade accounts payable— — 1,387 
Accrued expenses— — 25,226 
Refundable fees and deferred revenue— — 57,314 
Operating lease obligations— — 8,145 
Other liabilities— — 9,165 
Non-operating loss (gain) on sale of assets, net— — (286,489)
Net cash received$— $— $(312,558)
Proceeds from sale of other assets, net:
Prepaid expenses and other assets, net$(1,889)$(1,308)$(1,983)
Assets held for sale— (3,668)(16,166)
Property, plant and equipment and leasehold intangibles, net(36,545)(107)(878)
Investment in unconsolidated ventures(27,392)— — 
Refundable fees and deferred revenue9,347 — — 
Other liabilities10,690 1,025 (75)
Non-operating loss (gain) on sale of assets, net(1,441)(595)(2,346)
Loss (gain) on sale of communities, net(36,296)— — 
Net cash received$(83,526)$(4,653)$(21,448)
Supplemental Schedule of Non-cash Operating, Investing and Financing Activities:
For the Years Ended December 31,
(in thousands)
2023
2022
2021
Gain on sale for master lease amendment:
Property, plant and equipment and leasehold intangibles, net$— $(220,477)$— 
Operating lease right-of-use assets— 91,641 — 
Financing lease obligations— 294,327 — 
Operating lease obligations— (91,641)— 
Loss (gain) on sale of communities, net— (73,850)— 
Net$— $— $— 
Other non-cash lease transactions, net:
Property, plant and equipment and leasehold intangibles, net$(51,518)$11,098 $4,056 
Operating lease right-of-use assets223,309 11,419 17,197 
Operating lease obligations(260,611)(16,179)(17,197)
Financing lease obligations88,820 (6,338)(4,056)
Net$— $— $— 
Schedule of Cash and Restricted Cash
Restricted cash consists principally of escrow deposits for interest rate caps, real estate taxes, property insurance, capital expenditures, and debt service reserves required by certain lenders under mortgage debt agreements, deposits as security for self-insured retention risk under workers' compensation programs and property insurance programs, and regulatory reserves for certain CCRCs. The components of restricted cash are as follows.

 December 31,
(in thousands)20232022
Current:  
Interest rate cap escrows$17,843 $3,797 
Real estate tax and property insurance escrows16,061 15,722 
Replacement reserve escrows7,194 7,999 
Other243 217 
Subtotal41,341 27,735 
Long term:
Insurance deposits15,961 18,230 
CCRCs escrows10,813 15,847 
Debt service reserve3,472 13,779 
Letters of credit collateral110 107 
Subtotal30,356 47,963 
      Total$71,697 $75,698 

The following table provides a reconciliation of cash, cash equivalents, and restricted cash reported within the consolidated balance sheets that sums to the total of the same such amounts shown in the consolidated statements of cash flows.

December 31,
(in thousands)20232022
Reconciliation of cash, cash equivalents, and restricted cash:
Cash and cash equivalents$277,971 $398,850 
Restricted cash41,341 27,735 
Long-term restricted cash30,356 47,963 
Total cash, cash equivalents, and restricted cash$349,668 $474,548 
v3.24.0.1
Segment Information (Tables)
12 Months Ended
Dec. 31, 2023
Segment Reporting [Abstract]  
Schedule of Segment Reporting Information
The following tables set forth selected segment financial data.

For the Years Ended December 31,
(in thousands)202320222021
Revenue and other operating income:
Independent Living (1)(2)
$564,499 $518,699 $477,050 
Assisted Living and Memory Care (1)(2)
1,968,440 1,815,722 1,595,684 
CCRCs (1)(2)
333,404 331,577 306,213 
All Other (3)
149,486 159,381 202,043 
Health Care Services (1)(2)
— — 177,269 
Total revenue and other operating income3,015,829 2,825,379 2,758,259 
Segment operating income:(4)
Independent Living184,645 158,950 146,108 
Assisted Living and Memory Care502,317 379,958 294,320 
CCRCs49,581 43,485 34,109 
All Other10,161 12,020 20,598 
Health Care Services— — 5,816 
Total segment operating income746,704 594,413 500,951 
For the Years Ended December 31,
(in thousands)202320222021
General and administrative expense (including non-cash stock-based compensation expense)178,894 168,594 184,916 
Facility operating lease expense:
Independent Living39,114 39,700 42,162 
Assisted Living and Memory Care146,166 106,961 111,117 
CCRCs12,943 13,883 15,932 
Corporate and All Other4,187 4,750 5,147 
Depreciation and amortization:
Independent Living83,637 79,521 74,922 
Assisted Living and Memory Care196,994 207,344 200,677 
CCRCs36,951 38,039 37,891 
Corporate and All Other25,130 22,540 23,783 
Health Care Services— — 340 
Asset impairment:
Independent Living1,647 10,893 3,483 
Assisted Living and Memory Care11,574 11,613 14,384 
CCRCs1,368 5,970 4,790 
Corporate and All Other25,983 1,142 346 
Loss (gain) on sale of communities, net(36,296)(73,850)— 
Loss (gain) on facility operating lease termination, net— — (2,003)
Income (loss) from operations$18,412 $(42,687)$(216,936)
Total interest expense:
Independent Living$61,624 $48,788 $45,209 
Assisted Living and Memory Care141,330 133,139 121,785 
CCRCs24,889 21,251 18,756 
Corporate and All Other10,431 1,539 9,390 
$238,274 $204,717 $195,140 
Total capital expenditures for property, plant and equipment, and leasehold intangibles:
Independent Living$51,188 $44,857 $36,992 
Assisted Living and Memory Care121,240 111,978 105,177 
CCRCs37,414 20,467 19,086 
Corporate and All Other18,750 22,707 21,463 
$228,592 $200,009 $182,718 
    
As of December 31,
(in thousands)20232022
Total assets:
Independent Living(5)
$1,206,021 $1,267,825 
Assisted Living and Memory Care3,315,921 3,329,516 
CCRCs612,521 664,502 
Corporate and All Other438,972 675,219 
Total assets$5,573,435 $5,937,062 

(1)All revenue and other operating income is earned from external third parties in the United States.
(2)Includes other operating income recognized for the credits or grants pursuant to the Provider Relief Fund, employee retention credit, and other government sources, as described in Note 19. Allocations to the applicable segment generally reflect the credits earned by the segment, the segment’s receipt and acceptance of the grant, or the segment’s proportional utilization of the grant. Other operating income by segment is as follows.

For the Years Ended December 31,
(in thousands)202320222021
Independent Living$487 $10,906 $1,512 
Assisted Living and Memory Care8,008 60,630 5,963 
CCRCs578 8,933 1,788 
Health Care Services— — 3,105 
Total other operating income$9,073 $80,469 $12,368 
(3)All Other revenue and other operating income includes management fees and reimbursements of costs incurred on behalf of managed communities. For the years ended December 31, 2023, 2022, and 2021, revenue and other operating income includes $0.9 million, $4.2 million, and $17.2 million of revenue earned from unconsolidated ventures in which the Company had or has an ownership interest.
(4)Segment operating income is defined as segment revenues and other operating income less segment facility operating expenses (excluding facility depreciation and amortization) and costs incurred on behalf of managed communities.
