Where swallowing difficulties are chronic or progressive, or a patient is palliative, tube feeding is often not deemed appropriate. Instead, patients continue to eat and drink despite the risks of pneumonia and death. There is currently little evidence to guide clinical practice in this field often termed “risk feeding.” This qualitative study investigated staff, patient, and family member perceptions of risk feeding practices in one New Zealand hospital. Twenty-nine staff members and six patients and/or their family were interviewed. Thematic analysis revealed four global themes: supporting practice, communication, complexity of feeding decisions, and patient and family-centered care. Staff described limited education and organizational policy around risk feeding decisions. Communication was considered a major factor in the success. Feeding decisions are complex in the hospital environment. The themes identified in this study provide a foundation for hospital guideline development and implementation.