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                                                                   Exhibit 10.43

                                    GUARANTY

                           AND AGREEMENT OF SURETYSHIP
                              REGARDING OBLIGATIONS

                            OF LESSEE AND AFFILIATES

                                      from

                          GENESIS HEALTH VENTURES, INC.

                                     and its

                              MATERIAL SUBSIDIARIES

                            Dated as of July 24, 1996



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                                    GUARANTY

                           AND AGREEMENT OF SURETYSHIP
                              REGARDING OBLIGATIONS

                            OF LESSEE AND AFFILIATES

         THIS GUARANTY AND AGREEMENT OF SURETYSHIP REGARDING OBLIGATIONS OF
LESSEE AND AFFILIATES, dated as of July 24, 1996, is made by GENESIS HEALTH
VENTURES, INC., a Pennsylvania corporation ("Genesis") and the Material
Subsidiaries set forth on Schedule 1 (the "Material Subsidiaries") (Genesis and
each of the Material Subsidiaries are individually a "Guarantor" and
collectively referred to herein, in their capacity as guarantors hereunder, as
the "Guarantors") in favor of the Beneficiaries (as hereinafter defined).

                              W I T N E S S E T H:

         WHEREAS, contemporaneously herewith, Genesis Eldercare Properties, Inc.
("Lessee"), as Lessee, Mellon Financial Services Corporation #4 ("Lessor"), as
Lessor, the Persons named on Schedule 2 attached hereto, as Lenders and Mellon
Bank, N.A., as Agent have entered into that certain Participation Agreement, and
Lessee and Lessor have entered into that certain Lease and Agreement, each dated
as of July 24, 1996. The Participation Agreement and the Lease and Agreement, as
they each may be modified, amended or restated from time to time as and to the
extent permitted thereby, are hereinafter referred to as the "Participation
Agreement" and "Lease" respectively. Unless otherwise defined herein or the
context hereof otherwise requires, terms which are defined or defined by
reference in the Participation Agreement or Lease shall have the same meanings
when used herein as such terms have therein; and

         WHEREAS, Lessor has entered into a Loan Agreement dated as of even date
herewith (as amended or otherwise modified from time to time, the "Loan
Agreement" by and among Lessor, Lenders and Agent, pursuant to which the Lenders
have agreed to make a loan to Lessor, as evidenced by those certain non-recourse
promissory notes (the "Notes") from Lessor to Agent and secured by those certain
Mortgages and Deeds of Trust (the "Mortgages") made by Lessor to Agent, as agent
for the Lenders and those certain Assignments of Lease from Lessor to Agent, as
agent for the Lenders (the "Assignments of Lease").

         WHEREAS, Lessee is a wholly-owned subsidiary of Genesis and
each of the Material Subsidiaries are Subsidiaries of Genesis;
and


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Guaranty

         WHEREAS, it is a covenant in the Participation Agreement that Lessee
shall cause the Guarantors to execute and deliver this Guaranty; and

         WHEREAS, it is in the best interests of Guarantors that the
Overall Transaction and the Document Closing Date occur; and

         WHEREAS, this Guaranty, and the execution, delivery and performance
hereof, have been duly authorized by all necessary corporate action of
Guarantors;

         NOW, THEREFORE, in consideration of the foregoing and for other good
and valuable consideration, the receipt and sufficiency of which are hereby
acknowledged by Guarantors, Guarantors hereby agree as follows:

         SECTION I. Guarantee and Agreement of Suretyship. Guarantors hereby
jointly and severally, irrevocably and unconditionally guarantee to the
Beneficiaries and agree to act as surety to the Beneficiaries for (a) the full
and prompt payment when due, whether by acceleration or otherwise, and at all
times thereafter, and (b) the full and prompt performance, of all of the
Liabilities (as hereinafter defined), including interest and Yield on any such
Liabilities, whether accruing before or after any bankruptcy or insolvency case
or proceeding involving Lessee or any other Person, and, if interest or Yield on
any portion of such obligations ceases to accrue by operation of law by reason
of the commencement of such case or proceeding, including such interest and
Yield as would have accrued on any such portion of such obligations if such case
or proceeding had not commenced, and further agree to pay all expenses
(including attorneys' fees and legal expenses) paid or incurred by Lessor, Agent
or any of the Lenders (each a "Beneficiary") in endeavoring to collect the
Liabilities, or any part thereof, and in enforcing this Guaranty. The term
"Liabilities", as used herein, shall mean all of the following, in each case
howsoever created, arising or evidenced, whether direct or indirect, joint or
several, absolute or contingent, or now or hereafter existing, or due or to
become due: all amounts payable by Lessee or any Affiliate (now or hereafter) of
Genesis, all obligations to be performed by Lessee or any such Affiliate and all
representations, warranties, covenants, undertakings and agreements of Lessee or
any such Affiliate, under the Lease, the Participation Agreement and any other
Operative Document (whether or not Lessee, any such Affiliate or any other
Person shall be released or relieved from any or all liability or obligation
under any thereof).


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         In any action or proceeding involving any state corporate law, or any
state or federal bankruptcy, insolvency, reorganization or any other law
affecting the rights of creditors generally, if the obligations of Guarantor
under this Guaranty would otherwise be held or determined by a final and
non-appealable order of a court of competent jurisdiction to be void, invalid or
unenforceable, or subordinated to the claims of any other creditors, on account
of the amount of its liability under this Guaranty, then, notwithstanding any
other provision hereof to the contrary, the amount of such liability shall,
without any further action by Guarantor or any other Person, be automatically
limited and reduced to the highest amount which is valid and enforceable as
determined in such action or proceeding pursuant to such final and
non-appealable order.

         Guarantors agree that, in the event of the dissolution, bankruptcy or
insolvency of Lessee, or the inability or failure of Lessee to pay debts as they
become due, or an assignment by Lessee for the benefit of creditors, or the
commencement of any case or proceeding in respect of Lessee under any
bankruptcy, insolvency or similar laws, and if such event shall occur at a time
when any of the Liabilities may not then be due and payable, Guarantors will pay
to the Beneficiaries forthwith the full amount which would be payable hereunder
by Guarantors as if all Liabilities were then due and payable.

         Guarantors agree that, in the event of the dissolution, bankruptcy or
insolvency of Lessor, or the inability or failure of Lessor to pay debts as they
become due, or an assignment by Lessor for the benefit of creditors, or the
commencement of any case or proceeding in respect of Lessor under any
bankruptcy, insolvency or similar laws, and if such event (a "Lessor Bankruptcy
Event") shall occur at a time when any of the Liabilities may not then be due
and payable, Guarantors will pay to the Beneficiaries from time to time all
Liabilities then or thereafter due under the Operative Documents pursuant to
their terms or if the provisions of the immediately preceding paragraph are
applicable, at the time specified in the immediately preceding paragraph, all as
if such Lessor Bankruptcy Event shall not have occurred.