(5)The Company's total carrying amount of goodwill is included on the Independent Living segment and was $27.3 million as of December 31, 2023, 2022, and 2021.
v3.24.0.1
Description of Business - Narrative (Details)
Dec. 31, 2023
community
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]  
Number of communities leased 277
Current Property Ownership Status  
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]  
Number of senior living communities 652
Number of communities owned 345
Number of communities leased 277
Number of communities managed by third party 30
v3.24.0.1
Summary of Significant Accounting Policies - Narrative (Details) - USD ($)
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Oct. 01, 2021
Revenue Recognition      
Term of residency agreements - minimum (in days) 30 days    
Term of residency agreements - maximum (in years) 1 year    
Stock-Based Compensation      
Award vesting period (in years) 3 years    
Award requisite service period (in years) 4 years    
Weighted average volatility rate (as percent) 83.30% 76.00%  
Risk free interest rate (as percent) 4.40% 1.80%  
Convertible Senior Notes Due 2026 | Convertible notes payable      
Accounting Standards Update and Change in Accounting Principle      
Debt face amount     $ 230,000,000
Interest rate (as percent)     2.00%
Minimum      
Stock-Based Compensation      
Award vesting period (in years) 3 years    
Award vesting rights percentage 0.00%    
Fair value vesting rights, percentage 0.00%    
Maximum      
Stock-Based Compensation      
Award vesting period (in years) 4 years    
Award vesting rights percentage 150.00%    
Fair value vesting rights, percentage 150.00%    
v3.24.0.1
Summary of Significant Accounting Policies - Property, Plant and Equipment and Leasehold Intangibles, Net (Details)
Dec. 31, 2023
Buildings and improvements  
Property, Plant and Equipment [Line Items]  
Estimated Useful Life (in years) 40 years
Furniture and equipment | Minimum  
Property, Plant and Equipment [Line Items]  
Estimated Useful Life (in years) 3 years
Furniture and equipment | Maximum  
Property, Plant and Equipment [Line Items]  
Estimated Useful Life (in years) 10 years
Resident in-place lease intangibles | Minimum  
Property, Plant and Equipment [Line Items]  
Estimated Useful Life (in years) 1 year
Resident in-place lease intangibles | Maximum  
Property, Plant and Equipment [Line Items]  
Estimated Useful Life (in years) 3 years
v3.24.0.1
Acquisitions, Dispositions, and Other Significant Leasing Transactions - Welltower Lease Amendments (Details)
$ in Thousands
3 Months Ended 12 Months Ended
Jun. 30, 2023
USD ($)
community
lease
Dec. 31, 2023
USD ($)
community
Dec. 31, 2022
USD ($)
Business Acquisition [Line Items]      
Operating lease right-of-use assets   $ 670,907 $ 597,130
Mortgages      
Business Acquisition [Line Items]      
Operating lease, covenant provisions, required minimum tangible net worth   2,000,000  
Welltower Inc.      
Business Acquisition [Line Items]      
Number of communities company continues to lease | community 74    
Number of communities leased | community 69    
Maximum fund costs $ 17,000    
Operating lease right-of-use assets   122,300  
Operating lease, covenant provisions, required minimum stockholders equity   400,000  
Welltower Inc. | Mortgages      
Business Acquisition [Line Items]      
Operating lease, covenant provisions, required minimum tangible net worth   $ 1,500,000  
Welltower Inc. | Revision of Prior Period, Reclassification, Adjustment      
Business Acquisition [Line Items]      
Number of communities leased | community   35  
Lease expense   $ 19,300  
Welltower Inc. | Lease Expire From December 31, 2026 Until June 30, 2032      
Business Acquisition [Line Items]      
Number of leases extended | lease 1    
Number of communities leased | community 39    
Welltower Inc. | Lease Expire On June 30, 2032      
Business Acquisition [Line Items]      
Number of communities leased | community 69    
Welltower Inc. | Lease Expire On December 31, 2024      
Business Acquisition [Line Items]      
Number of communities leased | community 5    
Welltower Inc. | Minimum Rent Leasing Arrangement | Secured Overnight Financing Rate (SOFR)      
Business Acquisition [Line Items]      
Annual escalator rate (as percent) 4.00%    
Welltower Inc. | Minimum Rent Leasing Arrangement | Minimum | Secured Overnight Financing Rate (SOFR)      
Business Acquisition [Line Items]      
Annual escalator rate (as percent) 3.00%    
v3.24.0.1
Acquisitions, Dispositions, and Other Significant Leasing Transactions - Community Transactions (Details)
$ in Millions
12 Months Ended 36 Months Ended
Dec. 31, 2023
USD ($)
community
Dec. 31, 2022
USD ($)
community
Dec. 31, 2021
USD ($)
community
Dec. 31, 2023
community
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]        
Number of communities leased   1    
Remaining equity interest 50.00%      
Number of communities acquired 1      
Communities Disposed of Through Lease Terminations        
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]        
Number of communities disposed of 18 4 2 24
Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations | Communities Disposed of Through Sale        
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]        
Number of communities disposed of 2 2 3  
Cash proceeds | $ $ 25.6 $ 4.4 $ 16.5  
Mortgage debt repaid | $ 29.6      
Gain on sale of communities | $ $ 36.3      
v3.24.0.1
Acquisitions, Dispositions, and Other Significant Leasing Transactions - Sale of Health Care Services (Details) - USD ($)
$ in Thousands
1 Months Ended 3 Months Ended 12 Months Ended
Nov. 01, 2021
Jul. 01, 2021
Dec. 31, 2023
Oct. 31, 2021
Dec. 31, 2023
Sep. 30, 2023
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]                  
Investment in unconsolidated ventures     $ 1,906   $ 1,906   $ 1,906 $ 55,333  
Distributions from unconsolidated ventures from cumulative share of net earnings             $ 430 561 $ 6,191
Healthcare Services Venture | Variable Interest Entity, Not Primary Beneficiary                  
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]                  
Contribution to venture           $ 7,500      
Health Care Services | HCA Healthcare, Inc.                  
