The police, the National Supervisory Authority for Welfare and Health (Valvira) and the Regional State Administrative Agency are investigating the fatal assault in January of a 76-year-old woman, Vuokko, who was a client at a senior care home in southwest Finland, run by the private health care firm Pihlajalinna.
The elderly woman perished after an assault by another resident of the facility, according to Pihlajalinna officials.
Vuokko's son, Veijo Kujala, said that his mother's face was so swollen that he had a difficult time recognising her.
"That memory will be with me for the rest of my life," Kujala said about the tragedy that unfolded in early January at the privately-run senior home Setälänpiha in the southwestern town of Lieto.
"A neurologist explained that she suffered two cerebral haemorrhages and that there was hardly any hope," Kujala recalled.
His mother never regained consciousness and died in hospital a week after the assault.
Kujala said that not long after losing his mother, he ran into obstacles negotiating with the care facility after it sent him a bill claiming occupancy for the entire month of January, despite the fact she died at the beginning of the month.
Assault and aftermath
Setälänpiha specialises in care for seniors who require extra assistance. The facility is managed by Pihlajalinna, a private health firm which markets social and health care services across the country.
The night of the assault, Vuokko had participated in a evening prayer session in the facility's common room and then returned to a room that she apparently thought was hers.
Vuokko had recently moved to a different room and suffering from memory loss, she apparently went into the wrong room - one belonging to a male client, who'd also taken part in the evening prayer session.
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Staff had been monitoring the man when he was in the common room but reportedly let him return to his room on his own.
When he did, the man reportedly beat Vuokko so severely that she never recovered from her injuries.
A report issued by ambulance technicians who were called to the scene stated they saw that both of Vuokko's eyes were blackened with bruises and she had lumps on her head as well as bite marks on her right wrist. The hospital physician who cared for Vuokko confirmed the injuries resulted from an assault.
However, no one else witnessed the assault when it took place, though another female resident called on staff for help.
When they did go to the room, caregivers found Vuokko still conscious, lying on a bed. But shortly afterwards she began to show symptoms of paralysis.
Local police are investigating the incident as aggravated assault and homicide.
Risk loomed for months
According to information obtained by Yle's investigative team MOT, staff had been worried for several months about the male client suspected of the attack, believing he was a serious threat to other clients at the home.
The suspect was younger than the other clients at the home - as well as heavily-built. During mealtimes, staff placed him facing a wall because he was occasionally provoked by the other clients - none of whom were permitted to sit at the same table as him.
The man had previously been prevented by staff from assaulting other residents. Some neurological illnesses and disorders are known to cause aggressive behaviour.
Facility staff said the man's behaviour was exceptionally erratic and threatening. Some said they thought the man had been placed at the wrong facility and that it was difficult to adequately monitor him.
Facility's board, city aware of risk before assault
According to information obtained by Yle, the care facility's board had been aware for some time about the danger the man potentially posed. The city of neighbouring Turku was also aware of the situation.
Pihlajalinna's southwestern Finland district chief, Paula Arvilommi, said she could not comment about the January incident due to the ongoing police investigation, but said that staffing at the Setälänpiha facility was adequate and competent.
"We at Pihlajalinna are extremely shocked and regret what occurred," she said.
"Clients cared for at care facilities providing enhanced services face behavioural challenges. Specialised staff at such facilities [regularly] face various behavioural disorders [of clients] and it is part of their special expertise," Arvilommi said.
The January assault has prompted changes at Pihlajalinna's operations across the southwestern region, according to Arvilommi.
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Now, all unit chiefs at the company's enhanced service units receive extra support from a specialist physician when making decisions with municipal social workers about a client's care. Also, the rooms of clients have been equipped with alert systems that notify staff when their doors are opened.
"They are used as needed - with permission - and for particularly weighty reasons," the region chief explained.
Arvilommi said Pihlajalinna is taking the incident "extremely seriously."
"The entire management team is aware of the incident. If there are ways we can change so that things like this do not occur in the future, we of course will change them," she said.
City of Turku asks for inquest
"We have presented materials to officials and we are doing everything in order to determine how this could have occurred," Arvilommi said.
Turku officials said they would not directly comment about the assault, citing patient privacy and the ongoing police probe.
The director of Turku's welfare sector, Riitta Liuksa, said the city has requested an inquest into the Pihlajalinna incident.
"It is clear that we do everything we can to find the appropriate care facility that suits each client - to a unit that is able to carry out its duties," Liuksa said.
Southwest Finland's Regional State Administrative Agency is also looking into the Setälänpiha unit.
Among other matters, the agency is reviewing how clients are monitored at the facility - as well as staffing levels. The agency said it also wants to know how and why the assailant was placed at Setälänpiha in the first place.
Police have also called on Valvira, the National Supervisory Authority for Welfare and Health, for its opinion about the case, but that investigation has only just begun.
Son gets bill for full rent, despite client's death
Vuokko's son said he has been trying to get to the bottom of the reasons for his mother's violent, fatal assault and said that so far, he's not received a satisfactory answer from the company charged with her care.
He said that the assault case has been bouncing between the police, Valvira and the administrative agency and that nothing seems to be going forward.
"It has been two months and everything's just only started. If you kill someone on a market square, the police are quick to sort it out. If you do the same thing at a care facility, it seems it doesn't interest anyone at all," Kujala said.
At the end of January Kujala received a call from the care facility about his mother's rental contract, informing him that there was a minimum one-month notification period on the agreement.
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"They called from the care home and demanded rent for the whole month. I answered them that they should have kept my mother alive. Then I would have gladly paid. They have no nuance at all. In the end we agreed that due to "the special circumstances," the amount of rent due was only for the actual days of care [that she received]," Kujala said.
However, Kujala said that he received a bill for the entire month, anyway. After a long series of emails and several phone calls he said that the rent was paid.
Pihlajalinna's district chief Arvilommi said the billing matter was a question of regrettable human error.
Vuokko's funeral was held in mid-February in Turku, according to her son.
"It seems unreal that the assault took place at a care home that I thought was safe. It has been an anxiety-filled experience for mum's relatives," Kujala said.