         To secure all obligations of Guarantors hereunder, each Beneficiary
shall have a lien upon and security interest in (and may, without demand or
notice of any kind, at any time and from time to time when any amount shall be
due and payable by Guarantors hereunder, appropriate and apply toward the
payment of such amount, in such order of application as the Agent may elect) any
and all balances, credits, deposits, accounts or moneys of or in the name of
Guarantors or any of its Affiliates now or


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Guaranty

hereafter, for any reason or purpose whatsoever, in the possession or control
of, or in transit to Lessor or any Beneficiary or any agent or bailee for Lessor
or any Beneficiary. Each Beneficiary shall provide prompt written notice to the
Agent of the exercise by such Beneficiary of its rights under this paragraph,
which notice shall set forth in reasonable detail the amount of such application
and shall remit such amount to Agent or as Agent may direct.

         The obligations of the Guarantors hereunder are secured by the Joint
Stock Collateral as set forth in that certain Amended and Restated Security
Agreement dated as of September 29, 1995, as amended, among Genesis and certain
of its subsidiaries and Mellon Bank, N.A. as Collateral Agent, subject to the
terms and provisions of that certain Amended and Restated Collateral Agency
Agreement dated as of September 29, 1995, as amended, among Genesis, such
subsidiaries and Mellon Bank, N.A., as RCA Agent, ACA Agent and Collateral
Agent.

         This Agreement shall constitute an agreement of suretyship as well as
of guaranty and shall constitute an absolute and unconditional guaranty of
payment and performance (and not of collection) and an absolute and
unconditional undertaking by each Guarantor with respect to the payment and
performance of the Liabilities. This Guaranty shall remain in full force and
effect (notwithstanding, without limitation, the dissolution of any of the
Guarantors). The liability of the Guarantors hereunder shall be direct, joint
and several, and may be enforced without the Beneficiaries being required to
resort to any other right, remedy or security.

         Agent on behalf of itself and the other Beneficiaries, may, from time
to time at its discretion and without notice to Guarantors, but subject to the
provisions of the Participation Agreement, take or cause any of the other
Beneficiaries to take, any or all of the following actions, subject to the terms
of the Credit Agreement as in effect on the date hereof as such Credit Agreement
may be amended with the consent of Agent under the Participation Agreement (on
behalf of the Participants) and subject to the provisions of the Collateral
Agency Agreement with respect to the Joint Stock Collateral: (a) retain or
obtain a lien upon or a security interest in any property to secure any of the
Liabilities or any obligation hereunder; (b) retain or obtain the primary or
secondary obligation of any obligor or obligors, in addition to Guarantors, with
respect to any of the Liabilities; (c) extend or renew for one or more periods
(regardless of whether longer than the original period), alter or exchange any
of the Liabilities, or release or compromise any obligation of Guarantors
hereunder or any obligation of any


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nature of any other obligor with respect to any of the Liabilities; (d) release
or fail to perfect its lien upon or security interest in, or impair, surrender,
release or permit any substitution or exchange for, all or any part of any
property securing any of the Liabilities or any obligation hereunder, or extend
or renew for one or more periods (regardless of whether longer than the original
period) or release, compromise, alter or exchange any obligations of any nature
of any obligor with respect to any such property; and (e) resort to Guarantors,
or any one or more of them, for payment of any of the Liabilities, regardless of
whether Agent or any other Beneficiary shall have resorted to any other Person
any property securing any of the Liabilities or any obligation hereunder or
shall have proceeded against any other obligor primarily or secondarily
obligated with respect to any of the Liabilities (all of the actions referred to
in this paragraph being hereby expressly waived by Guarantors).

         SECTION II. Guarantors' Obligations Unconditional. Guarantors'
obligations hereunder are independent in respect of any other Person, and each
Beneficiary may enforce any of its rights hereunder independently of any other
right or remedy that it may at any time hold with respect to the Liabilities or
any security or other guaranty therefor; provided that no double recovery of the
same amount shall be permitted. Such obligations shall be absolute and
unconditional, shall not be subject to any counterclaim, setoff, deduction,
diminution, abatement, recoupment, suspension, deferment, reduction or defense
(other than full and strict compliance by Guarantors with their obligations
hereunder), whether based upon any claim that Lessor, Lessee, Agent, any
Beneficiary or any other Person may have against any Beneficiary or any other
Person or otherwise, and shall remain in full force and effect without regard
to, and shall not be released, discharged or in any way affected by, any
circumstance or condition whatsoever (whether or not Guarantors or any other
Person shall have any knowledge or notice thereof) including, without
limitation:

         A.       any amendment, modification, addition, deletion,
                  supplement or renewal to or of or other change in the
                  Liabilities or any Operative Document or any of the
                  agreements referred to in any thereof, or any other
                  instrument or agreement applicable to any Operative
                  Document or any of the parties to such agreements, or
                  to the Sites, or any assignment, mortgage or transfer
                  thereof or of any interest therein, or any furnishing
                  or acceptance of additional security for, guaranty of
                  or right of offset with respect to, any of the
                  Liabilities; or the failure of any security or the



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                  failure of any Beneficiary to perfect or insure any
                  interest in any collateral;

         B.       any failure, omission or delay on the part of Lessor or
                  any Beneficiary to conform or comply with any term of
                  any instrument or agreement referred to in clause (A)
                  above;

         C.       any waiver, consent, extension, indulgence, compromise,
                  release or other action or inaction under or in respect
                  of any instrument, agreement, guaranty, right of offset
                  or security referred to in clause (A) above or any
                  obligation or liability of Lessor or any Beneficiary,
                  or any exercise or non-exercise by any Beneficiary of
                  any right, remedy, power or privilege under or in
                  respect of any such instrument, agreement, guaranty,
                  right of offset or security or any such obligation or
                  liability;

         D.       any bankruptcy, insolvency, reorganization,
                  arrangement, readjustment, composition, liquidation or
                  similar proceeding with respect to Lessor or any
                  Beneficiary or any other Person or any of their
                  respective properties or creditors, or any action taken
                  by any trustee, receiver or court in any such
                  proceeding;

         E.       any limitation on the liability or obligations of any
                  Person under any Operative Document, the Liabilities,
                  any collateral security for the Liabilities, any other
                  guaranty of the Liabilities or any discharge,
                  termination, cancellation, frustration, irregularity,
                  invalidity or unenforceability, in whole or in part, of
                  any of the foregoing or any other agreement,
                  instrument, guaranty or security referred to in
                  clause (A) above or any term of any thereof;

