Healthcare mistakes: 'I can't grieve for my mother'
Joan Johnson was 81 when she was receiving home care commissioned by the Northern Health and Social Care Trust.
In February 2015 she had two falls in the space of 48 hours while being raised in a device aimed at helping patients stand during care assistant visits.
A week later, Mrs Johnson died in hospital from a heart condition. The Northern Trust, initiated a Serious Adverse Incident (SAI) investigation.
The investigation took more than two years to complete and there were 18 drafts of the SAI report produced.
Mrs Johnson's family have criticised how the process was managed and the Northern Ireland Ombudsman is raising concerns about wider learning in the health service.