Not all companies operate like Apple. In the consumer electronics world if you don't treat your customers well they will simply move on to a competitor. In the health care world this is certainly not always the case. My parents were both legally blind but they were totally self sufficient living in their own home and not using any additional services until last few years. My mom needed some help for the last couple of years. Weekly visits to tend with a chronic wound and biweekly monitoring of her blood. When Home Care went private in Alberta the quality of service went from very good to horrid almost over night. Had we not been able to arrange for other alternatives it would have been enough to force them out of their home. The additional cost to the tax payer had that happened would have been far greater than the costs of the help they had before privatization.
PSW's can play a huge role in keeping seniors in their own homes. But they also need to be trained, paid and treated as professionals. So far there is little evidence that the private sector wants to make this happen. A similar thing happens in seniors care homes. Often the private homes are worse than non-profit or public facilities. Again, its not the case that if you don't like the service you can simply move on to a competitor. These places literally have a captive customer base.
Just as another side to this anecdotal report My mother spend many years in a convalescent home, my dad had to pay high monthly costs to have her stay there. He went every day to be with my mom, not only served my mother but served most of the patients in the unit, who would otherwise be waiting an hour for their food that would be by then cold. The Union paid porter was busy bs with any nurse they could find while the food was waiting to be set out to the patients. On the rare day my father was ill, there were lots of stories about people not even receiving their meal. At all. But rarely prompt or efficient, or even friendly or cordial service by the actual porters.
The serviced provided by my father, sometimes myself, and other unofficial standby volunteers, (friends, relatives of anybody on the unit) was better and seemingly necessary. The unionized porters did not provide better service than anybody else, even volunteers, could provide.