Background: Dysphagia is a common complication of stroke, and enteral feeding is often necessary. If present, cognitive impairment can complicate the process of reintroducing oral intake. There is limited evidence concerning the outcomes of enteral feeding with this particular patient group and decision-making can be challenging when considering long-term feeding options. Aims: To consolidate best practice and begin working towards developing a pathway for patients with cognitive impairment and dysphagia. Methods & Procedures: A survey was conducted among post-acute stroke units in Wales to determine current practices and identify variations in the management of this patients group. We invited all stroke rehabilitation units that were part of a stroke-specific pathway in Wales to participate (n = 9). Outcomes & Results: Of the seven units that provided data, we identified great variety in experience and practice. Conversion to oral intake varied from 21.3% to 81.8% and to eating and drinking with acknowledged risk varying from 0.0% to 66.7%. Only one centre had a pathway specifically tailored to cognitively impaired nasogastric (NG)-fed patients. Conclusions & Implications: This heterogeneity in practice and experience highlights a need to develop formal pathways for the weaning of NG feeding with these patients. Any variation in patient outcomes for those with both cognitive impairment and dysphagia compared with those unaffected need to be explored. We present a model pathway for conversion from NG feeding for patients with cognitive impairment. We also propose future work to develop a patient-centred evidence base to inform practice for patients with dysphagia and cognitive impairment post-stroke.