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]                  
Percentage of ownership sold in transaction   80.00% 20.00%            
Purchase price   $ 400,000              
Net cash proceeds   312,600              
Cash proceeds   $ 305,800 $ 27,400            
Proceeds from post closing working capital adjustment       $ 6,800          
Percentage of ownership after transaction   20.00%              
Investment in unconsolidated ventures   $ 100,000              
Gain on sale of equity method investment               $ 286,500  
Distributions from unconsolidated ventures from cumulative share of net earnings $ 35,000                
Impairment of unconsolidated ventures         $ 26,000        
v3.24.0.1
Acquisitions, Dispositions, and Other Significant Leasing Transactions - Master Lease Amendment (Details)
$ in Thousands
3 Months Ended 12 Months Ended
Dec. 31, 2022
USD ($)
community
Dec. 31, 2023
USD ($)
Dec. 31, 2022
USD ($)
Dec. 31, 2021
USD ($)
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]        
Gain on sale of communities   $ 36,296 $ 73,850 $ 0
Operating lease expense   209,515 $ 171,623 $ 186,964
Ventas, Inc        
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]        
Number of communities company continues to lease | community 24      
Number of communities previously accounted | community 16      
Gain on sale of communities $ 73,900      
Operating lease expense   $ 22,200    
v3.24.0.1
Fair Value Measurements - Narrative (Details)
$ in Thousands
3 Months Ended 12 Months Ended
Jul. 01, 2021
USD ($)
Dec. 31, 2023
USD ($)
community
lease
Dec. 31, 2023
USD ($)
community
lease
Dec. 31, 2022
USD ($)
community
Dec. 31, 2021
USD ($)
community
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]          
Marketable securities   $ 29,755 $ 29,755 $ 48,680  
Total long-term debt   3,697,313 3,697,313 3,850,142  
Long-term debt, fair value   $ 3,400,000 $ 3,400,000 3,400,000  
Number of communities leased | lease   263 263    
investment in unconsolidated ventures   $ 1,906 $ 1,906 55,333  
HCA Healthcare, Inc. | Health Care Services          
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]          
Long-term debt, fair value   27,400 27,400    
investment in unconsolidated ventures $ 100,000        
Percentage of ownership after transaction 20.00%        
Purchase price $ 400,000        
Non-cash impairment charge   $ 26,000      
Nonrecurring          
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]          
Operating lease right-of-use assets     8,300 13,700 $ 16,600
Property, plant and equipment and leasehold intangibles, net     $ 6,300 $ 15,900 $ 6,400
Condensed Consolidated Balance Sheet          
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]          
Number of communities leased | community   12 12 8 11
Estimated fair value   $ 16,400 $ 16,400 $ 30,900 $ 31,000
Reported Value Measurement          
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]          
Total long-term debt   3,700,000 3,700,000 3,900,000  
Level 2          
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]          
Marketable securities   $ 29,800 $ 29,800 $ 48,700  
v3.24.0.1
Fair Value Measurements - Interest Rate Caps (Details) - Level 2 - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Interest Rate Cap    
Derivative [Line Items]    
Derivative asset, notional amount $ 1,231,920  
Weighted average fixed cap rate 4.07%  
Weighted average remaining term 9 months 18 days  
Estimated asset fair value (included in other assets, net) $ 13,268 $ 10,599
Interest Rate Swap    
Derivative [Line Items]    
Derivative asset, notional amount $ 220,000  
Fixed interest rate 3.00%  
Remaining term 3 months 18 days  
Estimated asset fair value (included in other assets, net) $ 1,611 $ 4,834
v3.24.0.1
Fair Value Measurements - Asset Impairment Expense (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]      
Asset impairment $ 40,572 $ 29,618 $ 23,003
Nonrecurring      
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]      
Operating lease right-of-use assets 8,300 13,700 16,600
Property, plant and equipment and leasehold intangibles, net 6,300 15,900 6,400
Investment in unconsolidated ventures 26,000 0 0
Asset impairment $ 40,600 $ 29,600 $ 23,000
v3.24.0.1
Revenue - Disaggregation of Revenue (Details) - Revenue Benchmark - Customer Concentration Risk
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Private pay      
Disaggregation of Revenue [Line Items]      
Revenue (as percent) 93.70% 93.50% 86.80%
Government reimbursement      
Disaggregation of Revenue [Line Items]      
Revenue (as percent) 4.80% 5.10% 10.30%
Other third-party payor programs      
Disaggregation of Revenue [Line Items]      
Revenue (as percent) 1.50% 1.40% 2.90%
v3.24.0.1
Revenue - Narrative (Details) - USD ($)
$ in Millions
1 Months Ended 12 Months Ended
Jul. 01, 2021
Dec. 31, 2023
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Disaggregation of Revenue [Line Items]          
Monthly resident fees   $ 24.1 $ 24.1 $ 25.2  
Revenue recognized     50.2 54.5 $ 60.2
Deferred Revenue and Credits          
Disaggregation of Revenue [Line Items]          
Deferred revenue   $ 48.3 $ 48.3 $ 67.3  
Government reimbursement | Revenue Benchmark | Customer Concentration Risk          
Disaggregation of Revenue [Line Items]          
Revenue (as percent)     4.80% 5.10% 10.30%
CCRCs | Government reimbursement | Revenue Benchmark | Customer Concentration Risk          
Disaggregation of Revenue [Line Items]          
Revenue (as percent)     16.90% 18.00% 18.80%
HCA Healthcare, Inc. | Health Care Services          
Disaggregation of Revenue [Line Items]          
Percentage of ownership sold in transaction 80.00% 20.00%      
v3.24.0.1
Revenue - Accounts Receivable, Allowance for Credit Loss (Details) - Allowance for Doubtful Accounts - USD ($)
$ in Millions
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Valuation and qualifying accounts [Roll forward]      
Balance at beginning of period $ 12.8 $ 13.3 $ 9.8
Provision within facility operating expense 22.6 20.0 21.6
Write-offs (22.5) (22.2) (19.2)
Recoveries and other 1.2 1.7 1.1
Balance at end of period $ 14.1 $ 12.8 $ 13.3
v3.24.0.1
Property, Plant and Equipment and Leasehold Intangibles, Net - Property, Plant and Equipment (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Property, Plant and Equipment [Line Items]      
Property, plant and equipment and leasehold intangibles $ 8,347,406 $ 8,589,429  
Accumulated depreciation and amortization (4,016,777) (4,053,727)  
Property, plant and equipment and leasehold intangibles, net 4,330,629 4,535,702  
Depreciation and amortization expense for plant and equipment and leasehold intangibles 342,700 347,400 $ 337,600
Land      
Property, Plant and Equipment [Line Items]      
Property, plant and equipment and leasehold intangibles 500,649 506,968  
Buildings and improvements      
Property, Plant and Equipment [Line Items]      
Property, plant and equipment and leasehold intangibles 5,348,133 5,323,736  
Furniture and equipment      
Property, Plant and Equipment [Line Items]      
Property, plant and equipment and leasehold intangibles 1,111,408 1,055,304  
Resident in-place lease intangibles      
Property, Plant and Equipment [Line Items]      
Property, plant and equipment and leasehold intangibles 282,411 286,122  
Construction in progress      
Property, Plant and Equipment [Line Items]      
Property, plant and equipment and leasehold intangibles 33,905 41,778  
Assets under financing leases and leasehold improvements      
Property, Plant and Equipment [Line Items]      
Property, plant and equipment and leasehold intangibles $ 1,070,900 $ 1,375,521  
v3.24.0.1
Debt - Schedule of Debt (Details) - USD ($)
$ in Thousands
Dec. 31, 2023
Dec. 31, 2022
Oct. 01, 2021
Debt Instrument [Line Items]      
Long-term debt, gross $ 3,726,311    
Deferred financing costs, net (28,998) $ (29,866)  
Total long-term debt 3,697,313 3,850,142  
Current portion 41,463 66,043  
Total long-term debt, less current portion 3,655,850 3,784,099  
Fixed Mortgage Notes Payable      
Debt Instrument [Line Items]      
Long-term debt, gross $ 1,953,414 $ 2,055,867  
Weighted average interest rate (as percent) 4.26% 4.14%  
Variable mortgages note payble      
Debt Instrument [Line Items]      
Long-term debt, gross $ 1,524,907 $ 1,568,555  
Weighted average interest rate (as percent) 7.74% 6.68%  
Convertible notes payable      
Debt Instrument [Line Items]      
Long-term debt, gross $ 230,000 $ 230,000  
Convertible notes payable | Convertible Senior Notes Due 2026      
Debt Instrument [Line Items]      
Total long-term debt     $ 223,300
Weighted average interest rate (as percent) 2.00% 2.00%  
Other notes payable | Tangible equity units senior amortizing notes due November 2025; interest rate of 10.25% as of both December 31, 2023 and 2022.      
