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                                                                   Exhibit 10.20

                       SECOND AMENDMENT TO LEASE AGREEMENT

      THIS SECOND AMENDMENT TO LEASE AGREEMENT ("Amendment") is made and entered
into as of this 25th day of October, 1999, by and between McCormick Place,
L.L.C., an Arizona limited liability company ("Landlord"), and VistaCare, Inc. a
Delaware corporation ("Tenant").

1.    RECITALS

      1.1   Landlord and Tenant entered into a Lease Agreement dated April 12,
            1999 which was modified by First Amendment to Lease Agreement dated
            August 31, 1999 (the "Lease"), wherein Landlord leased to Tenant the
            Third Floor with 25,774 rentable square feet at 8125 North Hayden
            Road, Scottsdale, Arizona, 85258 (the "Premises"). The Lease
            Agreement, as amended, is hereinafter referred to as the "Lease".

      1.2   By this Second Amendment to Lease Agreement, the parties desire to
            further amend the Lease on the terms and conditions hereafter set
            forth.

      1.3   Except as specifically defined in this Amendment, all capitalized
            terms shall have the same meaning as set forth in the Lease.

      NOW, THEREFORE, the parties hereto, for good and valuable consideration,
the receipt and adequacy of which is hereby acknowledged, state, confirm and
agree as follows:

2.    AGREEMENT

      2.1   Article 13 Use of Premises/Rules and Regulation modified by:

            (a)   deleting all of Section 13.5 and inserting the following in
                  lieu thereof: "13.5 Sections 13.3(d) and 14(b) of the Lease
                  notwithstanding, Landlord agrees Tenant may install a sign
                  consisting of the lettering "VistaCare", using Tenant's
                  style and logo, on the building facade, at Tenant's sole
                  cost, as shown on Exhibit "F-1", with letters not larger
                  than thirty inches (30"). Interior lobby signage directing
                  visitors to the Tenant on the third floor shall be as shown
                  on Exhibit "F-2" or as otherwise reasonably approved by
                  Landlord and Tenant. Tenant's cost for its
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                  exterior and interior signs and installation may, at Tenant's
                  election be paid out of the Leasehold Improvement Allowance.
                  Tenant may change its signs to reflect any change in Tenant's
                  name or identity. Tenant's sign design and installation, and
                  any changes in Tenant's exterior sign, shall be subject to
                  Landlord's reasonable approval and exterior signs shall also
                  be subject to approval by McCormick Ranch Property Owners'
                  Association. Tenant's sign or lettering shall comply with all
                  ordinances, regulations and orders of the City of Scottsdale,
                  Arizona ("City"). Landlord makes no warranty as to approval of
                  Tenant's sign by the City and denial of a sign permit by the
                  City shall impose no additional obligations upon Landlord.
                  Tenant's sign shall be removed upon Tenant's vacation of the
                  Premises for a period of twelve months with or without
                  termination of the Lease or acceptance of the Premises by
                  Landlord, but may be reinstalled upon Tenant (or its
                  successor) resuming occupancy of the Third floor Premises.

      2.2   Exhibits "F-1" and "F-2" attached hereto are added as part of the
            Lease.

      2.3   As amended herein, all of the terms and conditions of the Lease are
            hereby ratified and confirmed in their entirety.

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

LANDLORD:

MCCORMICK PLACE, L.L.C.

An Arizona limited liability company

BY: /s/ Robert G. Mayfield
       _________________________

         Robert G. Mayfield

         Its: Member
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TENANT:

VistaCare, Inc.

A Delaware corporation

BY: /s/ David Daucher
       _________________________

Its: CFO<PAGE>
                                                                   Exhibit 10.21

             EMPLOYEE CONFIDENTIALITY AND NON-COMPETITION AGREEMENT

      In consideration of and as a condition of my employment by Vista Hospice
Care, Inc. (the "Company") and the promise by the Company to pay me twelve
months salary as severance pay in the event of my termination of employment with
the Company, I hereby covenant, warrant and agree as follows:

      1.    During the period of my employment by the Company, I will
            devote my full time and best efforts to the business of
            the Company. I will not, until after my employment by the
            Company is terminated, undertake or engage in any other
            employment, occupation or business enterprise; provided,
            however, that I will be permitted to engage in any
            activities permitted by Section 2.