         F.       any defect in the title, compliance with
                  specifications, condition, design, operation or fitness
                  for use of, or any damage to or loss or destruction of,
                  or any interruption or cessation in the use of the
                  Sites by Lessee or any other Person for any reason
                  whatsoever (including, without limitation, any
                  governmental prohibition or restriction, condemnation,
                  requisition, seizure or any other act on the part of
                  any governmental or military authority, or any act of
                  God or of the public enemy) regardless of the duration
                  thereof (even though such duration would otherwise
                  constitute a frustration of a lease), whether or not



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                  resulting from accident and whether or not without
                  fault on the part of Lessee or any other Person;

         G.       any merger or consolidation of Lessor, Lessee or
                  Guarantors into or with any other Person, or any sale,
                  lease or transfer of any of the assets of Lessor,
                  Lessee or Guarantors to any other Person;

         H.       any change in the ownership of any shares of capital
                  stock of Lessor, Lessee or Guarantors or any corporate
                  change in Lessor, Lessee or Guarantors;

         I.       any loan to or other transaction between the
                  Beneficiaries, or any of them, and Lessee or Lessor;

         J.       any assignment or consummation of assignment of the
                  Lease pursuant to Section 12.1 of the Lease; or

         K.       any other occurrence or circumstance whatsoever, whether
                  similar or dissimilar to the foregoing, and any other
                  circumstance that might otherwise constitute a legal or
                  equitable defense or discharge of the liabilities of a
                  guarantor or surety or that might otherwise limit recourse
                  against Guarantors.

         The obligations of Guarantors set forth herein constitute the full
recourse obligations of Guarantors enforceable against them to the full extent
of all of their assets and properties, notwithstanding any provision in the
Lease or any other Operative Document or any other document or agreement to the
contrary.

         Guarantors waive any and all notice of the creation, renewal, extension
or accrual of any of the Liabilities and notice of or proof of reliance by any
Beneficiary upon this Guaranty or acceptance of this Guaranty, and the
Liabilities, and any of them, shall conclusively be deemed to have been created,
contracted or incurred in reliance upon this Guaranty. Guarantors
unconditionally waive, to the extent permitted by law: (a) acceptance of this
Guaranty and proof of reliance by any Beneficiary hereon; (b) notice of any of
the matters referred to in clauses A through K above, or any right to consent or
assent to any thereof; (c) all notices that may be required by statute, rule of
law or otherwise, now or hereafter in effect, to preserve intact any rights
against Guarantors, including, without limitation, any demand, presentment,
protest, proof or notice of nonpayment under any Operative Document, and notice
of default or any failure on the part of Lessor to perform and comply with any
covenant, agreement, term or condition of any Operative Document; (d) any right
to the enforcement, assertion or exercise against


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Lessor of any right, power, privilege or remedy conferred in any Operative
Document or otherwise; (e) any requirement of diligence on the part of any
Person; (f) any requirement of any Beneficiary to take any action whatsoever, to
exhaust any remedies or to mitigate the damages resulting from a default by any
Person under any Operative Document; (g) any notice of any sale, transfer or
other disposition by any Person of any right under, title to or interest in any
Operative Document or the Sites; and (h) any other circumstance whatsoever that
might otherwise constitute a legal or equitable discharge, release or defense of
a guarantor or surety, or that might otherwise limit recourse against
Guarantors.

         Guarantors agree that this Guaranty shall be automatically reinstated
if and to the extent that for any reason any payment by or on behalf of itself
or Lessor is rescinded or must be otherwise restored by any Beneficiary whether
as a result of any proceedings in bankruptcy or reorganization or otherwise.

         Guarantors further agree that, without limiting the generality of this
Guaranty, if an Event of Default shall have occurred and be continuing and any
Beneficiary is prevented by applicable law from exercising its remedies under
the Operative Documents, such Beneficiary shall be entitled to receive hereunder
from Guarantors, upon demand therefor, the sums which would have otherwise been
due from Lessee had such remedies been exercised.

         Section III. Incorporated Financial Covenants. Genesis hereby covenants
and agrees that it shall at all times comply with the Financial Covenants, which
covenants are incorporated herein by this reference, provided that compliance
hereunder with the Financial Covenants shall be waived to the extent that
compliance with such Financial Covenants may be waived from time to time under
and in accordance with the Credit Agreement, exclusive of waivers made in
contemplation of the termination of the Credit Agreement.

         Section IV.  Waiver of Subrogation.  Guarantors hereby
irrevocably waive any claim or other rights which they may now or
hereafter acquire against Lessor.

         Section V. Reasonableness and Effect of Waivers. Guarantors warrant and
agree that each of the waivers set forth in this Guaranty is made with full
knowledge of its significance and consequences and that, under the
circumstances, the waivers are reasonable and not contrary to public policy or
law. If any of such waivers are determined to be contrary to any applicable


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law or public policy, such waivers shall be effective only to the maximum extent
permitted by law.

         Section VI. Representations and Warranties of Guarantors. As of the
date hereof, each of the Guarantors makes the representations and warranties set
forth in this Section 6 to each of the Beneficiaries.

                  A. Due Organization, etc. It is a corporation or partnership
duly organized, validly existing and in good standing under the laws of the
state of its organization and it has full corporate power and authority to
conduct its business as presently and presently proposed to be conducted, to own
or hold under lease its properties, to enter into and perform its obligations
under each of the Operative Documents to which it is or is to be a party and
each other agreement, instrument and document to be executed and delivered by it
on or before the Document Closing Date in connection with or as contemplated by
each such Operative Document to which it is or is to be a party, and it is duly
qualified as a foreign corporation authorized to do business and is in good
standing in every jurisdiction in which its failure to be so qualified would
have a Material Adverse Effect. The information set forth on Schedule 1 hereto
with respect to it is true and correct.

                  B. Authorization; No Conflict. The execution and delivery by
it of each of the Operative Documents to which it is or is to be a party, and
the performance by it of its obligations under such Operative Documents, have
been duly authorized by all necessary corporate action (including any necessary
stockholder action) on its part, and do not and will not: (i) contravene any
Applicable Laws and Regulations currently in effect applicable to or binding on
it or the Sites; (ii) violate any provision of its charter or bylaws; (iii)
result in a breach of or constitute a default under any indenture, loan or
credit agreement, or any other agreement or instrument to which it is a party or
by which it or its properties may be bound or affected, which breaches or
defaults would have, individually or in the aggregate, a Material Adverse
Effect; (iv) result in, or require, the creation or imposition of any Lien of
any nature upon or with respect to any of the properties now owned or hereafter
acquired by it (other than the security interests created pursuant to the
Operative Documents); or (v) require any Governmental Action by any Authority,
except for (A) the filings and recordings listed on Schedule 4.1B to the
Participation Agreement to perfect the rights of Lessor, the Lenders and Agent
intended to be created by the Operative Documents, and (B) those Governmental
Actions required with respect to Lessee or any of its Affiliates listed on
Schedule 4.1A to the Participation Agreement, each of which


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have been duly effected and are, or on the initial Advance Date will be, in full
force and effect; and it is not in default under or in violation of its charter
or bylaws. Attached as Schedule 4.1C to the Participation Agreement are correct
and complete computations demonstrating compliance by Genesis with Section 5.9
of the Indenture after giving effect as Indebtedness under such Indenture to the
obligations of Lessee and Guarantors under or in connection with the Operative
Documents.