Debt Instrument [Line Items]      
Long-term debt, gross $ 17,990 $ 25,586  
Weighted average interest rate (as percent) 10.25% 10.25%  
v3.24.0.1
Debt - Narrative (Details)
$ in Billions
Dec. 31, 2023
USD ($)
Debt Instrument [Line Items]  
Percentage of total debt 91.90%
Mortgages  
Debt Instrument [Line Items]  
Long term mortgage debt $ 3.4
v3.24.0.1
Debt - Maturities (Details)
$ in Thousands
12 Months Ended
Dec. 31, 2023
USD ($)
extension_option
Dec. 31, 2022
USD ($)
Maturities of Long-term Debt [Abstract]    
2024 $ 49,485  
2025 573,035  
2026 305,614  
2027 960,971  
2028 563,548  
Thereafter 1,273,658  
Total 3,726,311  
Less amount representing deferred financing costs, net (28,998) $ (29,866)
Total long-term debt $ 3,697,313 $ 3,850,142
Weighted Rate    
2024 6.46%  
2025 7.30%  
2026 2.71%  
2027 6.00%  
2028 5.79%  
Thereafter 5.03%  
Debt, weighted average interest rate (as percent) 5.58%  
Mortgages    
Maturities of Long-term Debt [Abstract]    
Total long-term debt $ 320,000  
Weighted Rate    
Extension option | extension_option 2  
Extension option term (in years) 1 year  
v3.24.0.1
Debt - Convertible Debt Offering and Capped Call Transactions (Details)
12 Months Ended
Oct. 01, 2021
USD ($)
day
$ / shares
Dec. 31, 2023
USD ($)
Dec. 31, 2022
USD ($)
Dec. 31, 2021
USD ($)
Sep. 28, 2021
$ / shares
Line of Credit Facility [Line Items]          
Cost of the capped call transactions   $ 0 $ 0 $ 15,916,000  
Repayments of notes payable $ 45,000,000        
Total long-term debt   3,697,313,000 $ 3,850,142,000    
Mortgages          
Line of Credit Facility [Line Items]          
Repayments of long-term debt 284,400,000        
Total long-term debt   $ 320,000,000      
Convertible Senior Notes Due 2026 | Convertible notes payable          
Line of Credit Facility [Line Items]          
Debt face amount $ 230,000,000        
Interest rate (as percent) 2.00%        
Net proceeds received $ 224,300,000        
Cost of the capped call transactions $ 15,900,000     $ 15,900,000  
Threshold trading days | day 20        
Threshold consecutive trading days | day 30        
Threshold percentage of stock price trigger 130.00%        
Threshold business days | day 5        
Threshold consecutive trading days, measurement period | day 10        
Percentage of product of the last reported sale price of the common stock and the conversion rate 98.00%        
Debt instrument, convertible, conversion ratio 0.1234568        
Debt instrument, convertible, conversion price (in dollars per share) | $ / shares $ 8.10        
Scheduled trading day | day 51        
Redemption price percentage 100.00%        
Total long-term debt $ 223,300,000        
Debt discount 5,700,000        
Debt issuance costs $ 1,000,000        
Derivative, exercise price (in dollars per share) | $ / shares $ 8.10        
Derivative, cap price (in dollars per share) | $ / shares $ 9.90        
Share price, premium percentage 65.00%        
Share price (in dollars per share) | $ / shares         $ 6.00
v3.24.0.1
Debt - Credit Facilities (Details) - Line of Credit
1 Months Ended 12 Months Ended
Dec. 31, 2023
USD ($)
term
Dec. 31, 2023
USD ($)
term
Dec. 11, 2020
USD ($)
Credit Agreement with Capital One, National Association | Revolving Credit Facility      
Line of Credit Facility [Line Items]      
Credit facility, maximum borrowing capacity $ 100,000,000 $ 100,000,000 $ 100,000,000
Line of credit facility, option to extend | term 2 2  
Line of credit facility, additional terms (in years) 1 year    
Commitment fee percentage (as percent)   0.25%  
Credit Agreement with Capital One, National Association | Revolving Credit Facility | Secured Overnight Financing Rate (SOFR)      
Line of Credit Facility [Line Items]      
Basis spread on variable rate basis (as percent)   3.00%  
Fifth Amended and Restated Credit Agreement | Letter of credit sublimit      
Line of Credit Facility [Line Items]      
Letters of credit outstanding $ 63,600,000 $ 63,600,000  
Fifth Amended and Restated Credit Agreement | Letters of credit collateral      
Line of Credit Facility [Line Items]      
Credit facility, maximum borrowing capacity 15,000,000 15,000,000  
Letters of credit outstanding $ 14,500,000 $ 14,500,000  
v3.24.0.1
Debt - 2024, 2023 and 2022 Financing (Details)
1 Months Ended
Feb. 09, 2024
USD ($)
community
renewal_option
Dec. 31, 2023
USD ($)
community
Oct. 31, 2022
USD ($)
renewal_option
community
Interest Rate Swap      
Debt Instrument [Line Items]      
Derivative liability     $ 6,100,000
Derivative, notional amount     $ 220,000,000
Derivative, fixed interest rate (as percent)     3.00%
Derivative, term of contract (in months)     18 months
First Mortgage      
Debt Instrument [Line Items]      
Number of communities securing debt | community   47 24
Number of debt renewal options | renewal_option     2
Debt instrument, term of renewal option     1 year
Debt instrument, liquidity maintenance amount     $ 130,000,000
Debt instrument, percentage of debt subject to guaranty     25.00%
First Mortgage | Subsequent event      
Debt Instrument [Line Items]      
Number of communities securing debt | community 11    
Number of debt renewal options | renewal_option 2    
Debt instrument, term of renewal option 1 year    
First Mortgage | Mortgages      
Debt Instrument [Line Items]      
Debt face amount   $ 179,500,000 $ 220,000,000
Interest rate (as percent)   5.97%  
Debt instrument, term of interest (in years)     3 years
First Mortgage | Mortgages | Subsequent event      
Debt Instrument [Line Items]      
Debt face amount $ 50,000,000    
First Mortgage | Mortgages | Secured Overnight Financing Rate (SOFR)      
Debt Instrument [Line Items]      
Basis spread on variable rate basis (as percent)     2.45%
First Mortgage | Mortgages | Secured Overnight Financing Rate (SOFR) | Subsequent event      
Debt Instrument [Line Items]      
Basis spread on variable rate basis (as percent) 3.50%    
Secured Debt | Mortgages      
Debt Instrument [Line Items]      
Debt face amount   $ 580,400,000  
Mortgage Debt Due 2024      
Debt Instrument [Line Items]      
Repayment of debt   $ 260,100,000  
Mortgage Debt Due 2023      
Debt Instrument [Line Items]      
Repayment of debt     $ 199,600,000
v3.24.0.1
Leases - Narrative (Details)
12 Months Ended
Dec. 31, 2023
lease
community
Lessee, Lease, Description [Line Items]  
Number of communities leased | community 277
Number of operating communities leased 263
Number of financing communities leased 14
Operating lease, weighted average remaining lease term (in years) 5 years 8 months 12 days
Finance lease, weighted average remaining lease term (in years) 2 years 3 months 18 days
Operating lease, weighted average discount rate (as percent) 8.40%
Finance lease, weighted average discount rate (as percent) 10.30%
Minimum  
Lessee, Lease, Description [Line Items]  
Renewal term (in years) 5 years
Maximum  
Lessee, Lease, Description [Line Items]  
Renewal term (in years) 20 years
v3.24.0.1
Leases - Lease Cost (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Operating Leases      
Facility operating expense $ 7,105 $ 6,329 $ 12,606
