Because you don't know how much money you'll make that year until the year is over.

This is where being a Canadian expat gets interesting: should elder care turn a profit, or should it pay its bills and it’s staff?

As an expat in the US, the big problem is that many don't have the money. Many were living on their Social Security checks before they needed full-time care, and then have to go to a facility that accepts Medicare/Medicaid, and those facilities operate on tight budgets.

Gwendoline Christie is 6'3" and that's enough to have her character referred to as "the big woman" in Game of Thrones.