                  C. Enforceability, etc. Each Operative Document to which it is
or is to be a party constitutes its legal, valid and binding obligation,
enforceable against it in accordance with the terms thereof, except as such
enforceability may be limited by applicable bankruptcy, insolvency and similar
laws affecting creditors' rights generally and by general equitable principles.

                  D. Litigation. There is no action, proceeding or investigation
pending or threatened which questions the validity of the Operative Documents to
which it is or is to be a party or any action taken or to be taken pursuant to
the Operative Documents to which it is or is to be a party, and there is no
action, proceeding or investigation pending or threatened which, if adversely
determined, would have a Material Adverse Effect.

                  E. Taxes. It has filed or caused to be filed all United States
Federal and all other material tax returns that are required to be filed by it,
and has paid or caused to be paid all taxes shown to be due and payable on such
returns or on any assessment received by it to the extent that such taxes have
become due and payable except to the extent that taxes due, but unpaid, are
being contested in good faith by it by appropriate action or proceeding and, to
the extent (if any) that such taxes are not due and payable, it has established
or caused to be established reserves that are adequate for the payment thereof
in accordance with GAAP.

                  F. Investment Company Act. It is not an "investment company"
or a company "controlled" by an "investment company", within the meaning of the
Investment Company Act of 1940, as amended.

                  G. Public Utility Holding Company. It is not subject to
regulation as a "holding company," an "affiliate" of a "holding company", or a
"subsidiary company" of a "holding company", within the meaning of the Public
Utility Holding Company Act of 1935, as amended.

                  H. Solvency. The consummation by Lessee and the Guarantors of
the transactions contemplated by the Operative


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Documents does not and will not render it insolvent, nor was it made in
contemplation of its insolvency; the value of its assets and properties at fair
valuation and at their then present fair salable value is and, after such
transactions, will be greater than its total liabilities, including contingent
liabilities, as they become due; the property remaining in its hands was not and
will not be an unreasonably small amount of capital.

         Section VII.  Covenants of Guarantors.

                  A. Consolidation, Merger, Sale, etc. No Guarantor shall
consolidate with any Person, merge with or into any Person or convey, transfer
or lease to any Person all or substantially all of its assets in any single
transaction (or series of related transactions), unless, immediately after
giving effect to such transaction, the conditions set forth in clauses (i)
through (v) shall have been satisfied:

                  1. the conditions of Section 7.09 or 7.10, as applicable, of
         the Credit Agreement shall have been satisfied with respect to such
         transaction; provided, that for purposes of this clause (i), (a) all
         references in said Sections 7.09 and 7.10 to an Event of Default or
         Potential Default shall include (x) a Lease Event of Default or Lease
         Default, respectively, and (y) a default under this Guaranty, (b) all
         notices, certificates and other documents required to be delivered
         under said Section 7.09 shall also be delivered to Agent, on behalf of
         the Participants, (c) all references in said Sections 7.09 and 7.10 to
         Lender Party or Agent shall include Agent, on behalf of the
         Participants, (d) all references in said Sections 7.09 and 7.10 to
         Borrower or Borrowers shall be references to Guarantor or Guarantors,
         respectively, and (e) all references in said Sections 7.09 and 7.10 to
         Loan Obligations shall be references to the obligations of the
         applicable parties under the Operative Documents and (f) all references
         in said Sections 7.09 and 7.10 to Loan Documents shall be references to
         the Operative Documents;

                  2. (x) the Person formed by such consolidation with or into
         which such Guarantor shall be merged or (y) the Person which shall
         acquire by conveyance, transfer or lease all or substantially all of
         the assets of such Guarantor, if in the case of this clause (y), such
         Person is obligated under the terms of the Credit Agreement to become a
         party thereto (in the case of clause (x) or clause (y), as applicable,
         the "Surviving Company"), if other than such Guarantor immediately
         prior to such transaction, shall execute and deliver to each of the
         parties hereto an agreement, in form


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         and substance reasonably satisfactory to Agent, containing the
         assumption by the Surviving Company of the due and punctual payment,
         performance and observation of each obligation, covenant and agreement
         of such Guarantor under this Guaranty;

                  3. if the applicable Guarantor is Genesis and the Surviving
         Company is not Genesis, such Surviving Company shall be a corporation
         that is organized under the laws of the United States of America, a
         state thereof or the District of Columbia;

                  4. the title of Lessor to the Sites and Lessor's rights under
         this Guaranty and the other Operative Documents and the first and prior
         Lien of the Mortgage on the Collateral shall not be adversely affected;
         and

                  5. Lessee shall have delivered to Agent, on behalf of Lessor
         and the Lenders, an Officer's Certificate and an opinion of counsel
         reasonably satisfactory to each such Person stating that such
         transaction complies with this Section 7, that all conditions to the
         consummation of such transaction have been fulfilled and that all
         Governmental Actions required in connection with such transaction have
         been obtained, given or made.

         Upon the consummation of such transaction, the Surviving Company, if
other than the applicable Guarantor immediately prior thereto, shall succeed to,
and be substituted for, and may exercise every right and power of, such
Guarantor immediately prior to such transaction under this Guaranty and each
other Operative Document to which such Guarantor was a party immediately prior
to such transaction, with the same effect as if the Surviving Company had been
named herein and therein. Notwithstanding the foregoing provisions of this
Section 7, no conveyance, transfer or lease of all or substantially all of the
assets of any Guarantor shall release Guarantor from its payment or other
obligations under this Guaranty or any other Operative Document without the
written consent of Lessor and Agent.

                  B. Existence. Subject to Section 7(A), each Guarantor shall at
all times maintain its existence as a corporation or partnership in good
standing under the laws of the state of its organization and shall use
commercially reasonable efforts to preserve and keep in full force and effect
its franchises material to its business.