Facility lease expense 202,410 165,294 174,358
Operating lease expense 209,515 171,623 186,964
Operating lease expense adjustment 45,739 34,896 23,280
Changes in operating lease assets and liabilities for lessor capital expenditure reimbursements (9,844) (13,718) (30,965)
Operating net cash outflows from operating leases 245,410 192,801 179,279
Financing Leases      
Depreciation and amortization 16,444 38,126 37,921
Interest expense: financing lease obligations 21,950 48,061 46,282
Financing lease expense 38,394 86,187 84,203
Operating cash outflows from financing leases 21,950 48,061 46,282
Financing cash outflows from financing leases 8,473 22,221 19,874
Changes in financing lease assets and liabilities for lessor capital expenditure reimbursement (475) (11,932) (11,135)
Total net cash outflows from financing leases $ 29,948 $ 58,350 $ 55,021
v3.24.0.1
Leases - Maturity (Details)
$ in Thousands
Dec. 31, 2023
USD ($)
Operating Leases  
2024 $ 260,694
2025 260,501
2026 145,832
2027 147,660
2028 84,767
Thereafter 251,579
Total lease payments 1,151,033
Purchase option liability and non-cash gain on future sale of property 0
Imputed interest and variable lease payments (274,526)
Total lease obligations 876,507
Financing Leases  
2024 20,266
2025 6,849
2026 6,833
2027 6,082
2028 5,917
Thereafter 20,625
Total lease payments 66,572
Purchase option liability and non-cash gain on future sale of property 145,136
Imputed interest and variable lease payments (59,859)
Total lease obligations $ 151,849
v3.24.0.1
Tangible Equity Units - TEU Amortizing Notes (Details)
$ / shares in Units, $ in Millions
12 Months Ended
Dec. 31, 2022
USD ($)
day
component
$ / shares
shares
Debt Instrument [Line Items]  
Number of components | component 2
Tangible equity units senior amortizing notes due November 2025; interest rate of 10.25% as of both December 31, 2023 and 2022. | Other notes payable  
Debt Instrument [Line Items]  
Number of shares issued (in shares) 2,875,000
Interest rate (as percent) 7.00%
Stated amount, per unit (in dollars per share) | $ / shares $ 50.00
Aggregate offering | $ $ 143.8
Proceeds from debt, net of issuance costs | $ $ 139.4
Prepaid stock purchase contracts | $ / shares $ 8.8996
Debt instrument, settlement, threshold trading days | day 20
Debt instrument, interest rate during period 10.25%
Tangible equity units senior amortizing notes due November 2025; interest rate of 10.25% as of both December 31, 2023 and 2022. | Other notes payable | Minimum  
Debt Instrument [Line Items]  
Equity units, required to be delivered to the holder (in shares) 12.9341
Tangible equity units senior amortizing notes due November 2025; interest rate of 10.25% as of both December 31, 2023 and 2022. | Other notes payable | Maximum  
Debt Instrument [Line Items]  
Equity units, required to be delivered to the holder (in shares) 15.1976
v3.24.0.1
Tangible Equity Units - Proceeds From Issuance Allocated To Equity and Debt Component (Details) - USD ($)
$ / shares in Units, $ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Debt Instrument [Line Items]      
Less: issuance costs $ (10,831) $ (7,077) $ (3,904)
Total | Other notes payable      
Debt Instrument [Line Items]      
Value per unit (in dollars per share) $ 50.00    
Gross proceeds $ 143,750    
Less: underwriters' discount (4,312)    
Proceeds from issuance of Units 139,438    
Less: issuance costs (1,415)    
Net proceeds $ 138,023    
Equity Component | Other notes payable      
Debt Instrument [Line Items]      
Value per unit (in dollars per share) $ 41.10    
Gross proceeds $ 118,164    
Less: underwriters' discount (3,544)    
Proceeds from issuance of Units 114,620    
Less: issuance costs (1,163)    
Net proceeds $ 113,457    
Debt Component | Other notes payable      
Debt Instrument [Line Items]      
Value per unit (in dollars per share) $ 8.90    
Gross proceeds $ 25,586    
Less: underwriters' discount (768)    
Proceeds from issuance of Units 24,818    
Less: issuance costs (252)    
Net proceeds $ 24,566    
v3.24.0.1
Tangible Equity Units - Debt Instrument Settlement Prepaid Stock Purchase Contract (Details)
Dec. 31, 2023
day
$ / shares
shares
Common Stock Issued [Abstract]  
Debt instrument, settlement, threshold consecutive trading days | day 20
Debt instrument, settlement, prepaid stock, minimum settlement rate (in shares) | shares 12.9341
Debt instrument, settlement, prepaid stock values, divided by applicable market value (in dollars per share) $ 50
Debt instrument, settlement, prepaid stock, maximum settlement rate (in shares) | shares 15.1976
Applicable Market Value [Abstract]  
Threshold appreciation price (in dollars per share) $ 3.87
Reference price (in dollars per share) $ 3.29
v3.24.0.1
Accrued Expenses (Details) - USD ($)
$ in Thousands
Dec. 31, 2023
Dec. 31, 2022
Accounts Payable and Accrued Liabilities, Current [Abstract]    
Employee compensation $ 104,322 $ 85,610
Insurance reserves 54,834 65,757
Real estate taxes 26,988 26,661
Interest 17,838 17,569
Utilities 8,444 8,533
Income taxes payable 2,071 2,081
Other 28,171 30,937
Total $ 242,668 $ 237,148
v3.24.0.1
Commitments and Contingencies (Details)
12 Months Ended
Dec. 31, 2023
lawsuit
Commitments and Contingencies Disclosure [Abstract]  
Number of lawsuits 2
v3.24.0.1
Self-Insurance (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Self Insurance Reserves [Abstract]    
Self insurance reserve $ 122.6 $ 135.9
Self insurance reserves, noncurrent 67.8 70.2
Accrual receivable 4.3 9.9
Cash deposits for self insured retention risk 8.3 14.5
Letters of credit associated to the secured self-insured retention risk 57.2 62.1
Restricted cash $ 10.3 $ 6.0
v3.24.0.1
Stock-Based Compensation - Restricted Stock Units and Stock Awards Activity (Details) - $ / shares
shares in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Number of Restricted Stock Units and Stock Awards      
Beginning balance (in shares) 5,373 5,011 8,505
Granted (in shares) 3,992 2,921 1,998
Vested (in shares) (2,001) (2,039) (2,641)
Cancelled/forfeited (in shares) (961) (520) (2,851)
Ending balance (in shares) 6,403 5,373 5,011
Weighted Average Grant Date Fair Value      
Beginning balance (in dollars per share) $ 6.00 $ 6.80 $ 7.68
Granted (in dollars per share) 2.98 5.58 5.12
Vested (in dollars per share) 5.87 7.15 8.40
Cancelled/forfeited (in dollars per share) 5.90 6.88 6.77
Ending balance (in dollars per share) $ 4.17 $ 6.00 $ 6.80
v3.24.0.1
Stock-Based Compensation - Narrative (Details) - USD ($)
$ in Millions
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]        
Unrecognized compensation cost related to nonvested share-based compensation arrangements granted $ 15.8      
Period over which cost is expected to be recognized (in years) 2 years 3 months 18 days      
Unvested restricted shares (in shares) 6,403,000 5,373,000 5,011,000 8,505,000
Restricted stock        
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]        
Unvested restricted shares (in shares) 0 422,542    
v3.24.0.1
Stock-Based Compensation - Restricted Stock Units and Stock Awards Grants (Details) - USD ($)
