Registered nurses’ (RNs’) perceptions and understanding of the health problems and care needs of patients with chronic obstructive pulmonary disease (COPD) play a crucial role in the quality and continuity of care. This qualitative multiple-case study aimed to explore how RNs identify patients’ problems and care needs during home visits to older adults with COPD. In addition, the study explored the agreement and disagreement between RNs’ and patients’ perceptions and priorities regarding problems and needs. The study followed consolidated criteria for reporting qualitative research (COREQ). Data were collected through observations of five home care visits, interviews with RNs, and mapping forms administered to both RNs and patients. Deductive content analysis of five cases revealed that RNs identified the patients’ problems through observation, dialogue, and direct questions during home visits. RNs and patients had different perceptions of the patients’ problems and care needs, particularly regarding psychosocial and communication-related issues. This knowledge contributes to improvements in patient safety in COPD care.