EXHIBIT 10.4

                                 THIRD AMENDMENT
                                       TO
                              EMPLOYMENT AGREEMENT

                 This  Third  Amendment  to  Employment  Agreement,  dated as of
August 1, 2000 (the  "Amendment"),  is by and between  NATIONAL HOME HEALTH CARE
CORP.,  a  Delaware  corporation  having an address  at 700 White  Plains  Road,
Scarsdale,  New York 10583 (the  "Company")  and STEVEN  FIALKOW,  an individual
having an  address  at 700 White  Plains  Road,  Scarsdale,  New York 10583 (the
"Employee").

                 WHEREAS,  the  Company  and  the  Employee  are  parties  to an
Employment Agreement dated as of November 1, 1997 (the "Agreement"),  as amended
by a  First  Amendment  thereto  dated  as  of  December  1,  1998  (the  "First
Amendment")  and a Second  Amendment  thereto  dated as of  October 7, 1999 (the
"Second Amendment"); and

                 WHEREAS,  the  Company  and the  Employee  desire  to amend the
Agreement in certain respects.

                 NOW,  THEREFORE,  in  consideration  of the  foregoing  and the
mutual covenants and conditions  hereinafter set forth, the parties hereby agree
as follows:

         1. Amendment to the Agreement.  The Agreement hereby is further amended
effective as of the date hereof such that  "$230,000"  contained in Section 5(a)
therein pursuant to the First Amendment is changed to "$265,000."

         2. Agreement to Continue as Amended.  Except as modified and amended by
the First Amendment,  the Second Amendment and by this Amendment,  the Agreement
shall remain and continue in full force and effect after the date hereof.

         3.   Applicable  Law.  This  Amendment  shall  be  negotiated  and  the
transactions contemplated hereby consummated and fully performed in the State of
New York and shall be governed by and construed in  accordance  with the laws of
the State of New York,  without  regard to the  conflicts of law rules  thereof.
Nothing  contained  in this  Amendment  shall be  construed so as to require the
commission  of any act  contrary  to law,  and  whenever  there is any  conflict
between any provision of this Amendment and any statute,  law, ordinance,  order
or  regulation,  contrary  to which the  parties  hereto  have no legal right to
contract,  the latter  shall  prevail,  but in such event any  provision of this
Amendment  so  affected  shall  be  curtailed  and  limited  only to the  extent
necessary to bring it within the legal requirements.


<PAGE>

         4.  Jurisdiction  and Venue. It is hereby  irrevocably  agreed that all
disputes or  controversies  between the Company and the Employee arising out of,
in connection  with or relating to this Amendment  shall be  exclusively  heard,
settled and determined by arbitration to be held in the City of New York, County
of New York, in accordance with the Commercial Arbitration Rules of the American
Arbitration Association to be conducted before a single arbitrator, who shall be
either an attorney or retired judge licensed to practice law in the State of New
York.  The parties also agree that  judgment may be entered on the  arbitrator's
award by any court having  jurisdiction  thereof and the parties  consent to the
jurisdiction  of any court  located in the City of New York,  County of New York
for this purpose.

         5. Full Understanding. The Employee represents and agrees that he fully
understands  his right to discuss all aspects of this Amendment with his private
attorney;  that to the extent,  if any, that he desired,  he availed  himself of
this  right;  that  he has  carefully  read  and  fully  understands  all of the
provisions of this  Amendment;  that he is competent to execute this  Amendment;
that his  agreement  to execute  this  Amendment  has not been  obtained  by any
duress,  and that he freely and voluntarily enters into it; and that he has read
this  document in its entirety  and fully  understands  the meaning,  intent and
consequences  of this  document  which is that it  constitutes  an  agreement of
employment.

         6.  Counterparts.  This  Amendment  may be  executed  in any  number of
counterparts,  each of which shall be deemed an original  and all of which taken
together shall constitute one and the same Amendment.

                 IN WITNESS WHEREOF, the parties have executed this Amendment as
of the date first above written.

                               NATIONAL HOME HEALTH CARE CORP.


                               By: /s/ Robert P. Heller
                                  ----------------------------------------------
                                  Name: Robert P. Heller
                                  Title: Executive Vice President of Finance and
                                         Chief Financial Officer

                                  /s/ Steven Fialkow
                                  ------------------
                                  STEVEN FIALKOW