$ / shares in Units, shares in Thousands, $ in Thousands
3 Months Ended 12 Months Ended
Dec. 31, 2023
Sep. 30, 2023
Jun. 30, 2023
Mar. 31, 2023
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]              
Granted (in shares)         3,992 2,921 1,998
Restricted stock              
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]              
Granted (in shares) 7 16 10 3,959      
Shares granted (in dollars per share) $ 4.14 $ 4.01 $ 2.95 $ 2.97      
Total value of restricted shares granted $ 29 $ 65 $ 29 $ 11,778      
v3.24.0.1
Earnings Per Share - Narrative (Details) - $ / shares
shares in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Jul. 26, 2020
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]        
Common stock, par value (in dollars per share) $ 0.01 $ 0.01    
Weighted average shares outstanding - basic (in shares) 225,209 190,463 184,975  
Ventas, Inc | The Warrant        
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]        
Number of shares authorized to be purchased       16,300
Common stock, par value (in dollars per share)       $ 0.01
Share price (in usd per share)       $ 3.00
Convertible Senior Notes Due 2026        
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]        
Number of shares issuable upon conversion (in shares) 38,300      
Incremental shares issuable under purchase contracts        
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]        
Number of shares issuable upon conversion (in shares) 43,700      
Weighted average shares outstanding - basic (in shares) 37,200 37,200    
v3.24.0.1
Earnings Per Share - Earnings Per Share, Basic and Diluted (Details) - shares
shares in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Earnings Per Share [Abstract]      
Weighted average common shares outstanding (in shares) 188,023 186,574 184,975
Weighted average minimum shares issuable under purchase contracts (in shares) 37,186 3,889 0
Weighted average shares outstanding - basic (in shares) 225,209 190,463 184,975
v3.24.0.1
Earnings Per Share - Potentially Dilutive Securities (Details) - shares
shares in Millions
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]      
Antidilutive securities (in shares) 67.5 66.5 59.6
Convertible senior notes      
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]      
Antidilutive securities (in shares) 38.3 38.3 38.3
Warrants      
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]      
Antidilutive securities (in shares) 16.3 16.3 16.3
Restricted stock and restricted stock units      
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]      
Antidilutive securities (in shares) 6.4 5.4 5.0
Incremental shares issuable under purchase contracts      
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]      
Antidilutive securities (in shares) 6.5 6.5 0.0
v3.24.0.1
Share Repurchase Program (Details) - USD ($)
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2016
Equity, Class of Treasury Stock [Line Items]        
Total number of shares repurchased (in shares) 0 0 0  
Amount available under the share repurchase program $ 44,000,000      
2016 Repurchase Program        
Equity, Class of Treasury Stock [Line Items]        
Authorized share repurchased program amount       $ 100,000,000
v3.24.0.1
Retirement Plans (Details) - USD ($)
$ in Millions
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Retirement Benefits [Abstract]      
Matching contribution (as percent) 25.00%    
Maximum contributed compensation (as percent) 4.00%    
Additional matching contribution (as percent) 12.50%    
Expense related to retirement savings plan $ 4.8 $ 4.1 $ 4.6
v3.24.0.1
Income Taxes - Income Tax Expense (Benefit) (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Federal:      
Current $ (183) $ (17) $ 161
Deferred (7,590) 1,325 9,837
Total federal (7,773) 1,308 9,998
State:      
Current (1,011) 251 (1,835)
Deferred (included in federal above) 0 0 0
Total state (1,011) 251 (1,835)
Total $ (8,784) $ 1,559 $ 8,163
v3.24.0.1
Income Taxes - Reconciliation of Income Tax Expense (Benefit) (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Income Tax Disclosure [Abstract]      
Statutory income tax rate 21.00% 21.00% 21.00%
Tax benefit (provision) at U.S. statutory rate $ 37,848 $ 50,397 $ 22,565
State taxes, net of federal income tax 5,766 10,811 7,673
Valuation allowance (49,109) (57,080) 13,027
Goodwill derecognition 0 0 (31,829)
Stock compensation (1,312) (181) (1,856)
Other (1,977) (2,388) (1,417)
Total $ (8,784) $ 1,559 $ 8,163
v3.24.0.1
Income Taxes - Deferred Tax Assets and Liabilities (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Deferred income tax assets:      
Operating loss carryforwards $ 392,577 $ 361,160  
Operating lease obligations 220,003 199,226  
Tax credits 50,415 50,415  
Accrued expenses 46,814 42,828  
Intangible assets 26,816 39,360  
Financing lease obligations 0 12,749  
Capital loss carryforward 2,102 2,140  
Other 3,268 3,091  
Total gross deferred income tax asset 741,995 710,969  
Valuation allowance (474,152) (425,043)  
Net deferred income tax assets 267,843 285,926  
Deferred income tax liabilities:      
Operating lease right-of-use assets (168,398) (149,881)  
Property, plant and equipment (92,580) (122,377)  
Investment in unconsolidated ventures 0 (12,064)  
Financing lease obligations (10,273) 0  
Other (2,579) 0  
Total gross deferred income tax liability (273,830) (284,322)  
Net deferred tax asset (liability) (5,987)    
Net deferred tax asset (liability)   1,604  
Deferred Tax Valuation Allowance      
Valuation and qualifying accounts [Roll forward]      
Balance at beginning of period 425,043 367,963 $ 380,990
Charged to deferred income tax (benefit) provision 49,109 57,080 (13,027)
Balance at end of period $ 474,152 $ 425,043 $ 367,963
v3.24.0.1
Income Taxes - Narrative (Details) - USD ($)
$ in Thousands
Dec. 31, 2023
Dec. 31, 2022
Operating Loss Carryforwards [Line Items]    
Valuation allowance $ (474,152) $ (425,043)
Gross unrecognized tax benefits 18,200 18,100
Penalties and interest accrued 200 100
Federal    
Operating Loss Carryforwards [Line Items]    
Net operating loss carryforwards 790,800 802,200
Operating loss carryforwards, indefinite lived 799,300 659,700
State | Capital loss carryforward    
Operating Loss Carryforwards [Line Items]    
Net operating loss carryforwards 2,100 2,100
Federal and state    
Operating Loss Carryforwards [Line Items]    
Net operating loss carryforwards valuation allowance 421,600 372,500
Tax credit valuation allowance 50,400 50,400
Federal and state | Capital loss carryforward    
Operating Loss Carryforwards [Line Items]    
Tax credit valuation allowance $ 2,100 $ 2,100
v3.24.0.1
Income Taxes - Unrecognized Tax Benefits (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Unrecognized tax benefits [Roll Forward]    
Balance at beginning of period $ 18,088 $ 18,089
Additions for tax positions related to prior years 173 0
Reductions for tax positions related to prior years (56) (1)
Balance at end of period $ 18,205 $ 18,088
v3.24.0.1
