Anna's sister Alex and her mother are dead due to the accidental boathouse fire and their ghosts are trying to warn Anna about this dangerous black widow woman known as Mildred Kemp. Mildred was a nurse/nanny who mudered the three children she took care of, to marry their father. According to Anna, Mildred changed her name to Rachel.
Rachel tried to marry Anna's father, who was unaware of the danger and the malicious intention of this woman. Anna also knew that the necklace that Rachel has is exactly identical to Mildred Kemp's necklace. Anna tried to warn her father but her father did not believe her, or believe in ghosts. Anna killed Matt because he knew what really happened on the night of the fire: Anna arrived home to find Rachel and her father having sex. Disgusted, she went to the boathouse to fill a watering can with gasoline so she could burn down the house. She did not shut off the faucet all the way, and when Alex arrived she knocked over a lantern. The boathouse exploded, killing Alex and her mother.
Anna was the one that finally stabbed Rachel to death and not Alex. Anna was arrested and institutionalized. The psychiatrist comes by to see Anna, and she tells him "I finished what I started," meaning to return home and kill Rachel. Standing in her room with pearls in her hand is another patient; the name on her door reads "Mildred Kemp." It turns out that Mildred Kemp was really a patient who gave Anna the pearls. She says "welcome home" to Anna who smiles back at her and the movie ends.
Rachel was really a nice person who had changed her last name to escape from her abusive ex. Anna was so unstable, she believes her sister Alex is alive. Since Anna 'finished what she started', we can assume she planned to kill Rachel from the start, and used the pearls her friend Mildred gave her, as well as the story she made up.
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