For ease of installation, I give this item 5 stars. Remove your standard toilet seat and bolts. Use the long bolts provided and sandwich this raiser between your own toilet seat and your toilet rim. *Note about this below! For ease of use, this model is superior - better than the rest because the size of the opening is ample, giving much better access for toileting, and it goes under a regular toilet seat, not on top of it, as many of these raisers do, so also, you can use your own toilet seat and close your toilet seat cover when not in use. *NOTE: Stability of this product is definitely an issue, but an easily remedied issue. Because the raiser is only secured to the toilet fixture using 2 long toilet seat bolts to replace your 2 regular toilet seat bolts, sandwiching the raiser between the toilet seat and the toilet rim, no matter how much you tighten the bolts, because they're at that farthest point at the back of the raiser and seat, both the raiser and the toilet seat will have a tendency to move from side to side at the front of the toilet. To remedy this, we applied a small length (2 or 3 inches) of 3M Dual-Lock Tape between the raiser and the toilet fixture's front rim to secure the raiser to the toilet rim. Now the raiser and toilet seat cannot move from side-to-side. The 3M Dual-Lock Tape is rather like Velcro, but instead of being cloth-like as Velcro is, 3M Dual-Lock is a two-part plastic locking tape with super-adhesive backing. It holds very firmly, but the two locked parts can be pulled apart for cleaning, and the tape itself, unlike Velcro, is non-porous plastic so it's easy to clean. This is installed in my friend's house, so I have never tried to clean her toilet using the seat-raiser, but I can't see any way to clean under the raiser or on the toilet rim without disassembling the whole thing, and that's where it will certainly need cleaning the most - under the raiser and on the toilet rim. This is a pretty fatal design flaw, in my opinion, but my friend needed something. I imagine something can be slipped between the raiser and the toilet rim to clean in between there, at least on a day-to-day basis, but I don't know what I'd use. Maybe a paint-stirring stick with a Clorox Disinfecting Wipe wrapped around the end, slipped between the raiser and toilet rim? Something like that could be tried. As for actually using the raiser, it serves its intended purpose very well. Once the front of the raiser is secured to the toilet fixture as I described with 3M Dual-Lock Tape, the seat is very secure and sturdy, the toilet seat is at a much more comfortable and accessible height, and the seat arms are very helpful. We tried the other toilet seat raiser that's available everywhere, and my friend couldn't use it because the opening wasn't large enough to give her the access she needed. My friend is very pleased to have this toilet seat raiser. It's not a "perfect" solution, but short of buying a higher toilet fixture, knowing what I know now, I wouldn't hesitate to choose this model again. I recommend it. Get some 3M Dual-Lock Tape, though. You'll need it!