Supplemental Disclosure of Cash Flow Information - Supplemental Disclosure of Cash Flow Information (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Supplemental Disclosure of Cash Flow Information:      
Interest paid $ 231,786 $ 200,308 $ 188,791
Income taxes paid, net of (refunds) (1,429) (330) 5,923
Capital expenditures, net of related payables 233,205 196,924 176,657
Prepaid expenses and other assets, net 21,629 (21,240) (15,483)
Investment in unconsolidated ventures (7,589) (218) (5,436)
Other non-operating loss (income) (21,687) (12,114) (5,903)
Accounts receivable, net 7,380 (4,624) 502
Refundable fees and deferred revenue (654) (1,934) (10,066)
Loss (gain) on sale of communities, net (36,296) (73,850) 0
Capital expenditures, net of related payables:      
Supplemental Disclosure of Cash Flow Information:      
Capital expenditures, net of related payables 233,205 196,924 176,657
Trade accounts payable 4,613 (3,085) (6,061)
Acquisition of assets, net of cash acquired:      
Supplemental Disclosure of Cash Flow Information:      
Prepaid expenses and other assets, net 23 0 0
Property, plant and equipment and leasehold intangibles, net 6,872 4 0
Investment in unconsolidated ventures (3,395) 0 0
Financing lease obligations 0 6,000 0
Other liabilities (384) 0 0
Other non-operating loss (income) (2,542) 0 0
Net cash paid 574 6,004 0
Proceeds from HCS Sale, net:      
Supplemental Disclosure of Cash Flow Information:      
Trade accounts payable 0 0 1,387
Prepaid expenses and other assets, net 0 0 (32,963)
Property, plant and equipment and leasehold intangibles, net 0 0 (1,806)
Other liabilities 0 0 9,165
Operating lease right-of-use assets 0 0 (8,145)
Accounts receivable, net 0 0 (57,582)
Investment in unconsolidated ventures 0 0 100,000
Goodwill 0 0 (126,810)
Accrued expenses 0 0 25,226
Refundable fees and deferred revenue 0 0 57,314
Operating lease obligations 0 0 8,145
Non-operating loss (gain) on sale of assets, net 0 0 (286,489)
Net cash received 0 0 (312,558)
Proceeds from sale of other assets, net:      
Supplemental Disclosure of Cash Flow Information:      
Prepaid expenses and other assets, net (1,889) (1,308) (1,983)
Property, plant and equipment and leasehold intangibles, net (36,545) (107) (878)
Investment in unconsolidated ventures (27,392) 0 0
Other liabilities 10,690 1,025 (75)
Refundable fees and deferred revenue 9,347 0 0
Non-operating loss (gain) on sale of assets, net (1,441) (595) (2,346)
Loss (gain) on sale of communities, net (36,296) 0 0
Assets held for sale 0 (3,668) (16,166)
Net cash received (83,526) (4,653) (21,448)
Non-Development | Capital expenditures, net of related payables:      
Supplemental Disclosure of Cash Flow Information:      
Capital expenditures, net of related payables 216,511 168,166 137,410
Development | Capital expenditures, net of related payables:      
Supplemental Disclosure of Cash Flow Information:      
Capital expenditures, net of related payables 1,762 6,193 3,208
Non-development - Reimbursable | Capital expenditures, net of related payables:      
Supplemental Disclosure of Cash Flow Information:      
Capital expenditures, net of related payables $ 10,319 $ 25,650 $ 42,100
v3.24.0.1
Supplemental Disclosure of Cash Flow Information - Supplemental Schedule of Non-Cash Operating, Investing and Financing Activities (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Acquisition of assets, net of related payables [Line Items]      
Loss (gain) on sale of communities, net $ (36,296) $ (73,850) $ 0
Gain on sale for master lease amendment      
Acquisition of assets, net of related payables [Line Items]      
Property, plant and equipment and leasehold intangibles, net 0 (220,477) 0
Operating lease right-of-use assets 0 91,641 0
Financing lease obligations 0 294,327 0
Operating lease obligations 0 (91,641) 0
Loss (gain) on sale of communities, net 0 (73,850) 0
Net 0 0 0
Lease termination and modification, net      
Acquisition of assets, net of related payables [Line Items]      
Property, plant and equipment and leasehold intangibles, net (51,518) 11,098 4,056
Operating lease right-of-use assets 223,309 11,419 17,197
Financing lease obligations 88,820 (6,338) (4,056)
Operating lease obligations (260,611) (16,179) (17,197)
Net $ 0 $ 0 $ 0
v3.24.0.1
Supplemental Disclosure of Cash Flow Information - Cash and Restricted Cash (Details) - USD ($)
$ in Thousands
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Restricted Cash and Cash Equivalents Items [Line Items]        
Restricted cash $ 41,341 $ 27,735    
Long-term restricted cash 30,356 47,963    
Cash and escrow deposits - restricted, total 71,697 75,698    
Reconciliation of cash, cash equivalents, and restricted cash:        
Cash and cash equivalents 277,971 398,850    
Restricted cash 41,341 27,735    
Long-term restricted cash 30,356 47,963    
Total cash, cash equivalents, and restricted cash 349,668 474,548 $ 438,314 $ 465,148
Interest rate cap escrows        
Restricted Cash and Cash Equivalents Items [Line Items]        
Restricted cash 17,843 3,797    
Reconciliation of cash, cash equivalents, and restricted cash:        
Restricted cash 17,843 3,797    
Real estate tax and property insurance escrows        
Restricted Cash and Cash Equivalents Items [Line Items]        
Restricted cash 16,061 15,722    
Reconciliation of cash, cash equivalents, and restricted cash:        
Restricted cash 16,061 15,722    
Replacement reserve escrows        
Restricted Cash and Cash Equivalents Items [Line Items]        
Restricted cash 7,194 7,999    
Reconciliation of cash, cash equivalents, and restricted cash:        
Restricted cash 7,194 7,999    
Other        
Restricted Cash and Cash Equivalents Items [Line Items]        
Restricted cash 243 217    
Reconciliation of cash, cash equivalents, and restricted cash:        
Restricted cash 243 217    
Insurance deposits        
Restricted Cash and Cash Equivalents Items [Line Items]        
Long-term restricted cash 15,961 18,230    
Reconciliation of cash, cash equivalents, and restricted cash:        
Long-term restricted cash 15,961 18,230    
CCRCs escrows        
Restricted Cash and Cash Equivalents Items [Line Items]        
Long-term restricted cash 10,813 15,847    
Reconciliation of cash, cash equivalents, and restricted cash:        
Long-term restricted cash 10,813 15,847    
Debt service reserve        
Restricted Cash and Cash Equivalents Items [Line Items]        
Long-term restricted cash 3,472 13,779    
Reconciliation of cash, cash equivalents, and restricted cash:        
Long-term restricted cash 3,472 13,779    
Letters of credit collateral        
Restricted Cash and Cash Equivalents Items [Line Items]        
Long-term restricted cash 110 107    
Reconciliation of cash, cash equivalents, and restricted cash:        
Long-term restricted cash $ 110 $ 107    
v3.24.0.1
COVID-19 Pandemic (Details) - USD ($)
1 Months Ended 12 Months Ended
Jul. 01, 2021
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Unusual or Infrequent Item, or Both [Line Items]                
Revenue from government grants         $ 9,100,000 $ 10,000,000 $ 1,700,000  
Health Care Services | HCA Healthcare, Inc.                
