Last week, 86-year-old Alzheimer's patient Dora Parry died after tumbling down a flight of stairs while strapped into her wheelchair at a nursing home in Victoria, B.C.
Her son Richard Dickie has a lot of questions about what happened at Mount Edwards Court Care Home.
"They heard a noise, somebody investigated, and found my mother dead," he told CTV News.
"There's been nothing expressed to me as to what could have happened."
Those who run the facility call Parry's death tragic and unexplainable -- to access the area where she was found, she would have had to open a secure steel fire door.
"(It) requires two simultaneous actions to open the door -- the push of a button with the turn of a handle -- and it's designed to protect residents who have dementia," said Marc Kinna, chief operating officer for Baptist Housing.
"In our 46-year history, no one can recall an incident of this magnitude happening in any of our communities of care."
But only two years ago, in Kamloops, Juliette Bombardier froze to death after getting past a similar door in a care home run by a different company.
In the Parry case, the coroner and police are investigating.
And Dickie wants to warn other families whose loved ones live in care homes.
"They're not as safe and secure as you might expect. They aren't," he said.
"When you pass away falling in a wheelchair falling down a stairwell, there's got to be a moment…of stark terror, and it just bothers me immensely.
With a report from CTV British Columbia's Sarah Galashan
