When I see that in Walmart or wherever, I assume the person is genuinely struggling and move along. As you point out, location matters. In a care facility? Find a way to wear PPE correctly when and where you need to. Period.
I do feel the general public would have better compliance allowing face shields for those who struggle rather than insisting on masks. It cannot be worse, in lower risk settings, than pulled down under the nose, constantly being fussed with, thus 'contaminating' hands. What's that saying about recycling? We need millions of people doing it imperfectly, rather than one person doing it perfectly.
Hopefully not too off topic. The constant quarantining of seniors is a huge problem.