Unusual or Infrequent Item, or Both [Line Items]                
Percentage of ownership sold in transaction 80.00% 20.00%            
Medicare advance payments $ 63,600,000              
Employer portion of payroll taxes delayed $ 9,600,000              
CARES Act                
Unusual or Infrequent Item, or Both [Line Items]                
Proceeds from recoupment of accelerated/advanced payments           3,100,000 20,800,000  
Employer portion of payroll taxes delayed   $ 0     0     $ 72,700,000
Payment of payroll taxes     $ 31,600,000 $ 31,600,000        
Employee Retention Credit, Amount Recognized         0 9,400,000 9,900,000  
Employee retention credit, amount received         14,700,000 4,600,000    
CARES Act | Prepaid Expenses and Other Current Assets                
Unusual or Infrequent Item, or Both [Line Items]                
Employee retention credit, amount received           14,700,000    
CARES Act | Accelerated and Advance Payment Program                
Unusual or Infrequent Item, or Both [Line Items]                
Amount received from Accelerated and Advance Payment Program         $ 0     87,500,000
CARES Act | Health Care Services | Accelerated and Advance Payment Program                
Unusual or Infrequent Item, or Both [Line Items]                
Amount received from Accelerated and Advance Payment Program               75,200,000
CARES Act | CCRC Venture | Accelerated and Advance Payment Program                
Unusual or Infrequent Item, or Both [Line Items]                
Amount received from Accelerated and Advance Payment Program               $ 12,300,000
Loans Insured or Guaranteed by US Government Authorities | CARES Act                
Unusual or Infrequent Item, or Both [Line Items]                
Relief received from Provider Relief Fund           $ 61,100,000 $ 800,000  
v3.24.0.1
Segment Information (Details)
$ in Thousands
12 Months Ended
Jul. 01, 2021
Dec. 31, 2023
USD ($)
segment
Dec. 31, 2022
USD ($)
Dec. 31, 2021
USD ($)
Segment Reporting Information [Line Items]        
Number of reportable segments | segment   3    
Revenue   $ 3,015,829 $ 2,825,379 $ 2,758,259
Segment operating income   746,704 594,413 500,951
General and administrative expense (including non-cash stock-based compensation expense)   178,894 168,594 184,916
Facility operating lease expense   202,410 165,294 174,358
Depreciation and amortization   342,712 347,444 337,613
Asset impairment   40,572 29,618 23,003
Loss (gain) on sale of communities, net   (36,296) (73,850) 0
Loss (gain) on facility operating lease termination, net   0 0 (2,003)
Income (loss) from operations   18,412 (42,687) (216,936)
Total interest expense   238,274 204,717 195,140
Total capital expenditures for property, plant and equipment, and leasehold intangibles   228,592 200,009 182,718
Assets   5,573,435 5,937,062  
Equity in earnings (loss) of unconsolidated ventures   (3,996) (10,782) 10,394
Goodwill   27,321 27,321  
CARES Act        
Segment Reporting Information [Line Items]        
Cash made available for Provider Relief Fund   9,073 80,469 12,368
Independent Living        
Segment Reporting Information [Line Items]        
Goodwill   27,300 27,300 27,300
Health Care Services | HCA Healthcare, Inc.        
Segment Reporting Information [Line Items]        
Percentage of ownership after transaction 20.00%      
Operating segments | Independent Living        
Segment Reporting Information [Line Items]        
Revenue   564,499 518,699 477,050
Segment operating income   184,645 158,950 146,108
Facility operating lease expense   39,114 39,700 42,162
Depreciation and amortization   83,637 79,521 74,922
Asset impairment   1,647 10,893 3,483
Total interest expense   61,624 48,788 45,209
Total capital expenditures for property, plant and equipment, and leasehold intangibles   51,188 44,857 36,992
Assets   1,206,021 1,267,825  
Operating segments | Independent Living | CARES Act        
Segment Reporting Information [Line Items]        
Cash made available for Provider Relief Fund   487 10,906 1,512
Operating segments | Assisted Living and Memory Care        
Segment Reporting Information [Line Items]        
Revenue   1,968,440 1,815,722 1,595,684
Segment operating income   502,317 379,958 294,320
Facility operating lease expense   146,166 106,961 111,117
Depreciation and amortization   196,994 207,344 200,677
Asset impairment   11,574 11,613 14,384
Total interest expense   141,330 133,139 121,785
Total capital expenditures for property, plant and equipment, and leasehold intangibles   121,240 111,978 105,177
Assets   3,315,921 3,329,516  
Operating segments | Assisted Living and Memory Care | CARES Act        
Segment Reporting Information [Line Items]        
Cash made available for Provider Relief Fund   8,008 60,630 5,963
Operating segments | CCRCs        
Segment Reporting Information [Line Items]        
Revenue   333,404 331,577 306,213
Segment operating income   49,581 43,485 34,109
Facility operating lease expense   12,943 13,883 15,932
Depreciation and amortization   36,951 38,039 37,891
Asset impairment   1,368 5,970 4,790
Total interest expense   24,889 21,251 18,756
Total capital expenditures for property, plant and equipment, and leasehold intangibles   37,414 20,467 19,086
Assets   612,521 664,502  
Operating segments | CCRCs | CARES Act        
Segment Reporting Information [Line Items]        
Cash made available for Provider Relief Fund   578 8,933 1,788
Operating segments | Corporate and All Other        
Segment Reporting Information [Line Items]        
Revenue   149,486 159,381 202,043
Segment operating income   10,161 12,020 20,598
Facility operating lease expense   4,187 4,750 5,147
Depreciation and amortization   25,130 22,540 23,783
Asset impairment   25,983 1,142 346
Total interest expense   10,431 1,539 9,390
Total capital expenditures for property, plant and equipment, and leasehold intangibles   18,750 22,707 21,463
Assets   438,972 675,219  
Equity in earnings (loss) of unconsolidated ventures   $ 900 $ 4,200 17,200
Operating segments | Health Care Services        
Segment Reporting Information [Line Items]        
Revenue       177,269
Segment operating income       5,816
Depreciation and amortization       340
Operating segments | Health Care Services | CARES Act        
Segment Reporting Information [Line Items]        
Cash made available for Provider Relief Fund       $ 3,105