How do immobile people go to the toilet?

This guide is for families and carers looking after someone who cannot get up, stand or walk without full help, whether after a stroke, through a progressive condition, frailty in later life, or a lifelong disability.

If the person can still stand for a moment or shuffle a few steps, the equipment options are often simpler. Our separate guide on what can be used if a person is unable to walk to the toilet compares commodes, urinals, toilet frames and raised seats in detail. Here we focus on the methods used when someone cannot move independently at all.

Every person is different. Please check with the person's GP, district nurse or occupational therapist (OT) before changing how they go to the toilet, as they can assess what is safe and arrange the right equipment.

Getting to the toilet or commode with a hoist

For many people who cannot weight bear, a hoist is the safest way to move from a bed or chair to a commode or toilet. It protects the person from falls and protects the carer's back.

Mobile hoists and ceiling track hoists

A mobile hoist sits on wheels and is pushed between rooms. It needs clear floor space to turn and does not work well on thick carpets or in tight bathrooms. A ceiling track hoist runs along a rail fixed to the ceiling, sometimes from the bedroom straight into the bathroom. It takes up no floor space and is often easier to use in a small room, but it needs installing and the ceiling has to be strong enough to take it.

Slings for toileting

Some slings are designed with an opening so clothing can be adjusted and the person can sit over a commode or toilet while still in the sling. The OT or moving and handling team will choose the right sling and size, and show carers how to fit it. Never swap slings between people or use one that does not match the hoist.

A typical hoisted toilet visit

1. Explain what is happening and check the person is ready.
2. Position the commode or wheeled shower commode chair, with brakes on.
3. Fit the sling, attach it to the hoist and lift slowly, keeping the person covered where possible.
4. Lower them onto the seat, then give them privacy if it is safe to do so, with a way to call you back.
5. Help with wiping and washing as needed, check the skin, then hoist back to the bed or chair.

The person's care plan will say how many carers are needed for each transfer. Follow it, even when you are in a hurry.

Going to the toilet in bed

When someone cannot be moved out of bed, or a transfer would be too tiring or painful, toileting happens in bed.

Bedpans and slipper pans

A bedpan is placed under the person while they lie on their back or are rolled gently onto it. A slipper pan is flatter at one end, which makes it easier for people who cannot lift their hips. Raising the head of the bed slightly, if allowed, and having wipes, a towel and a cover ready all help.

Urinals

Handheld urinals come in designs for men and women and can be used lying down or sitting up. Keeping one within reach can give someone back a little control, particularly at night.

Catheters

Some people have a catheter to drain urine, either one that stays in place or one used several times a day. Whether a catheter is suitable is a medical decision made by the NHS team caring for the person. District nurses usually manage catheter care at home and can show carers what to do.

Continence products and NHS continence services

Pads, pull-up pants and bed protection can give security when getting to the toilet in time is not always possible. They work best as a back up rather than a replacement for going to the toilet when that can be made to happen.

In Scotland, continence services are available through the NHS. Ask the person's GP or district nurse for a referral. A continence assessment looks at the cause of the problem, what might improve it, and which products suit the person. It is worth asking before buying products privately, as the right size and absorbency make a big difference to comfort and skin health.

Skin care, dignity and support for carers

Skin care

People who spend most of their time in bed or a chair are at higher risk of pressure damage, and moisture from urine or faeces makes the skin more fragile. After each toilet visit:

• Clean gently with warm water or a soap substitute rather than harsh soaps.
• Pat the skin dry instead of rubbing.
• Check for redness, soreness or broken skin, especially over the bottom, hips and heels.
• Use barrier creams only as advised by the district nurse.

Report any skin that stays red or starts to break down to the district nurse or GP promptly.

Dignity

Needing help with the toilet can feel very exposing. Small things help a lot:

• Talk the person through what you are doing and ask before you help.
• Keep them covered as much as possible and close doors and curtains.
• Let them do any part they can, even if it takes longer.
• Respect preferences, for example about who helps them or when.
• Keep the tone matter of fact and kind. Avoid baby language or rushing.

Our guide on how disabled people use the bathroom covers transfers and independence for people with a wider range of abilities.

Looking after yourself as a carer

Helping with the toilet several times a day and night is physically and emotionally demanding, and you do not have to manage alone. Ask for moving and handling training, ask the council about a carer support plan and whether paid carers could cover some visits, and talk to the district nurse if night time toileting is wearing you down.

A bathroom that works with a hoist

Often the bathroom, not the person, is the real barrier. A standard bathroom with a bath, a narrow door and a toilet tucked into a corner is very hard to use with a hoist or a shower commode chair.

• Level floor throughout: a wheeled shower commode chair can roll from the toilet straight into the shower.
• Space around the toilet: room on at least one side, ideally both, for a carer to help and for side transfers. Scottish guidance for public accessible toilets uses a clear space of at least 1.5m by 1.5m, which is a useful benchmark at home.
• A wall-hung toilet at the right height: it can be set to suit the person and makes cleaning underneath easy.
• A shower area that drains well: Scottish guidance for accessible showers suggests a level drainage area of at least 1.2m by 1.2m.
• A route for a ceiling hoist: planning the track before the bathroom is built avoids awkward changes later.

A disabled wet room is often the best fit for hoist users because the whole floor is level and waterproof. Our own team handles the plumbing, electrics, joinery and flooring, and many installations take as little as 3 days, which matters when someone still needs a working toilet.

Funding the work

In Scotland, the council's Scheme of Assistance must give a grant of at least 80% of the eligible cost to adapt a home so a disabled person can use a toilet, bath or shower, or 100% for people on certain benefits. You will usually need an OT assessment first, arranged through the council or Health and Social Care Partnership. Equipment such as hoists, commodes and shower chairs is usually provided separately through the same route, often on free loan.

Going out: Changing Places toilets

A standard accessible toilet is not enough for someone who needs a hoist and a changing bench. Changing Places toilets are designed for this. They include a height-adjustable adult changing bench, a ceiling track hoist, a toilet with space on both sides and room for up to two assistants. In Scotland, the guidance asks for a room of at least 3m by 4m.

They are now required in certain new large buildings, such as big shopping centres, venues and hospitals, but they are still far from everywhere. Check before a day out where the nearest one is. Our guide to the rules for disabled toilets in the UK explains the different types of public toilet and how to raise a problem.

Frequently asked questions

Sources

• Scottish Government: Building standards technical handbook 2022 non-domestic, 3.12 sanitary facilities
• Citizens Advice Scotland: Housing grants and loans
• Scottish Government: Funding adaptations to the home, a guide for homeowners