For close to a decade, Helen Garland took care of her older sister: giving her a home, doing her shopping, fixing her meals and snacks. Alice Keyho liked hot chocolate and the grilled cheese sandwiches her sister made by toasting the bread first and then using the microwave to melt the cheese.

On March 19, 2004, Garland served her 85-year-old sister a double order of oatmeal for breakfast, and gravy-topped hamburger and onions with leftover mashed potatoes for lunch.

But in the midst of their mundane routine that day, something terrible happened.

Authorities say Garland broke 22 of Keyho's ribs and backhanded her so hard the imprints of her rings were left in her sister's face. An autopsy also revealed bleeding between Keyho's brain and skull and rug burns along her back from being dragged across the floor after she died.

Garland, 75, was charged with second-degree murder, but her trial has been delayed over questions about her competency. She has shown signs of dementia and will be evaluated. In the meantime, she continues to live in the small blue ranch-style home she shared with her sister.

Through her lawyer, Garland declined to be interviewed for this article. But in transcripts of her interviews with police, she describes her relationship with her sister and their last days together.

Keyho first came to live with her widowed sister when one of their brothers died. After seven years in Hampton, she moved in with another brother for two years, then returned to Garland's home 10 months before her death.

"They just came and dropped her off to me, you know? They didn't even tell me they were going to do it," Garland told police. "She didn't stop to think that I owned this house, that she had nothing to do with it. She was just here."

They settled in together, but relations were not always smooth.

"I tried to do everything for my sister, without a doubt. But sometimes she really aggravated me, so I put on my coat, got in my car and left," Garland said. "She made me mad all the time, but I learned to control."

That scenario isn't surprising, said Stephen Read, a Los Angeles psychiatrist who specializes in geriatrics and has served as medical director of a nursing home dedicated to dementia patients.

"Having sisters not be best friends is not that uncommon, but it's a very small percentage of those impulses that lead to assault, much less fatal assault," he said.

Elder abuse by siblings accounts for just 1.8 percent of elder abuse cases nationwide, according to the National Center on Elder Abuse. In most cases, the abuser is the spouse or an adult child of the victim.

Keyho herself never got angry, Garland said. She described her sister as carefree and generous but also said she was stubborn and insisted on having the last word.

"Even at home when I was little. She was always in trouble with my father because no matter what he said to her, she gave him back talk. And she'd whisper it under her breath thinking he didn't hear it, and he'd hear it," she said.

Keyho also liked to gossip and eavesdrop on her sister's phone conversations, Garland said.

"Yet," she added, "she'd give you her right arm. I mean, she was very generous."

Though Keyho had health problems all her life, including "epileptic fits" that eventually went away, Garland said her sister hadn't seen a doctor in decades. By the time she moved in with Garland, Keyho had trouble walking, though it's not clear why, and her frequent falls were a source of frustration for her sister.

"She's going to get up and then she falls and hits her head on the wall or hits her head on the framework or whatever, so I don't know what you can do with somebody like that," she said.

A longtime friend told the Hampton Union that Keyho used to walk everywhere, stopping to chat with people she met along the way. But in Hampton, one neighbor who moved in two years ago said he didn't even know Keyho lived with Garland because he never saw her outside.

"I never knew a second woman lived in the house. I always thought it was just Helen," said Todd Bucci, who lives across the street.

Garland told police the sisters passed their days according to a strict routine. Garland got up at 7 a.m. and made sure Keyho awoke soon after so that the breakfast dishes could be cleared by 8:30 a.m. Both women did housework until noon, followed by lunch.

"She would get up in the morning and have her breakfast and then she was working. She was dusting or vacuuming or something," Garland said. "And she shined all my silver. She loved to stand there and shine silver because she could watch everybody out the window."

Dinner was at 5, and Keyho usually went to bed by 8 p.m. Garland stayed up later, especially if the Boston Bruins hockey team had a game on TV.

Garland, who retired from a banking career in 1991, also kept busy away from home. She sang in the church choir and belonged to several civic groups. Two days before Keyho's death, she joined other members of the Oceanside Grange to deliver dictionaries to third-graders.

"It's heartbreaking to have someone like Helen, who's been a completely law-abiding citizen her whole life, spend her waning years in the grips of a criminal trial," said Garland's lawyer, Barbara Keshen. "It's really hard."

Keshen describes her client as vulnerable and unfocused, saying Garland has the intelligence to stand trial but probably wouldn't be able to handle the stress. She believes police coerced Garland into making derogatory statements about her sister to bolster their case and implied they'd be lenient if she confessed.

"You start with a woman who is probably not fully psychologically and mentally there to begin with, and you have hours and hours and hours of police questioning," she said.

The attorney suggested an exhausted Garland "simply adopted the police language" for what happened.

Early in the police interviews, Garland said she left Keyho sitting in the breezeway between the house and garage on the night of March 20 and found her dead the next morning, when she called 911. But gradually, her story changed: After insisting she had never hit Keyho, she said she sometimes did, but not that weekend.

"For any one thing she did I might just hit her with the back of my hand," she said. "As long as she got the message, that would be all I'd do is hit her."

Eventually, she acknowledged backhanding Keyho three or four times on March 18 and 19 and "giving her a boot" with the side of her foot.

"I struck her because she gave me back talk," Garland said.

After lunch on the 19th, Garland said she went to the store to get some milk. When she got home, she found her sister in the dining room.

"I was upset because when she fell into the hutch she knocked two of my crystal pieces on top of the thing together and I heard them smash," she said. "I haven't had the heart to open it up to see if any of my bone china is broken."

Finally, the detective asked: "Did you kill your sister by accident? Did you kill her because of a serious accident?"

Garland answered, "I would say yes."

Prosecutors agree that Garland shows some signs of age-related dementia but will have her reevaluated to see if medication helps. If she remains incompetent, prosecutors could have her committed to the state psychiatric hospital if they can prove she is a danger to herself or others. Otherwise, she'll remain free.

That scenario raises some troubling issues, said Read, the Los Angeles psychiatrist.

If Garland has a progressive form of dementia and eventually could not live alone, authorities would face a dilemma, especially if no family could care for her. Neither sister had children; they had two nieces and a nephew.

"If you run a nice place for little old ladies with Alzheimer's disease, this isn't someone you necessarily want to take a chance on," Read said.

For now, Garland remains at her home where, on a recent day, lace curtains covered the windows and a pink sweater dangled from the clothesline.

Bucci, the neighbor, said most of the street's residents are elderly, though a few young families have moved in recently. He said he doesn't see Garland much anymore, but she's pleasant when he waves or says hello.

"Nothing's changed," he said. "She keeps to herself, more so now because she doesn't want the attention. . . . No one's scared of her."

"Let her live there," he added. "It's terrible, but she's already almost a prisoner."

Helen Garland is accused of killing her 85-year-old sister.