Earlier in the finale show, Ketterer was revealed as the fifth act in the top five, edging out Courtney Hadwin. In the next set of results, it was revealed that Ketterer had finished in fifth place. Cowell spoke to Ketterer over a backdrop of surprised murmurs from the crowd, reassuring him, "You and I are going to continue this relationship, you have been an absolute star." Ketterer walked off the stage with a smile on his face and his arms raised in celebration.
In the package before his final performance in the competition, Ketterer walked into a room where a video was waiting for him. When the video started, he was met with a montage of family, friends, patients, and the family of former patients describing how he has impacted their lives, ending with a heartfelt message from his son. An emotional Ketterer finished the competition with a soulful performance of "Ain't No Mountain High Enough."
In the semifinal round, Cowell urged Garth Brooks to write a song for Ketterer. The result was the song "The Courage to Love," which Ketterer performed on the season finale. After he was eliminated, Ketterer announced that he would perform the song with Brooks during a sold-out show at Notre Dame on October 20.