                  C. Senior Indebtedness. This Guaranty is an obligation of the
Guarantors under and in respect of the Lease,


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which lease refunded, refinanced and replaced that certain Acquisition Credit
Agreement, dated as of September 29, 1995, as amended, among Genesis, certain of
its Subsidiaries, Mellon Bank, N.A. ("Mellon") as Agent, Citibank, N.A.
("Citibank") as Co-Agent and the Lenders named therein, which agreement
supplemented that certain Amended and Restated Credit Agreement, dated as of
September 29, 1995, as amended, among Genesis, certain of its Subsidiaries,
Mellon as Issuer of Letters of Credit, Mellon as Agent and Citibank as Co-Agent,
which agreement refunded, refinanced and replaced that certain Credit Agreement,
dated as of November 22, 1993, among Genesis, certain of its Subsidiaries,
Mellon as Agent and the Lenders named therein. The obligations hereunder are
secured and superior in right of payment to the obligations under those certain
debentures issued pursuant to the 1993 Indenture and the 1995 Indenture (each as
hereinafter defined). The obligations hereunder constitute "Indebtedness" as
such term is defined in the 1995 Indenture (as hereinafter defined) and this
guarantee is a "Credit Facility", "Senior Indebtedness" and "Designated Senior
Indebtedness" within the meaning of that certain Indenture, dated as of June 15,
1995, between Genesis and Delaware Trust Company as Trustee (the "1995
Indenture") and is "Senior Indebtedness" within the meaning of that certain
Indenture, dated as of November 30, 1993, between Genesis and First Fidelity
Bank, N.A., Pennsylvania as Trustee (the "1993 Indenture").

         Section VIII. Transfers by Beneficiaries. Each Beneficiary may, from
time to time, whether before or after any discontinuance of this Guaranty, at
its sole discretion (subject to the requirements of the Participation Agreement)
and without notice to or consent of Guarantors, assign or transfer any or all of
its portion of the Liabilities or any interest therein; and, notwithstanding any
such assignment or transfer or any subsequent assignment or transfer thereof,
such Liabilities shall be and remain Liabilities for the purposes of this
Guaranty, and each and every immediate and successive assignee or transferee of
any of the Liabilities or of any interest therein shall, to the extent of such
assignee's or transferee's interest in the Liabilities, be entitled to the
benefits of this Guaranty to the same extent as if such assignee or transferee
were such Beneficiary.

         Section IX. No Waiver by Beneficiaries. No delay in the exercise of any
right or remedy shall operate as a waiver thereof, and no single or partial
exercise of any right or remedy shall preclude other or further exercise thereof
or the exercise of any other right or remedy; nor shall any modification or
waiver of any of the provisions of this Guaranty be binding upon any Beneficiary
except as expressly set forth in a writing duly


                                      -13-


<PAGE>


Guaranty

signed and delivered on its behalf. No action permitted hereunder shall in any
way affect or impair any Beneficiary's rights or Guarantors' obligations under
this Guaranty. For the purposes of this Guaranty, Liabilities shall include all
of the obligations described in the definition thereof, notwithstanding any
right or power of Guarantors or anyone else to assert any claim or defense as to
the invalidity or unenforceability of any such obligation, and no such claim or
defense shall affect or impair the obligations of Guarantors hereunder.
Guarantors' obligations under this Guaranty shall be absolute and unconditional
irrespective of any circumstance whatsoever which might constitute a legal or
equitable discharge or defense of Guarantors. Guarantors hereby acknowledge that
there are no conditions to the effectiveness of this Guaranty.

         Section X. Joint and Several Obligations; Successors and Assigns. All
obligations under this Guaranty are joint and several to each of the Guarantors
and any other party which hereafter guarantees any portion of the Liabilities,
and shall be binding upon them and upon their successors and assigns. All
references herein to Guarantors shall be deemed to include any successor or
successors, whether immediate or remote, to such Person.

         Section XI. Severability. Wherever possible, each provision of this
Guaranty shall be interpreted in such manner as to be effective and valid under
Applicable Laws and Regulations, but if any provision of this Guaranty shall be
prohibited by or invalid thereunder, such provision shall be ineffective only to
the extent of such prohibition or invalidity, without invalidating the remainder
of such provision or the remaining provisions of this Guaranty.

         Section XII. Submission to Jurisdiction; Waivers. EACH PARTY HERETO
IRREVOCABLY AND UNCONDITIONALLY:

                  (A) AGREES THAT ANY ACTION, SUIT OR PROCEEDING BY ANY PERSON
ARISING FROM OR RELATING TO THIS AGREEMENT OR ANY OTHER OPERATIVE DOCUMENT OR
ANY STATEMENT, COURSE OF CONDUCT, ACT OR OMISSION, OR EVENT OCCURRING IN
CONNECTION HEREWITH OR THEREWITH (COLLECTIVELY, "RELATED LITIGATION") MAY BE
BROUGHT IN ANY STATE OR FEDERAL COURT OF COMPETENT JURISDICTION SITTING IN
ALLEGHENY COUNTY OR PHILADELPHIA COUNTY, PENNSYLVANIA, SUBMITS TO THE
JURISDICTION OF SUCH COURTS, AND TO THE FULLEST EXTENT PERMITTED BY LAW AGREES
THAT, TO THE EXTENT THAT ANY SUCH COURT HAS OR IS ABLE TO OBTAIN PERSONAL
JURISDICTION OVER THE PARTY AGAINST WHICH SUCH PARTY IS SEEKING TO BRING RELATED
LITIGATION, IT WILL NOT BRING ANY RELATED LITIGATION IN ANY OTHER FORUM (BUT
NOTHING


                                      -14-


<PAGE>


Guaranty

HEREIN SHALL AFFECT THE RIGHT OF ANY LENDER TO BRING ANY ACTION, SUIT OR
PROCEEDING IN ANY OTHER FORUM);

                  (B) WAIVES ANY OBJECTION WHICH IT MAY HAVE AT ANY TIME TO THE
LAYING OF VENUE OF ANY RELATED LITIGATION BROUGHT IN ANY SUCH COURT, WAIVES ANY
CLAIM THAT ANY SUCH RELATED LITIGATION HAS BEEN BROUGHT IN AN INCONVENIENT
FORUM, AND WAIVES ANY RIGHT TO OBJECT, WITH RESPECT TO ANY RELATED LITIGATION
BROUGHT IN ANY SUCH COURT, THAT SUCH COURT DOES NOT HAVE JURISDICTION OVER SUCH
PARTY;

                  (C) CONSENTS AND AGREES TO SERVICE OF ANY SUMMONS, COMPLAINT
OR OTHER LEGAL PROCESS IN ANY RELATED LITIGATION BY REGISTERED OR CERTIFIED U.S.
MAIL, POSTAGE PREPAID, TO SUCH PARTY'S ADDRESS FOR NOTICES DESCRIBED IN SCHEDULE
II HEREOF, AND CONSENTS AND AGREES THAT SUCH SERVICE SHALL CONSTITUTE IN EVERY
RESPECT VALID AND EFFECTIVE SERVICE (BUT NOTHING HEREIN SHALL AFFECT THE
VALIDITY OR EFFECTIVENESS OF PROCESS SERVED IN ANY OTHER MANNER PERMITTED BY
LAW); AND

                  (D)  WAIVES THE RIGHT TO TRIAL BY JURY IN ANY RELATED
LITIGATION.

