Independence, Safety, and Well-Being: A Mixed-Methods Study on Self-Set Care Goals of Home Care Clients With Dementia

Background: The number of people with dementia is increasing, and many are living at home longer and receiving care there. However, little is known about their participation in their own care. Aim: This mixed-methods study examined the extent to which home care clients with dementia participated in setting care goals during routine Resident Assessment Instrument (RAI) assessments and how cognitive functioning relates to the number and types of documented care goals. Methods: We analyzed RAI data collected in 2023 from Finnish home care clients aged 65 or older who participated in their own RAI assessment (N = 38 901), of whom 41% (n = 16 058) had a dementia diagnosis. We used descriptive statistics to examine the relationship between cognitive functioning and the number of goals set, and a qualitative content analysis on the goal descriptions (n = 321). Results: The results showed that people with dementia had documented care goals less frequently than those without dementia. Among home care clients with dementia, 60% (n = 9655) had set at least one goal. Goal setting was more common among those with higher cognitive functioning and declined progressively as cognitive functioning deteriorated. Three main categories characterized the content of goals: (1) maintaining independence, (2) ensuring care and safety, and (3) supporting daily well-being. Regardless of cognitive level, goals related to maintaining independence were the most common. Conclusion: Maintaining independence remained a key priority across cognitive levels, underscoring the need to identify and document goals in person-centered dementia care.