The true prevalence of home enteral nutrition (HEN) utilization is unclear and requires further study. HEN therapy has remained virtually unchanged for several decades. However, new trends in HEN are evolving; enteral nutrition is undergoing changes ranging from enteral feeding devices, ingredients used, practice innovations, and challenges with reimbursement. A 2006 Joint Commission call to action that reported 2 sentinel events related to misconnections set things into motion for the transition of enteral device connectors to become specific for enteral nutrition use, which will affect patients who receive HEN. Nutrition support clinicians are realizing that people fed enterally may also enjoy incorporating blended foods into their diets and may benefit from different nutrients and components (ie, phytonutrients, fiber, and prebiotics) present in natural foods, thereby resulting in the renaissance of food-based blenderized tube feedings. This article reviews HEN therapy data or the lack thereof, current practices, risks and benefits, future trends, and challenges with access devices, enteral feedings, and reimbursement. It also highlights areas where more research is needed, and it urges clinicians to get involved in legislative action or committees to facilitate improved processes and reimbursement for HEN.