I did retirement home training and used to think it was a sweet job. Then I got in the business and underestimated how demoralizing it was as they give you the easy elders in training while the others make you, or at least me, really think of the fact the job just amounts to an unkarmic freebie.
People think this without a hint of irony, and yet have never worked in a place without management. Good management improves productivity and efficiency, while also shielding workers from executives. Bad/no management almost always leads to chaos.
It's like the whole idea of not having leaders; it's a great theory, but it assumes that everyone is capable of working together perfectly towards the same goal, when the reality is that not everyone has the same goal.
Middlemen, etc., are trading in knowledge. They know who can do what, and decrease duplication of effort.