Document:

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                                                                    EXHIBIT 10.9
                                                                    (Afton Oaks)
                       TENTH AMENDMENT TO PROMISSORY NOTE

                  This Tenth Amendment to Promissory Note (this "Tenth
Amendment") is effective as of April 1, 2006, by DIVERSICARE AFTON OAKS, LLC, a
Delaware limited liability company (the "Borrower"), and GMAC COMMERCIAL
MORTGAGE CORPORATION, a California corporation (the "Lender").

                                    Recitals

                  A. Diversicare Management Services Co., ("DMSC") executed to
the order of Lender that certain Promissory Note dated December 27, 1996, in the
original principal amount of $3,750,000, as amended by that certain Amendment to
Promissory Note dated November 30, 1999, by that certain Second Amendment to
Promissory Note dated April 30, 2000, by that certain Third Amendment to
Promissory Note dated June 30, 2000, by that certain Memorandum of Lender dated
September 8, 2000, by that certain Fourth Amendment to Promissory Note dated
September 29, 2000, by that certain Fifth Amendment to Promissory Note dated
December 31, 2000, by that certain Memorandum of Lender dated January 26, 2001,
by that certain Sixth Amendment to and Assumption of Promissory Note dated
February 28, 2001, by that certain Seventh Amendment to Promissory Note dated
December 23, 2002, by that certain Eighth Amendment to Promissory Note dated
March 31, 2004, and by that certain Ninth Amendment to Promissory Note dated
April 1, 2005 (the "Note"). Pursuant to the terms of the Sixth Amendment to and
Assumption of the Promissory Note dated February 28, 2001, the Note was assumed
by the Borrower. Unless otherwise defined herein, capitalized terms shall have
the meanings assigned to them in the Note.

                  B. The Note matures on April 1, 2006.

                  C. The Borrower has requested that the Lender renew the debt
evidenced by the Note and extend the maturity date of the Note, and the Lender
has agreed to such renewal and extension on certain conditions, one of which is
the execution of this Tenth Amendment by the Borrower.

                                    Agreement

                  NOW, THEREFORE, in consideration of the above Recitals, the
Borrower and the Lender hereby amend the Note as follows:

         1. Section 4 of the Note, Maturity Date, is hereby amended to extend
the Maturity Date to July 1, 2006. All references in the Note to the "Maturity
Date" are hereby amended to mean July 1, 2006.

         Except as expressly amended herein, the Note shall remain in full force
and effect in accordance with its terms and conditions.

                                       1
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         Notwithstanding the execution of this Tenth Amendment, the indebtedness
evidenced by the Note shall remain in full force and effect, and nothing
contained herein shall be interpreted or construed as resulting in a novation of
such indebtedness. The Borrower acknowledges and agrees that there are no
offsets or defenses to payment of the obligations evidenced by the Note, as
hereby amended, and hereby waives any defense, claim or counterclaim of the
Borrower regarding the obligations of the Borrower under the Note, as hereby
amended. The Borrower represents that there are no conditions of default or
facts or consequences which will or could lead to a default under the
obligations due from the Borrower under the Note, as amended herein, except as
disclosed by Borrower and Diversicare Management Services Co. in that certain
Quarterly Compliance Statement & Census Data report and that certain Compliance
Certificate, each for the period ending September 30, 2005, and signed by
Borrower's Chief Financial Officer and Vice President.

                  [SIGNATURES BEGIN ON THE FOLLOWING PAGE]

                                       2

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                  IN WITNESS WHEREOF, the Borrower and Lender have caused this
Tenth Amendment to be executed by their respective duly authorized
representatives, as of the date first set forth above.

                                BORROWER:

                                DIVERSICARE AFTON OAKS, LLC, a Delaware
                                limited liability company

                                By: Diversicare Leasing Corp., its sole member

                                /s/ Glynn Riddle
                                --------------------------------------------
                                Glynn Riddle,
                                Chief Financial Officer

                                LENDER:

                                GMAC COMMERCIAL MORTGAGE CORPORATION,
                                a California corporation

                                By /s/ Laura Y. McDonald
                                   -----------------------------------------
                                  Its Senior Vice President
                                      --------------------------------------

         The Guarantor joins in the execution of this Tenth Amendment to confirm
its acknowledgment and agreement to the terms contained herein.

                                GUARANTOR:

                                ADVOCAT INC., a Delaware corporation

                                        By: /s/ Glynn Riddle
                                            --------------------------------
                                            Its:  _________________________

                                       3<PAGE>
                                                                   EXHIBIT 10.10
                        FIRST AMENDMENT TO LOAN AGREEMENT

                  This First Amendment to Loan Agreement is effective as of
April 1, 2006, by and between DIVERSICARE PINEDALE, LLC, a Delaware limited
liability company (together with its successors and assigns, the "Borrower"),
and GMAC COMMERCIAL MORTGAGE CORPORATION, a California corporation (together
with its successors and assigns, the "Lender").

