Nana is actually an escapee from the local psych ward. Apparently, she drowned her two children.
Collectively, Nana and Pop Pop killed the real grandparents and likely the gal from the asylum who came to check on the couple when they didn’t show up to volunteer.
I’m actually not sure what they used to kill anyone, but likely their own hands or a combo with some kind of object.
They’re straight from the psych ward, having been put there for the deaths of their own children.