When LaShuan Bethea entered the senior living industry after graduating high school, she had no idea she’d spend the next 25 years in it—let alone that she’d become one of its most important advocates in Washington, D.C., as executive director of the National Center for Assisted Living (NCAL).
“I never knew that that would be my long-term career option,” she recalled of her first job as an licensed practical nurses at a nursing home. “But I found that as I tried a whole bunch of different types of nursing, I kept coming back to long term care.”
It was the human element of the job that pulled her back over and over again: the opportunity not just to take care of residents, but to spend quality time with them. “I loved engaging with the residents, hearing their story, and getting to know them as individual people and their history,” she said. “There was no other environment where I was able to get that same type of joy. Working with residents and their families, you get this immediate return on the investment that you make in caring for them, because they truly appreciate the work that you do.”
The longer Bethea spent working as a clinician, the more she came to recognize a tension between the realities on the floor and the regulations determining what happens there. However well-intentioned various rules may be, she realized, there was still a gap between the world regulators envisioned and the world as it exists.
“One of the things that became clear to me is there’s this disconnect between the people who write the regulations and what happens when you work in the industry,” she reflected. “I would often find myself saying, ‘There’s no way that a person who worked in our industry could have ever written a rule like this.’ Because they don’t. There’s a disconnect between them and what is happening at the bedside, what’s happening in the day-to-day work that we do.”
From the Bedside to the Beltway
Instead of navigating around that disconnect, Bethea decided to get to work bridging it. After years working in various nursing home roles—direct care nurse, unit manager, staff development coordinator, assessment coordinator—not to mention earning a JD and an MEd along the way, she started working at Genesis Healthcare in 2007, where she eventually became the operator’s vice president of legislative affairs. The role empowered her to draw upon her time with residents as she worked directly with policymakers, ensuring that the regulations they drafted helped the people they were meant to help.
“It allowed me to take my experience as a nurse and educate the people who make decisions—who make the laws, who make the regulations—about how we do what we do and how the legislation they write impacts us,” she said. “I always saw myself as an educator: I was there to help let them know that we are a resource, we want to collaborate, and we all want the same things—quality care and great outcomes for our residents.”
Having served in a wide range of positions and settings, from the memory care unit to the emergency room, Bethea has seen again and again that there truly is no one-size-fits-all approach to care. No two nursing homes are the same, no two units are the same, and no two care plans are the same, because no two residents are the same. This perspective has long informed her approach to advocacy work on a variety of critical issues, such as the new minimum staffing rule, which she describes as a blanket solution to a complex set of problems that does nothing to address the structural issues causing those problems. In other words, it’s exactly the sort of one-size-fits-all strategy that completely misunderstands how nursing homes work.
“We need a more deliberate approach to how we determine staffing needs, based on the needs of residents in each setting,” she explained. “It’s not the same in every single nursing home, just like it’s not the same in acute care versus post-acute care. A person who comes up with this rule doesn’t recognize that there is a variety of different residents in each of the types of settings that we have.”
Being an Effective Voice
When Bethea joined NCAL in 2021, her top priority was to hit the road. At Genesis, she advocated for almost 250 facilities in 22 states; now she represented thousands of facilities across every state. To be an effective voice for communities, residents, and employees, she’d have to meet them face-to-face, gaining a deeper understanding of their experiences and needs.
“I wanted to make sure that my voice is reflective of what’s happening in the various settings that I represent,” she recalled. “An assisted living facility in Oregon is very different from one in California, very different from Texas and Maryland. Going into those communities allows me to take that firsthand experience to legislators in D.C., and to make sure they’re aware that you can’t take one piece of legislation and use it to kind of paint that broad brush across the industry.”
Another priority is helping policymakers (and everyone else) understand what assisted living is and how it works. While the industry has received more attention in recent years, Bethea acknowledged that this attention often focuses on negative stories, isolated as they may be.
On one hand, the COVID-19 pandemic helped people understand what distinguishes assisted living from other care settings, such as home health and skilled nursing. On the other hand, common misconceptions remain prevalent—like the notion that assisted living isn’t regulated. The fact that it’s regulated at the state level, Bethea pointed out, is why it’s so misguided for policymakers to approach the sector with a broad brush. “Because it’s different in every state,” she argued, “it’s better to have hands that are closer to what it looks like at that level, rather than make a rule that would apply across all 50 states.”
Fostering the Next Generation of Leaders
As a leader, Bethea also considers it her responsibility to help cultivate and mentor other leaders. She thinks back to a former mentor at Genesis Healthcare, Marie Quinn, who once gave her some valuable encouragement before an anxiety-inducing presentation to senior executives.
“She said, ‘There’s no one better positioned to present this information than you,’” Bethea recalled. “‘If you go in the room and present as if you are uncomfortable or not confident, then people will receive it that way. But if you go into the room and present this information based on your own experience, the research that you’ve done that you’re confident about, people will walk away from that meeting understanding that you are the person that they need to go to with any questions; that you are the most knowledgeable person on this issue.’”
The pep talk was a game changer. Not only did it inform the presentation she was about to give, it stuck with her throughout every meeting she’s walked into since. “It’s something that I share with other people,” she said. “When I’m doing leadership presentations, I tell them about that experience, because it was so powerful and impactful for me.”
‘It Warms Your Heart’
Despite the challenges ahead, Bethea is looking forward to the future. She’s especially excited about the potential for new technology, such as wearable health trackers and AI solutions, to transform the assisted living space, making care workers’ lives easier and improving patient outcomes.
“Obviously we need the human touch; it’s a vital part of what we do,” she stressed. “But there are ways that we can complement the staff to be more efficient, and we can do that with AI. I’ve been visiting communities around the country and seeing some of the things that they’re doing, and it’s extremely exciting. We’re just scratching the surface of how technology will help us support our existing workers in our field.”
And, of course, she’s excited to continue doing her favorite part of the job: traveling the country and meeting the people she represents. “When you go into the communities and the nurses and the nurse aides and the other caregivers, like the environmental service and the housekeeping workers—when you see how they engage the residents, it warms your heart,” she concluded. “You can envision your own mom and dad there, enjoying themselves and having the best part of their life being in this community.”
Steve Manning is a freelance writer from New York City.