      2.    During the period commencing on the date hereof and
            including the date that is twelve months after the date on
            which I, for any reason, cease to be employed by the
            Company (the "Non-Competition Period"), within any
            geographic area in which I have responsibilities for the
            Company and the Company then does business or, known to
            me, then proposes to enter into business within one year
            (the "Non-Competition Territory") neither I nor any entity
            in which I may be interested as a partner, trustee,
            director, officer, employee, shareholder, option holder,
            lender of money or guarantor shall be engaged directly in
            any business that is in direct competition in the hospice
            field with the business of the Company during the period
            of employment, and that for a period of one year after the
            termination of my employment, neither I nor any entity in
            which I may be interested will deal with any actual or
            prospective customers of the Company of which I have
            knowledge.

      3.    I shall not any time during or after the term of this
            Agreement directly or indirectly divulge, furnish, use,
            publish or make accessible to any person or entity any
            Confidential Information (as hereinafter defined) except
            in the performance of my duties hereunder. Any records of
            Confidential Information prepared by me or which come into
            my possession during the term of this Agreement are and
            remain the property of the Company and upon termination of
            my employment all such records and copies thereof shall be
            either left with or returned to the Company.
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      4.    The term "Confidential Information" shall mean information
            disclosed to me or known, learned, created or observed by
            me as a consequence of or through my employment by the
            Company, not generally known in the relevant trade or
            industry, about the Company's business activities,
            services and processes, including but not limited to
            information concerning methods of doing business,
            marketing, advertising, promotion, publicity, research,
            finances, accounting, trade secrets, business plans,
            customer lists, and records and potential customers.
            Confidential Information shall also include information
            about third parties provided to the Company under a
            confidentiality agreement or arrangement.

      5.    I will not, during the Non-Competition Period, hire or
            offer to hire or entice away or in any other manner
            persuade or attempt to persuade, either in my individual
            capacity or as agent for another, any of the Company's
            officers, employees, or agents to discontinue their
            relationship with the Company nor contact, solicit or
            divert or attempt to divert from the Company any business
            whatsoever by influencing or attempting to influence any
            customer or account of the Company of which I have
            knowledge at the time of termination of my employment.

      6.    I understand that this Agreement does not create an
            obligation on the Company or any person to continue my
            employment.

      7.    Any waiver by the Company of a breach of any provision of
            this Agreement shall not operate or be construed as a
            waiver of any subsequent breach hereof.

      8.    The term "Company" shall include Vista Hospice Care, Inc.,
            its predecessor Vista Hospice Care, L.L.C., its parent
            organization, and any of its subsidiaries, subdivisions or
            affiliates. The Company shall have the right to assign
            this Agreement to its successors and assigns, and all
            covenants and agreements hereunder shall inure to the
            benefit of and be enforceable by said successors and
            assigns.

      9.    This Agreement shall be governed by, and construed in
            accordance with the laws of the State of Delaware.

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      IN WITNESS WHEREOF, the parties hereto have executed this Employee
Confidentiality and Non-Competition Agreement as of the 22nd day of November,
1995.

                                    Accepted by:     /s/ Barry M. Smith
                                                ----------------------------

                                    Name:       Barry M. Smith
                                         -----------------------------------

                                    Street:     5801 Bermil Lane,
                                           ---------------------------------
                                                Paradise Valley, AZ  85253
                                    ----------------------------------------

VISTA HOSPICE CARE, INC.

By:   /s/ Roseanne Berry
   ---------------------------------

Title:      V.P. of Administration
      ------------------------------

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