         Section XIII. Notices. All notices, demands, declarations, consents,
directions, approvals, instructions, requests and other communications required
or permitted by this Guaranty shall be in writing and shall be deemed to have
been duly given when addressed to the appropriate Person and delivered in the
manner specified in Section 21.3 of the Lease. The initial address for notices
to each of the Guarantors is set forth on Schedule 3 hereto.


                                      -15-


<PAGE>


Guaranty

         SECTION XIV. GOVERNING LAW. THIS GUARANTY HAS BEEN DELIVERED TO AGENT
AT PENNSYLVANIA AND SHALL BE CONSTRUED IN ACCORDANCE WITH AND GOVERNED BY THE
LAWS OF THE COMMONWEALTH OF PENNSYLVANIA, WITHOUT REGARD TO CONFLICT OF LAW
PRINCIPLES.

         Section XV. Joinder; Release. Genesis covenants that upon each and
every addition or deletion of a Subsidiary as a party to the Credit Agreement,
it will (i) promptly notify Agent thereof and (ii) cause to be executed and
delivered to Agent, on behalf of the Beneficiaries, a joinder or release in the
form of Exhibit A-1 or Exhibit A-2, respectively, attached hereto evidencing
such addition or deletion of a Material Subsidiary hereunder. Each Guaranty and
each Beneficiary hereby agree that no such joinder shall require the consent of
Agent, any other Beneficiary or any Guarantor. Each of the Beneficiaries hereby
authorizes Agent to execute and deliver any such release from time to time, but
no such release shall require the consent of any other Beneficiary or any
Guarantor. Each Guarantor agrees that no such joinder or release shall affect
the obligations of any Guarantor (other than the Guarantor which shall have
executed and delivered such joinder or release).

                            [SIGNATURE PAGES FOLLOW]


                                      -16-


<PAGE>


Guaranty

         IN WITNESS WHEREOF, Guarantors have caused this Guaranty and Agreement
of Suretyship Regarding Obligations of Lessee and Affiliates to be executed and
delivered as of the date first above written.

GENESIS HEALTH VENTURES, INC.,
 a Pennsylvania corporation

By:________________________________
   Title: Senior Vice President and
           Chief Financial Officer

BREVARD MERIDIAN LIMITED PARTNERSHIP,
 a Maryland limited partnership

         By: Meridian Healthcare, Inc., 
                  a Pennsylvania corporation, its
                  sole general partner

CATONSVILLE MERIDIAN LIMITED PARTNERSHIP,
 a Maryland limited partnership

         By: Meridian Health, Inc., 
                  a Pennsylvania corporation, one of its
                  sole general partners

EASTON MERIDIAN LIMITED PARTNERSHIP,
 a Maryland limited partnership

         By: Meridian Healthcare, Inc., 
                  a Pennsylvania corporation, its
                  sole general partner

EDELLA STREET ASSOCIATES, a Pennsylvania
 limited partnership

         By: Genesis Health Ventures of
                  Clarks Summit, Inc., its sole
                  general partner

GENESIS HEALTH VENTURES OF ARLINGTON, INC.,
 a Pennsylvania corporation

GENESIS HEALTH VENTURES OF BLOOMFIELD, INC.,
 a Pennsylvania corporation



<PAGE>


Guaranty

GENESIS HEALTH VENTURES OF CLARKS SUMMIT, INC.,
 a Pennsylvania corporation

GENESIS HEALTH VENTURES OF INDIANA, INC.,
 a Pennsylvania corporation

GENESIS HEALTH VENTURES OF MASSACHUSETTS, INC.,
 a Pennsylvania corporation

GENESIS HEALTH VENTURES OF NAUGATUCK, INC.,
 a Pennsylvania corporation

GENESIS HEALTH VENTURES OF SALISBURY, INC.,
 a Pennsylvania corporation

GENESIS HEALTH VENTURES OF WAYNE, INC.,
 a Pennsylvania corporation

GENESIS HEALTH VENTURES OF WEST VIRGINIA, INC.,
 a Pennsylvania corporation

GENESIS HEALTH VENTURES OF WINDSOR, INC.,
 a Pennsylvania corporation

GENESIS IMMEDIATE MED CENTER, INC.,
 a Pennsylvania corporation

GENESIS ELDERCARE NETWORK SERVICES, INC.
f/k/a GENESIS MANAGEMENT RESOURCES, INC.,
 a Pennsylvania corporation

GENESIS ELDERCARE PHYSICAL SERVICES, INC.
f/k/a GENESIS PHYSICIAN SERVICES, INC.,
 a Pennsylvania corporation

GENESIS PROPERTIES LIMITED PARTNERSHIP,
 a Pennsylvania limited partnership

         By: Genesis Health Ventures of
                  Arlington, Inc., its sole
                  general partner

GREENSPRING MERIDIAN LIMITED PARTNERSHIP,
 a Maryland limited partnership

         By: Meridian Healthcare, Inc., a
                  Pennsylvania corporation, its
                  sole general partner



<PAGE>


Guaranty

HALLMARK HEALTHCARE LIMITED PARTNERSHIP,
 a Maryland limited partnership

         By: Pharmacy Equities, Inc., a
                  Pennsylvania corporation, its
                  sole general partner

HAMMONDS LANE MERIDIAN LIMITED PARTNERSHIP,
 a Maryland limited partnership

         By: Meridian Health, Inc., a
                  Pennsylvania corporation, one of
                  its general partner

HEALTHCARE RESOURCES CORP.,
 a Pennsylvania corporation

HEALTHCARE SERVICES NETWORK, INC.,
 a Pennsylvania corporation

KNOLLWOOD MANOR, INC.,
 a Pennsylvania corporation

MERIDIAN HEALTH, INC.
 a Pennsylvania corporation

MERIDIAN HEALTHCARE, INC.
 a Pennsylvania corporation

MILLVILLE MERIDIAN LIMITED PARTNERSHIP,
 a Maryland limited partnership

         By: Meridian Healthcare, Inc., a
                  Pennsylvania corporation,
                  its sole general partner

PHARMACY EQUITIES, INC.,
 a Pennsylvania corporation

PHILADELPHIA AVENUE ASSOCIATES,
 a Pennsylvania limited partnership

         By: Philadelphia Avenue Corp.,
                  its sole general partner

PHILADELPHIA AVENUE CORPORATION,
 a Pennsylvania corporation

RIVER STREET ASSOCIATES,
  a Pennsylvania limited partnership
       
         By: Genesis Health Ventures of
                  Wilkes-Barre, Inc., its
                  sole general partner



<PAGE>


Guaranty

SEMINOLE MERIDIAN LIMITED PARTNERSHIP,
 a Maryland limited partnership

         By: Meridian Health, Inc., a
                  Pennsylvania corporation,
                  its sole general partner

