This paper examines perceptions of homeliness in palliative care environments through a photo-elicitation study involving 89 palliative care staff. The study finds that what is perceived as homely tends to exhibit a mutually exclusive relationship with a clinical antithesis. It also finds that antonymous or antithetical understandings of homeliness are as common as those based on actual attributes of homeliness. It is argued that a more nuanced understanding of the spatial and material constituents of homeliness is needed to make it a more realistic objective within the design and procurement of healthcare environments. It is also argued that the inverse relationship of homely and clinical environmental qualities could be translated into a design approach that aims to negotiate rather than negate their apparent mutual incompatibility.