<PAGE>


           AMENDMENT TO WORKING CAPITAL LOAN AND SECURITY AGREEMENT
           --------------------------------------------------------

                  This AMENDMENT TO WORKING CAPITAL LOAN AND SECURITY
AGREEMENT (this "Amendment") is made and entered into as of this 30th day of
January 1998, by and among AGE INSTITUTE OF FLORIDA, INC., a Florida
non-profit corporation (together with its successors in interest and assigns,
"Borrower"), GENESIS HEALTH VENTURES, INC., a Pennsylvania business
corporation (together with its successors in interest and assigns, "Genesis"),
and ET CAPITAL CORP., a Delaware corporation (together with its successors in
interest and assigns, "ET Capital"; Genesis and ET Capital are sometimes
collectively referred to herein as "Lenders").


                                  BACKGROUND
                                  ----------

                  A. On August 31, 1996, Borrower acquired from Edgemont
Partners, L.P. eleven (11) health care facilities located in the State of
Florida (the "Facilities").

                  B. Borrower and Genesis entered into that certain Working
Capital Loan and Security Agreement, dated as of August 31, 1996 (the
"Agreement"), whereby Genesis agreed to provide Borrower with a loan in the
maximum principal amount of $10,000,000 (the "Loan") for the working capital
needs of the Facilities.

                  C. The Loan was evidenced by a Promissory Note, dated as of
August 31, 1995 (the "Note"), payable to the order of Genesis in the maximum
principal amount of $10,000,000.

                  D. Pursuant to that certain Assignment and Assumption
Agreement, dated as of the date hereof (the "Assignment"), among Genesis, ET
Capital and Borrower, Genesis sold and ET Capital purchased a portion of the
principal amount of the Note equal to $7,500,000, and ET Capital assumed the
rights and obligations of a lender under the Agreement.

                  E. Contemporaneously with the execution and delivery hereof,
Borrower is executing and delivering (i) the Amended and Restated Promissory
Note, dated the date hereof, payable to the order of ET Capital in the
principal amount of $7,500,000 (the "ET Capital Note") and (ii) the Amended
and Restated Promissory Note, dated the date hereof, payable to the order of
Genesis in the principal amount of $2,500,000 (the "Genesis Note").

                  F. Borrower and Lenders have agreed to amend certain
provisions of the Agreement as set forth herein.
<PAGE>

                  G. As security for Borrower's obligations to Lenders,
Borrower has agreed to execute and deliver a Second Mortgage, Assignment of
Rents and Security Agreement in favor of Genesis, as agent on behalf of the
Lenders.


                                     TERMS
                                     -----

                  NOW, THEREFORE, in consideration of the terms and conditions
set forth herein, and of any loans, advances, or extensions of credit
heretofore, now or hereafter made to or for the benefit of Borrower by
Lenders, and intending to be legally bound hereby, the parties hereto agree as
follows:

         1.       Definitions.
                  ------------

                  1.1      All capitalized terms used and not otherwise defined
herein shall have the meanings set forth in the Agreement.

                  1.2 The Agreement is hereby amended such that all references
in the Agreement to "Lender" shall be deemed to be references to "Lenders", as
such term is defined in this Amendment.

                  1.3 The Agreement is hereby amended such that all references
in the Agreement to "Note" shall be deemed to refer collectively to the ET
Capital Note and the Genesis Note.

         2.       Amendment to Expiration Date.
                  -----------------------------

                  Section 1.1 of the Agreement is hereby amended by deleting
in the first sentence thereof "August 31, 2001" as the Expiration Date, and
replacing it with "August 31, 2007."

         3.       Elimination of Revolving Nature of the Loan.
                  --------------------------------------------

                  Section 1.1 of the Agreement is further amended by deleting
the last sentence of such Section in its entirety and replacing it with the
following sentence:

                  "Borrower shall be permitted to repay amounts drawn
hereunder, but shall not be permitted to draw again upon such amounts repaid."

         4.       Amendment to Security Interest Provisions.
                  ------------------------------------------

                  4.1 The parties hereto acknowledge that, pursuant to the
Assignment, Lenders have appointed ET Capital to act as their agent under the
Agreement, including, without limitation, with respect to the security
interests granted thereunder.

                                      2
<PAGE>

                  4.2      Section 1.5(a) of the Agreement is hereby amended by
deleting the first sentence of such sentence in its entirety and replacing it
with the following:

                  "Borrower hereby grants to ET Capital, as agent on behalf of
Lenders, a second priority lien and security interest on all of Borrower's
Gross Patient Accounts Receivable and other personal property utilized in the
Facilities or in connection with the operation thereof, tangible or
intangible, whether now owned or hereafter acquired, documents, contracts,
guarantees, books and records, processing cards, tapes, tabulating runs,
programs and similar material related thereto, together with all products and
replacements thereof and all proceeds of any of the foregoing (collectively,
"Personal Property" and the "Collateral"). Such lien and security interest
shall be held by ET Capital for the benefit of the Lenders in accordance with
the provisions of the Assignment."

         5.       Amendment to Notice Provision.
                  ------------------------------

         Section 9.1 of the Agreement is amended by adding the following to
the end of subsection (B) of such Section:

         "and a copy to:

         ET Capital Corp.
         415 McFarlan Rd., Suite 202
         Kennett Square, Pennsylvania  19348
         Attention:  President"

         6.       Successors and Assigns.
                  -----------------------

                  This Amendment shall be binding upon and inure to the
benefit of Borrower and Lenders and their respective successors and assigns,
except that Borrower shall not have the right to assign its rights hereunder
or any interest herein without the prior written consent of Lenders.

         7.       Ratification of Agreement.
                  --------------------------

                  Other than as specifically amended hereby and pursuant to
the Assignment, the Agreement is and shall continue to be in full force and
effect and is hereby ratified and confirmed in all respects.

         8.       Counterparts.
                  -------------

                  This Amendment may be executed in two or more counterparts,
each of which shall be deemed an original, but all of which taken together
shall constitute one and the same instrument.

                                      3
<PAGE>

         9.       Governing Law.
                  --------------

                  This Amendment and the rights and obligation of the parties
hereunder shall be governed by, and construed and interpreted in accordance
with, the laws of the State of Florida.

                  IN WITNESS WHEREOF, the parties hereto have caused this
Agreement to be executed by their respective officers thereunto duly
authorized, as of the date first above written.



ATTEST:                                           AGE INSTITUTE OF FLORIDA, INC.



                  /s/ Harry D. Madonna            /s/ Carol A. Tschop
--------------------------------------            ------------------------------
Name:             Harry D. Madonna                Name: Carol A. Tschop
Title:            Secretary                       Title: President


ATTEST:                                           GENESIS HEALTH VENTURES, INC.



                  /s/ Ira C. Gubernick                     /s/ Michael R. Walker
--------------------------------------            ------------------------------
Secretary                                         Name:    Michael R. Walker
                                                  Title:   Chairman & CEO


WITNESS:                                                ET CAPITAL CORP.



                  /s/ Deborah Gianoulis           /s/ Edward B. Romanov, Jr.
---------------------------------------           ------------------------------
Name:        Deborah Gianoulis                    Name:  Edward B. Romanov, Jr.
                                                  Title:    President & CEO






                                      4