A man in his eighties is recovering well in an intermediate care bed. He's walking with a frame, sleeping better and keen to get home. On the unit, he manages the toilet without help. The team is confident.
Then he gets home. His toilet is lower than the one he's been using. The only thing within reach to push up on is a towel rail, and there's barely room to turn his frame. By the second evening, his daughter is calling for help.
Nothing went wrong with his care. The bathroom he practised in just wasn't the bathroom he went home to.
The short answer: in intermediate care and discharge-to-assess settings, the bathroom is part of the assessment. The closer a person's toileting practice matches their home set-up (toilet height, which side any support sits on, and space to turn), the more useful that practice is. Height-adjustable toilets let staff recreate the height of a person's own toilet. Add-on equipment like seat risers, rails and toilet lifts lets them test what might be needed at home before discharge, not after.
Why this setting is different
Intermediate care sits between hospital and home. It might be a short stay in a community hospital, a step-down bed in a care home, or support delivered in the person's own home. In discharge-to-assess models, people leave hospital once they no longer need acute care, and staff assess their longer-term needs outside the ward.
Whatever the model, stays are short, turnover is high and the goal is clear: get the person home safely and help them stay there. That gives the bathroom a specific job. It isn't just somewhere to go to the toilet. It's one of the places where the team finds out whether home will work.
Recreating the bathroom they're going home to
The most useful piece of information is often the simplest: what does the person's bathroom at home actually look like?
A short "home bathroom snapshot", completed with the person or their family early in the stay, can capture most of what matters:
- Toilet seat height, measured from the floor to the top of the seat
- Which side of the toilet has a wall, and whether there's anything solid to hold
- The space in front of and beside the toilet, especially if they use a frame or wheelchair
- Which way the door opens, and whether it would block someone who fell
- Basin height, and whether they could sit to wash
- Any existing aids, such as rails, a raised seat or a toilet frame
Families are usually happy to measure, and a photo on a phone can tell the team a great deal. Our 5-minute bathroom accessibility audit is a handy guide to share with them.
With that information, a rise and fall toilet on the unit can be set to the height of the toilet at home. If the person can stand from that height, the team knows something real. If they can't, it knows exactly how much help they'll need.
Testing the solution before it goes home
Once the team knows where the difficulty lies, the next question is what would fix it at home. Intermediate care is the ideal place to try the options.
Most home solutions fall into a few categories, which we compare in our guide to the difference between a seat riser, a lifting toilet seat and a rise & fall WC:
A little extra height. For many people, a modest lift is enough. A 50mm toilet seat riser fitted to a standard toilet on the unit shows whether that small change makes standing manageable. Our article on the 50mm seat riser explains who it tends to suit.
Height plus something to push on. Where there's no wall to lean on at home, a seat riser with built-in support rails provides support on both sides without drilling into anything. The team can see whether the person uses the rails well before recommending them.
Powered help to sit and stand. Some people can manage with a lift doing the hard part of the movement. The Wash-Able Toilet Elevator fits over an existing toilet, so it can go into a home bathroom without replacing the toilet. We've written about how a toilet lift can avoid a full bathroom renovation.
Trying these on the unit gives the person a chance to say what feels right, and gives the team evidence for any recommendation they pass on.
Making the most of short stays
With people coming and going quickly, bathroom equipment needs to reset easily between them. An adjustable toilet can be changed to the next person's home height in moments, where a unit with fixed toilets and a cupboard of loose raised seats struggles to keep up.
It also helps to keep the approach consistent. When nurses, therapists and support workers all know the person's home toilet height and the aim of their practice, every toilet visit becomes a useful part of the stay. The same principle of recording the set height applies here as in rehabilitation units.
For step-down beds within care homes, the practical points in our guide to specifying rise and fall toilets in care homes apply too.
Bringing the family in
Families often feel shut out of discharge planning until the last minute. The bathroom gives them a practical way to help.
Measuring the toilet, photographing the room and fitting simple equipment before discharge are all tasks family members are usually glad to take on. Share our guides to planning an accessible bathroom for hospital discharge and why a temporary set-up helps in the first 12 weeks. They explain what to do in plain terms and why it matters.
Where longer-term adaptations may be needed, families will also want to know how the home assessment process works. Our article on how to get an occupational therapy assessment for bathroom aids is a useful starting point.
Frequently asked questions
What does discharge to assess mean?
Discharge to assess is an approach where people leave hospital once they no longer need acute care, and their ongoing needs are assessed at home or in a community setting rather than on a hospital ward. The idea is that it's easier to judge what support someone needs in surroundings closer to their everyday life. How it works in practice varies between areas.
What bathroom equipment might someone need after leaving hospital?
It depends on what they find difficult. Common options include a toilet seat riser to add a little height, a riser with support rails where there's nothing to hold, a powered toilet lift for people who need help to sit and stand, and grab rails beside the toilet or basin. An occupational therapist can advise on what suits an individual.
How do I measure the height of a toilet?
Measure from the floor to the top of the toilet seat with the seat down. Most standard toilets in UK homes sit lower than many people recovering from illness or surgery find comfortable, so this one measurement is often the most useful thing to share with a care team before discharge.
Talk to us about your intermediate care service
If you run intermediate care, step-down beds or a community rehab service, we'd be glad to help you think through bathroom equipment that reflects the homes your patients are returning to. Call us on 01745 346226 or send us your project details, including the type of service you run and how many bathrooms you're looking at.
