I offer to help with shower, etc, and he says later about everything.

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"I've had the space heater in the bathroom and it is nice and cozy in there. I have a basin of warm soapy water and some rinse water in the sink. The towels have just come out of the drier, so they will be warm, too. Come in there now, and I'll help you clean up."

Is it possible your friend would do better with a bath aide coming in every few days?

Also, I'd think about how important it is for him to live up to your hygiene standards. Being spotlessly clean every day is not going to cure his cancer or give him more days to live. Is his hygiene so poor that his skin is breaking down or getting sore? Is he incontinent? Do try to help him avoid health consequences of poor hygiene, but perhaps you could relax about matters that aren't really posing a health problem.
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Dear Malvin,

Good of you to want to help. This patient could be just tired or embarrassed about getting help with these personal hygiene needs. I would try to enlist family and friends to talk with him or her and try to get to the root of the issue.
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