STAFF REPLACEMENT SERVICES, INC.,
 a Pennsylvania corporation

STATE STREET ASSOCIATES, L.P., 
 a Pennsylvania limited partnership

         By: Genesis Health Ventures, Inc.,
                  its sole general partner

STATE STREET ASSOCIATES, INC.,
 a Pennsylvania corporation

SUBURBAN MEDICAL SERVICES, INC.
 a Pennsylvania corporation

GENESIS ELDERCARE REHABILITATION SERVICES, INC.
f/k/a TEAM REHABILITATION, INC.
 a Pennsylvania corporation

THERAPY CARE SYSTEMS, L.P.,
 a Pennsylvania limited partnership
     
    By: Team Rehabilitation, Inc., its
                  sole general partner

THE TIDEWATER HEALTHCARE SHARED
SERVICES GROUP, INC.,
 a Pennsylvania corporation

VOLUSIA MERIDIAN LIMITED PARTNERSHIP,
 a Maryland limited partnership

         By: Meridian Health, Inc., a
                  Pennsylvania corporation,
                  its sole general partner

WYNCOTE HEALTHCARE CORP.,
 a Pennsylvania corporation

         By:
         ------------------------------------------------
         Title (as to each of the foregoing Subsidiaries):



<PAGE>


Guaranty

ASCO HEALTHCARE, INC.,
 a Maryland corporation

By:______________________________
Title: Senior Vice President and
           Chief Financial Officer

BRINTON MANOR, INC.,
 a Delaware corporation

By:______________________________
Title: Senior Vice President and
           Chief Financial Officer

CONCORD HEALTHCARE CORPORATION,
 a Delaware corporation

By:______________________________
Title: Senior Vice President and
           Chief Financial Officer

CRYSTAL CITY NURSING CENTER, INC.,
 a Maryland corporation

By:______________________________
Title: Senior Vice President and
           Chief Financial Officer

EASTERN MEDICAL SUPPLIES, INC.,
 a Maryland corporation

By:______________________________
Title: Senior Vice President and
           Chief Financial Officer



<PAGE>


Guaranty

EASTERN REHAB SERVICES, INC.,
 a Maryland corporation

By:______________________________
Title: Senior Vice President and
           Chief Financial Officer

GENESIS HEALTH SERVICES CORPORATION,
 a Delaware corporation

By:______________________________
Title: Senior Vice President and
           Chief Financial Officer

GENESIS HEALTHCARE CENTERS HOLDINGS, INC.,
 a Delaware corporation

By:______________________________
Title: Senior Vice President and
           Chief Financial Officer

GENESIS HOLDINGS, INC.
 a Delaware corporation

By:______________________________
Title: Senior Vice President and
           Chief Financial Officer

GENESIS PROPERTIES OF DELAWARE
CORPORATION,
 a Delaware corporation

By:______________________________
Title: Senior Vice President and
           Chief Financial Officer



<PAGE>


Guaranty

GENESIS PROPERTIES OF DELAWARE
LTD PARTNERSHIP, L.P., 
 a Delaware limited partnership

         By: Genesis Properties of Delaware
                  Corporation, a general partner

By:______________________________
Title: Senior Vice President and
           Chief Financial Officer

GOVERNOR'S HOUSE NURSING HOME, INC.,
 a Delaware corporation

By:______________________________
Title: Senior Vice President and
           Chief Financial Officer

HEALTH CONCEPTS AND SERVICES, INC.,
 a Maryland corporation

By:______________________________
Title: Senior Vice President and
           Chief Financial Officer

HILLTOP HEALTH CARE CENTER, INC.,
 a Delaware corporation

By:______________________________
Title: Senior Vice President and
           Chief Financial Officer



<PAGE>


Guaranty

KEYSTONE NURSING HOME, INC.,
 a Delaware corporation

By:______________________________
Title: Senior Vice President and
           Chief Financial Officer

LINCOLN NURSING HOME, INC.,
 a Delaware corporation

By:______________________________
Title: Senior Vice President and
           Chief Financial Officer

WAYSIDE NURSING HOME, INC.,
 a Delaware corporation

By:______________________________
Title: Senior Vice President and
           Chief Financial Officer



<PAGE>


Guaranty

                                   SCHEDULE 1

                              Material Subsidiaries

<TABLE>
<CAPTION>
                                                                                          State of
Name                                        Type of Entity                              Organization
----                                        --------------                              ------------ 
<S>                                         <C>                                        <C>    
Genesis Health                              Corporation                                 Pennsylvania
Ventures, Inc.

Brevard Meridian                            Limited Partnership                         Maryland
Limited Partnership

Catonsville Meridian                        Limited Partnership                         Maryland
Limited Partnership

Easton Meridian                             Limited Partnership                         Maryland
Limited Partnership

Edella Street                               Limited Partnership                         Pennsylvania
associates

Genesis Health                              Corporation                                 Pennsylvania
Ventures of Arlington,
Inc.

Genesis Health                              Corporation                                 Pennsylvania
Ventures of Bloomfield,
Inc.

Genesis Health                              Corporation                                 Pennsylvania
Ventures of Clarks
Summit, Inc.

Genesis Health                              Corporation                                 Pennsylvania
Ventures of
Indiana, Inc.

Genesis Health                              Corporation                                 Pennsylvania
Ventures of
Massachusetts, Inc.

Genesis Health                              Corporation                                 Pennsylvania
Ventures of
Naugatuck, Inc.

Genesis Health                              Corporation                                 Pennsylvania
Ventures of
Salisbury, Inc.

</TABLE>


<PAGE>


Guaranty
<TABLE>
<CAPTION>
<S>                                         <C>                                        <C>    

Genesis Health                              Corporation                                 Pennsylvania
Ventures of Wayne,
Inc.

Genesis Health                              Corporation                                 Pennsylvania
Ventures of West
Virginia, Inc.

Genesis Health                              Corporation                                 Pennsylvania
of Windsor, Inc.

Genesis Immediate                           Corporation                                 Pennsylvania
Med Center, Inc.

Genesis Eldercare                           Corporation                                 Pennsylvania
Network Services, Inc.
f/k/a Genesis

Management Resources,
Inc.

Genesis Eldercare                           Corporation                                 Pennsylvania
Physical Services,
Inc. f/k/a Genesis

Physician Services,
Inc.

Genesis Properties                          Limited Partnership                         Pennsylvania
Limited Partnership

Greenspring Meridian                        Limited Partnership                         Maryland
Limited Partnership

Hallmark Healthcare                         Limited Partnership                         Maryland
Limited Partnership

Hammonds Lane                               Limited Partnership                         Maryland
Meridian Limited
Partnership

Healthcare Resources                        Corporation                                 Pennsylvania
Corp.

Healthcare Services                         Corporation                                 Pennsylvania
Network, Inc.

