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                                                                   EXHIBIT 10.33
 
                                 AMENDMENT TO

                     MASTER PHARMACY CONSULTING AGREEMENT

     AGREEMENT made and entered into as of the 19th day of September 1997 by and
between Vitalink Pharmacy Services, Inc. ("Vitalink") and ManorCare Health
Services, Inc. ("MCHS").

     WHEREAS, Vitalink and MCHS have previously entered into that certain Master
Pharmacy Consulting Agreement dated June 1, 1991 (the "Agreement"); and

     WHEREAS, Vitalink and MCHS desire to amend the Agreement.

     NOW, THEREFORE, in consideration of the mutual covenants herein, and other
good and sufficient consideration, receipt of which is acknowledged, the parties
agree as follows:

     1.   Section 1 of the Agreement is replaced in its entirety by the 
          following new Section 1:

          1. TERM. The term of this Agreement shall be from June 1, 1991 to
          September 30, 2002. At each October 1 during the remaining period of
          this Agreement, the term shall automatically renew for an additional
          one (1) year period unless either party notifies the other party of
          its intent not to renew no later than ninety (90) days prior to each
          such October 1.

     2.   Section 5 of the Agreement shall be amended by adding the additional
          following language:

               Effective June 1, 2001, for each Facility Consultant Pharmacy
          Services Agreement MCHS shall compensate Vitalink based upon
          prevailing market rates for each Facility. "Market rate" shall be
          defined as those within the fiftieth percentile (50%) of charges paid
          by similar licensed non-MCHS facilities that receive similar services
          from Vitalink. MCHS shall be allowed to audit Vitalink's books and
          records to verify market rates.

     3.   Each Facility Consultant Pharmacy Services Agreement for the 
          Facilities shall be deemed to have been amended consistently with the
          terms, conditions and obligations contained herein.

     4.   Except as specifically provided herein, the Agreement remains in full 
          force and effect.
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     IN WITNESS WHEREOF, the parties enter into this Agreement on the date first
above written.

                                       VITALINK PHARMACY SERVICES, INC.



ATTEST: /s/ Robert W. Horner III       By: /s/ Donna L. DeNardo             
        ------------------------           --------------------------------
          Secretary
                                       Title: President                        
                                              -----------------------------     

                                       MANORCARE HEALTH SERVICES, INC.




ATTEST: /s/ K. Peter Kemezys           By: /s/ James H. Rempe              
        ------------------------           --------------------------------
          Assistant Secretary
                                       Title: Senior VP                    
                                              -----------------------------