When people talk about ineffective altruism, they're generally talking about organizations like the American Heart Association, which spends over half of annual donations on payroll (https://projects.propublica.org/nonprofits/organizations/135...). I don't think many people in the effective altruist movement would complain about a targeted trust that successfully and reliably achieves some niche goal.
When effective altruists talk about ineffective altruism, they talk about AHA. When I talk about ineffective altruism, I talk about things like a targeted trust.
It's the EA people who generalize from AHA to make grand ethical claims that lead to absurdity.
Imagine you have a charitable organization that receives funds and then pays its staff of doctors to provide free treatment to the poor. All of their donations would be spent on payroll and overhead. But this would not demonstrate that the organization is wasteful.