Knollwood Manor, Inc.                       Corporation                                 Pennsylvania

Meridian Health, Inc.                       Corporation                                 Pennsylvania

</TABLE>


<PAGE>


Guaranty
<TABLE>
<CAPTION>
<S>                                         <C>                                        <C>    

Meridian Healthcare,                        Corporation                                 Pennsylvania
Inc.

Millville Meridian                          Limited Partnership                         Maryland
Limited Partnership

Pharmacy Equities, Inc.                     Corporation                                 Pennsylvania

Philadelphia Avenue                         Limited Partnership                         Pennsylvania
Associates

Philadelphia Avenue                         Corporation                                 Pennsylvania
Corporation

River Street                                Limited Partnership                         Pennsylvania
Associates

Seminole Meridian                           Limited Partnership                         Pennsylvania
Limited Partnership

Staff Replacement                           Corporation                                 Pennsylvania
Services, Inc.

State Street                                Limited Partnership                         Pennsylvania
Associates, L.P.

State Street                                Corporation                                 Pennsylvania
Associates, Inc.

Suburban Medical                            Corporation                                 Pennsylvania
Services, Inc.

Genesis Eldercare                           Corporation                                 Pennsylvania
Rehabilitation Services,
Inc. f/k/a Team
Rehabilitation, Inc.

Therapy Care Systems,                       Limited Partnership                         Pennsylvania
L.P.

The Tidewater                               Corporation                                 Pennsylvania
Healthcare Shared
Services Group, Inc.

Volusia Meridian                            Limited Partnership                         Maryland
Limited Partnership

Wyncote Healthcare                          Corporation                                 Pennsylvania
Corp.

</TABLE>


<PAGE>


Guaranty
<TABLE>
<CAPTION>
<S>                                         <C>                                        <C>    

Asco Healthcare, Inc.                       Corporation                                 Maryland

Brinton Manor, Inc.                         Corporation                                 Delaware

Concord Healthcare                          Corporation                                 Delaware
Corporation

Crystal City Nursing                        Corporation                                 Maryland
Center, Inc.

Eastern Medical                             Corporation                                 Maryland
Supplies, Inc.

Eastern Rehab                               Corporation                                 Maryland
Services, Inc.

Genesis Health                              Corporation                                 Delaware
Services Corporation

Genesis Healthcare                          Corporation                                 Delaware
Centers Holdings, Inc.

Genesis Holdings, Inc.                      Corporation                                 Delaware

Genesis Properties of                       Corporation                                 Delaware
of Delaware Corporation

Genesis Properties                          Limited Partnership                         Delaware
of Delaware Ltd.
Partnership, L.P.

Governor's House                            Corporation                                 Delaware
Nursing Home, Inc.

Health Concepts and                         Corporation                                 Maryland
Services, Inc.

Hilltop Health Care                         Corporation                                 Delaware
Center, Inc.

Keystone Nursing                            Corporation                                 Delaware
Home, Inc.

Lincoln Nursing                             Corporation                                 Delaware
Home, Inc.

Wayside Nursing                             Corporation                                 Delaware
Home, Inc.

</TABLE>


<PAGE>


Guaranty

                                   SCHEDULE 2

                                     Lenders

Mellon Bank, N.A.



<PAGE>


Guaranty

                                   SCHEDULE 3

                              Addresses for Notices

Suite 100
148 West State Street
Kennett Square, PA 19348

Attention:  Senior Vice President and
                           Chief Financial Officer

Telephone:  610-444-6350
Facsimile:  610-444-3365



<PAGE>


Guaranty

                                   EXHIBIT A-1

                                 FORM OF JOINDER

                                JOINDER AGREEMENT

         THIS JOINDER AGREEMENT, dated as of (this "Joinder"), is executed by
(the "Additional Guarantor"), with its principal place of business located at .

                                   BACKGROUND

         1. Genesis Eldercare Properties, Inc. ("Lessee"), Mellon Financial
Services Corporation #4 ("Lessor"), the Lenders party thereto, and Mellon Bank,
N.A., as Agent, entered into a Participation Agreement, dated as of July 24,
1996 (as heretofore amended, the "Participation Agreement") pursuant to which
Lessee has made a covenant that it shall cause the Guarantors to execute and
deliver the Guaranty and Agreement of Suretyship Regarding Obligations of Lessee
and Affiliates (the "Guaranty").

         2. The Guaranty and Agreement of Suretyship provides that upon each and
every addition of a Subsidiary as a party to the Credit Agreement, Genesis will
cause this Joinder to be executed and delivered by such Subsidiary to Agent.

         2. The Additional Guarantor desires to become a Guarantor pursuant to
Section 15 of the Guaranty.

         NOW, THEREFORE, in consideration of the foregoing and other good and
valuable consideration, the receipt and sufficiency of which are hereby
acknowledged, the Additional Guarantor hereby agrees as follows:

         Section 1.  Definitions.

         Capitalized terms used herein and not otherwise defined herein shall
have the meanings assigned thereto in the Participation Agreement.

         Section 2.  Operative Documents.

         The Additional Guarantor hereby agrees that it shall be bound by all
the terms and provisions of, and shall be deemed to be a party to (as if it were
an original signatory to), the Guaranty; from and after the date hereof, the
Additional Guarantor shall be a Guarantor of the Liabilities (as defined in



<PAGE>


Guaranty

the Guaranty). The Additional Guarantor hereby acknowledges that it has received
copies of the Participation Agreement, the Guaranty and the other Operative
Documents.

         Section 3.  Miscellaneous.

         This Joinder shall be governed by, and construed in accordance with,
the internal laws of the Commonwealth of Pennsylvania. This Joinder is hereby
executed by the Additional Guarantor for the benefit of Lessor, the Agent and
the Lenders, and each of the foregoing parties may rely hereon. This Joinder
shall be binding upon, and shall inure to the benefit of, the Additional
Guarantor and its successors and permitted assigns.

         IN WITNESS WHEREOF, the undersigned has caused this Joinder to be
executed by its duly authorized officer as of the date and year first above
written.

                                            By:___________________________
                                           
                                            Name:_________________________

                                            Its:__________________________



<PAGE>


Guaranty

                                   EXHIBIT A-2

                                 Form of Release

                               RELEASE OF GUARANTY

         Reference is made to the Guaranty and Agreement of Suretyship Regarding
Obligations of Lessee and Affiliates (the "Guaranty") dated as of July 24, 1996
made by Genesis Health Ventures, Inc. and its Material Subsidiaries for the
benefit of the Beneficiaries. Unless otherwise defined herein, terms used herein
have the meanings assigned to them in Appendix 1 to the Participation Agreement.

         _____________________________ is no longer a party to the Credit
Agreement and thus, pursuant to Section 15 of the Guaranty, Agent hereby
releases _____________________ as a Guarantor under the Guaranty.

Dated:  _______ __, ____

                                        MELLON BANK N.A., as Agent

                                        By:_______________________________

                                        Title:____________________________