Stairs, stairlifts and moving a bed downstairs: the choices when the stairs get hard

The NHS page on falls lists the common causes: weaker muscles, conditions that affect balance such as arthritis, stroke and Parkinson's, low blood pressure, the side effects of medicines, eyesight or hearing problems, and dementia. Ask the GP for a falls assessment and a medicines review at the same time as you ask about the stairs. NHS inform's guide to hazards at home covers clutter, lighting and night-time trips, and Guy's and St Thomas' falls advice says not to leave rugs or mats at the top or bottom of the stairs.

If your relative has stopped going upstairs and there is no clear physical reason, read fear of falling before you decide anything. Doing less can make the legs weaker, and a stairlift will not fix that on its own. Climbing stairs is also good exercise for people who can still manage it safely, which is climbing stairs good for older people explains. The mobility and falls care guide covers why older people fall more widely.

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For somebody who can still climb but has started to hold the wall, a rail on the other side of the stairs gives both hands something to hold. The NHS guide to home adaptations gives a banister on the stairs as one of its examples. Lighting matters as much as the rail. Living Made Easy, the equipment information service that grew out of the Disabled Living Foundation, suggests a light switch at the top and bottom of the stairs, and plug-in night lights on the landing cost little. An occupational therapist can have a rail fitted by the council.

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A stairlift is a seat, or a perch for somebody who can stand but not climb, on a rail fixed to the stairs. Living Made Easy explains that straight rails are significantly cheaper than curved ones, that most stairlifts run on batteries so they still work in a power cut, and that a staircase needs to be about 740mm wide. It recommends an inspection every six months and a service every year. Reconditioned stairlifts are sold by authorised dealers with a warranty, and some suppliers rent them by the month. We give no prices here, because they depend on the staircase and the supplier and no government or consumer body publishes a figure we could check.

A stairlift only moves your relative between floors. They still have to walk to it, sit down, fasten the belt, and stand up safely at the top, which may be on a narrow landing. That is what the occupational therapist will watch for. If they cannot do those steps safely, a stairlift can add a risk rather than take one away.

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A through-floor lift is a small lift car that rises through an opening cut in the ceiling, usually from a living room into a bedroom above. Living Made Easy says it needs more space than a stairlift on both floors and involves alteration work to the house, and that a wheelchair user can travel in some models without having to transfer out of the chair.

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If the house has room, your relative can move their bed downstairs and use a commode or a downstairs toilet. It can be the lasting answer or a stopgap while a stairlift is fitted, and the next section covers it on its own.

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A bungalow, a ground-floor flat or housing built for older people removes the stairs altogether. It is also the largest change, because it means leaving a home and neighbours they know. Age UK's housing options guides describe the kinds of housing available. The decision is your relative's to make, and if money from a sale will also pay for care, speak to a regulated financial adviser first, because PrimeCarers cannot give financial advice.

Moving the bedroom downstairs can feel like a loss, even to somebody who agrees it is safer. The bedroom upstairs may be where they have slept for decades, and a bed in the living room can feel like being on show. Ask your relative what matters most to them: which room, which side of the bed, where their things go, and who comes in. Privacy and dignity for older people covers the wider principles, and bathing and toileting an elderly parent covers the practical side of a commode and a strip wash.

Loaned equipment comes through the council or the NHS community equipment service after an assessment. North Bristol NHS Trust, as one example, lists commodes, perching stools, toileting equipment and bed raisers among the items it lends without charge. Ask what your area can provide.

If your relative is coming home from hospital unable to manage the stairs, raise it with the ward team before the discharge date, because equipment has to be delivered and a bed may need moving. Leaving hospital: what to arrange has the fuller list. If the stairs are part of a recovery, a physiotherapist may be working towards getting your relative back upstairs, and physio at home explains how that works.

1. 1

   Ask the council for an assessment

   Today

   Ring adult social services at your relative's council, or apply online, and ask for an assessment for equipment or home adaptations. A GP, a hospital ward or a district nurse can also refer them. Say it is about the stairs and describe what you have seen.
2. 2

   An occupational therapist visits

   At home

   They watch your relative on the stairs, getting in and out of bed and using the toilet, and ask what has become hard. They recommend what would help, in order of priority.
3. 3

   Small items are fitted or loaned

   Free to your relative

   Rails, lighting changes and other minor adaptations costing £1,000 or less should be paid for by the council, whatever your relative's savings. Equipment such as a commode is loaned.
4. 4

   Bigger work goes through a grant

   Means tested

   A stairlift, a through-floor lift or a downstairs bedroom can come under a Disabled Facilities Grant, worth up to £30,000 in England. The council must decide within 6 months, and work started before approval may not be paid for.

You can contact the council yourself, by phone or online, so you do not have to wait for the GP. GOV.UK's needs assessment page finds your relative's council, and if day-to-day tasks as well as the stairs have become hard, ask for a care needs assessment at the same time. If you are told to wait, ask what you can safely do in the meantime, and whether a private occupational therapist's report would be accepted.

The legal basis for the free small items is the charging regulations, which say an adaptation is minor if it costs £1,000 or less, and the NHS guide says the council should pay for each one. The Disabled Facilities Grant is set out in full in our guide to home adaptations that reduce the need for care, including the means test and how to apply, so we will not repeat it here. GOV.UK lists a stairlift and an extension for a downstairs bedroom among the things the grant can pay for, and says a grant will not affect any benefits your relative gets.

Walking aids and how to choose explains how an aid is fitted and why the stairs may need a second one, and pendant alarms and sensors covers what to have in place in case of a fall.

Moving and handling is about equipment and technique, not strength. If your relative needs help to stand or to move between the bed, a chair and a commode, the occupational therapist or physiotherapist decides how it is done and with what, and transfers, hoists and two carers explains when a hoist or a second person is needed, and personal care for a larger person covers equipment rated for a higher body weight. PrimeCarers does not check carers' training or qualifications, so ask each carer about their experience with transfers and equipment yourself, and ask the occupational therapist to show them how your relative's equipment is used.

For a family who have moved a parent's bed downstairs and need help mornings and evenings, an hour at the start of the day and an hour at the end is a sensible place to start. Carers on PrimeCarers charge £18 to £25 an hour with our fee included, so two one-hour visits a day, seven days a week, at the typical £20 comes to £280 a week. Agencies charge £28 to £35 an hour, and what an hour of care costs sets the two side by side. When you are ready, you can search for carers near you and compare their rates. Every carer's identity, right to work and enhanced DBS on the Update Service are checked, and they are interviewed online, before they appear. Separately, every visit booked through PrimeCarers is insured, by the carer's own policy or by cover PrimeCarers arranges where they do not hold one.