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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 9 Months Ended
Sep. 30, 2023
Sep. 30, 2022
Cash flows from operating activities:    
Net (loss) income $ (191,008) $ 49,548
Adjustments to reconcile net (loss) income to cash provided by (used in) operating activities:    
Depreciation and amortization 200,430 175,927
Net amortization of debt premiums, discounts and issuance costs 6,616 6,698
Straight line rental income 1,333 (7,193)
Amortization of acquired real estate leases (264) 204
Loss on modification or early extinguishment of debt 1,075 30,043
Impairment of assets 18,380 0
Gain on sale of properties (1,233) (322,064)
Gains and losses on equity securities, net (8,126) 21,384
Other non-cash adjustments, net (1,328) (1,376)
Unconsolidated joint venture distributions 3,870 7,400
Equity in net earnings of investees (2,137) (8,685)
Change in assets and liabilities:    
Deferred leasing costs, net (7,995) (6,188)
Other assets 4,315 9,809
Accrued interest 2,628 2,312
Other liabilities (8,864) 5,233
Net cash provided by (used in) operating activities 17,692 (36,948)
Cash flows from investing activities:    
Real estate acquisitions 0 (75,105)
Real estate improvements (168,400) (189,118)
Proceeds from sale of properties, net 3,548 822
Proceeds from sale of properties to joint venture, net 0 638,488
Proceeds from sale of interest in joint venture, net 0 108,626
Proceeds from AlerisLife Inc. tender offer 14,006 0
Net cash (used in) provided by investing activities (150,846) 483,713
Cash flows from financing activities:    
Repayments of borrowings on credit facility (250,000) (100,000)
Redemption of senior unsecured notes 0 (500,000)
Repayment of other debt (16,408) (28,373)
Loss on early extinguishment of debt settled in cash 0 (24,375)
Payment of debt issuance costs (2,057) (2,821)
Repurchase of common shares (386) (165)
Distributions to shareholders (7,192) (7,171)
Net cash used in financing activities (276,043) (662,905)
Decrease in cash and cash equivalents and restricted cash (409,197) (216,140)
Cash and cash equivalents and restricted cash at beginning of period 688,302 1,016,945
Cash and cash equivalents and restricted cash at end of period $ 279,105 $ 800,805