                                    RECITALS:

                  A. Borrower and the Lender entered that certain Loan Agreement
dated March 29, 2001 (the "Agreement"). Unless otherwise defined in this First
Amendment, capitalized terms shall have the meaning given to them in the
Agreement.

                  B. The Borrower and the Lender desire to amend the Agreement
and have agreed to execute this First Amendment to evidence such modification.

                                    AGREEMENT

                  NOW, THEREFORE, in consideration of the above Recitals, the
Borrower and the Lender hereby amend the Agreement as follows:

                  1. Paragraph 1.1, "Maturity Date" is hereby amended by
changing the date to "July 1, 2006".

                  Except as expressly amended hereby, the Agreement shall remain
in full force and effect in accordance with its terms.

                                       1

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                  IN WITNESS WHEREOF, the Borrower and the Lender have caused
this First Amendment to be properly executed by their respective duly authorized
officers as of the date first above written.

                                   DIVERSICARE PINEDALE, LLC, a Delaware limited
                                   liability company

                                   By: Diversicare Leasing Corp., a Tennessee
                                   corporation
                                   Its: Sole Member

                                            By: /s/ Glynn Riddle
                                                --------------------------------
                                                Glynn Riddle,
                                                Chief Financial Officer

                                   GMAC COMMERCIAL MORTGAGE
                                   CORPORATION, a California corporation

                                   By /s/ Laura Y. McDonald
                                      ------------------------------------------
                                     Its Senior Vice President
                                         ---------------------------------------

                                       2<PAGE>
                                                                   EXHIBIT 10.11

                       FIRST AMENDMENT TO PROMISSORY NOTE

         THIS FIRST AMENDMENT TO PROMISSORY NOTE (this "First Amendment") is
entered into as of the 1st day of April, 2006, by and between DIVERSICARE
PINEDALE, LLC, a Delaware limited liability company (the "Borrower"), and GMAC
COMMERCIAL MORTGAGE CORPORATION, a California corporation (the "Lender").

                                    RECITALS

             A. The Borrower executed to the order of the Lender that certain
Promissory Note dated March 29, 2001, in the principal amount of $2,913,000 (the
"Note"). Unless otherwise defined herein, capitalized terms shall have the
meaning assigned to them in the Note.

             B. The Borrower has requested that the Lender extend the Maturity
Date of the Note, and the Lender has agreed, upon certain conditions, one of
which is the execution of this First Amendment.

                                    AGREEMENT

         NOW, THEREFORE, in consideration of the above Recitals and other good
and valuable consideration, the Borrower and the Lender hereby amend the Note as
follows:

             Section 4 of the Note, Maturity Date, is hereby amended to extend
the Maturity Date from April 1, 2006 until July 1, 2006. All references in the
Note to the "Maturity Date" are hereby amended to mean July 1, 2006.

         Except as expressly amended herein, the Note shall remain in full force
and effect in accordance with its terms and conditions.

         Notwithstanding the execution of this First Amendment, the indebtedness
evidenced by the Note shall remain in full force and effect, and nothing
contained herein shall be interpreted or construed as resulting in a novation of
such indebtedness. The Borrower acknowledges and agrees that there are no
offsets or defenses to payment of the obligations evidenced by the Note, as
hereby amended, and hereby waives any defense, claim or counterclaim of the
Borrower regarding the obligations of the Borrower under the Note, as hereby
amended. The Borrower represents that there are no conditions of default or
facts or consequences which will or could lead to a default under the
obligations due from the Borrower under the Note, as amended herein, except as
disclosed by Borrower and Diversicare Management Services Co. in that certain
Quarterly Compliance Statement & Census Data report and that certain Compliance
Certificate, each for the period ending September 30, 2005, and signed by
Borrower's Chief Financial Officer and Vice President.

                                       1
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         IN WITNESS WHEREOF, the Borrower and Lender have caused this First
Amendment to be executed by their respective duly authorized representatives, as
of the date first set forth above.

                                      BORROWER:

                                      DIVERSICARE PINEDALE, LLC, a Delaware
                                      limited liability company

                                      By: Diversicare Leasing Corp., a Tennessee
                                      corporation
                                      Its: Sole Member

                                      By: /s/ Glynn Riddle
                                          --------------------------------------
                                             Glynn Riddle,
                                             Chief Financial Officer

                                      LENDER:

                                      GMAC COMMERCIAL MORTGAGE CORPORATION,
                                      a California corporation

                                      By /s/ Laura Y. McDonald
                                         ---------------------------------------
                                        Its Senior Vice President
                                            ------------------------------------

                                       2

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