Exhibit 10.54

                                 AGREEMENT AND WAIVER


               This AGREEMENT AND WAIVER (this "Agreement") dated as of
          September 2, 1993, by and among National Medical Enterprises,
          Inc., a Nevada corporation ("NME"), the subsidiaries of NME which
          are signatories hereto, The Hillhaven Corporation, a Nevada
          corporation ("Hillhaven"), and First Healthcare Corporation, a
          Delaware corporation ("FHC").

                                     WITNESSETH:

               WHEREAS, pursuant to that certain Revolving Credit and Term
          Loan Agreement dated as of January 31, 1990 between NME and
          Hillhaven, as amended by that certain First Amendment thereto
          dated as of November 12, 1992 (as amended, the "Revolving Credit
          Agreement"), NME agreed to make certain loans to Hillhaven
          through May 31, 1994 subject to the conditions set forth therein;
          and 

               WHEREAS, pursuant to that certain Commitment Letter dated
          May 31, 1990, between NME and FHC, as amended by that certain
          Amendment No. One thereto dated as of May 1, 1991 (as amended,
          the "Commitment Letter"), NME agreed to make certain loans to FHC
          subject to the conditions set forth therein; and

               WHEREAS, pursuant to that certain Master Loan Agreement
          dated as of April 1, 1992 among the lenders parties thereto, NME,
          FHC and Hillhaven, as amended by that certain First Amendment
          thereto dated as of November 12, 1992 (as amended, the "Master
          Loan Agreement"), the lenders which were parties thereto agreed
          to finance up to 100% of the purchase price of the facilities
          referred to therein; and

               WHEREAS, pursuant to that certain Guaranty dated as of April
          1, 1992 from Hillhaven in favor of the lenders listed thereon
          (the "Master Loan Agreement Guaranty"), Hillhaven guaranteed the
          obligations of FHC under the Master Loan Agreement; and

               WHEREAS, pursuant to that certain Master Loan Agreement for
          Purchase of Nine Facilities dated as of June 1, 1992 among the
          lenders parties thereto and FHC (the "Second Master Loan
          Agreement"), the lenders which were parties thereto agreed to
          finance up to 100% of the purchase price of the facilities
          referred to therein; and

               WHEREAS, pursuant to that certain Guaranty dated as of June
          1, 1992 from Hillhaven in favor of the lenders listed thereon
          (the "Second Master Loan Agreement Guaranty"), Hillhaven
          guaranteed FHC's obligations under the Second Master Loan
          Agreement; and

               WHEREAS, pursuant to that certain Promissory Note dated
          January 31, 1990 (the "Promissory Note") by FHC in favor of NME
          Properties Corp., a Tennessee corporation (formerly known as The
          Hillhaven Corporation), FHC owes certain monies to NME Properties
          Corp.; and 
          

 
               WHEREAS, pursuant to that certain Note Guarantee Agreement
          dated as of January 31, 1990 among Hillhaven, NME and the payees
          identified therein (the "Note Guarantee Agreement"), Hillhaven
          guaranteed FHC's obligations under the Promissory Note; and 

               WHEREAS, Hillhaven is restructuring its relationship with
          NME to, inter alia, repay amounts owing to NME pursuant to the
          Master Loan Agreement, the Second Master Loan Agreement and the
          Promissory Note, and terminate NME's commitment to loan funds
          pursuant to the Revolving Credit Agreement and the Master Loan
          Agreement; and

               WHEREAS, in connection therewith the parties desire to
          eliminate NME's commitments under the Revolving Credit Agreement,
          and the Master Loan Agreement, and to terminate Hillhaven's
          obligations under the Master Loan Agreement Guaranty, Second
          Master Loan Agreement Guaranty and Note Guarantee Agreement; and

               WHEREAS, the aforesaid restructuring will be financed
          through (1) the issuance by Hillhaven to NME or its subsidiaries
          of $120 million of a newly created series of payable-in-kind
          preferred stock, (2) the incurrence by FHC of up to $360 million
          of indebtedness in the form of term loans, letters of credit and
          working capital loans under a secured credit facility with Morgan
          Guaranty Trust Company of New York and a syndicate of other
          lenders (the "Bank Financing"), (3) the sale by Hillhaven of
          senior subordinated notes in the approximate amount of $175
          million (the "Notes"), (4) the extension of FHC's commercial
          paper program backed by certain of its (and certain of its
          subsidiaries') Medicaid accounts receivable and increase in
          permitted borrowings under such program from $30.0 million to
          $40.0 million and (5) the use of available cash; and

               WHEREAS, in connection with the Bank Financing, Hillhaven
          has transferred its bank accounts to FHC; and

               WHEREAS, pursuant to Sections 5(a), 5(b) and 5(i) of that
          certain Guarantee Reimbursement Agreement, as amended (as so
          amended, the "Guarantee Reimbursement Agreement"), Hillhaven
          agreed, inter alia, to certain covenants which may be violated as
          a result of the Bank Financing, the Notes and the transfer of
          bank accounts to FHC;

               NOW, THEREFORE, in consideration of the foregoing recitals
          and for other good and valuable consideration, the receipt and
          adequacy of which are hereby acknowledged, the parties hereto
          intending to be legally bound, hereby agree as follows:

               1.   Termination of Obligations to Lend.  NME's obligations
          to loan funds to Hillhaven under the Revolving Credit Agreement,
          the Master Loan Agreement, the Second Master Loan Agreement, the
          Promissory Note and the Commitment Letter shall terminate as of
          the date hereof.  

               2.   Termination of Guarantees.  Hillhaven's obligations
          under the Master Loan Agreement Guaranty, Second Master Loan
          Agreement Guaranty and Note Guarantee Agreement shall terminate
          as of the date hereof.  

          

 
               3.   Waiver.  NME hereby waives compliance with the
          following provisions of the Guarantee Reimbursement Agreement:

                    (a)  Sections 5(a) and 5(b) of the Guarantee
                         Reimbursement Agreement are hereby waived to the
                         extent necessary to permit (i) the transactions
                         contemplated by the Bank Financing, including the
                         placement of mortgages on facilities owned by FHC
                         or its subsidiaries, the substitution of
                         facilities as collateral and any subsequent
                         addition of collateral, and (ii) the issuance of
                         the Notes.

                    (b)  Section 5(i) of the Guarantee Reimbursement
                         Agreement is hereby waived to the extent necessary
                         to permit Hillhaven to transfer any or all of its
                         bank accounts to FHC.

               4.   Costs.  Each party shall bear its own cost and expenses
          in connection with the transactions contemplated in this
          Agreement.  
               5.   Cooperation.  The parties agree to execute and deliver
          such other documents and instruments and do all such other acts
          and things as may be reasonably required to give effect to the
          agreements contained in this Agreement.

               6.   Amendment.  No amendment or modifications of this
          Agreement shall be effective unless in writing signed by the
          parties.

               7.   Governing Law.  This Agreement shall be governed by and
          construed in accordance with California law.  

               8.   Counterparts.  This Agreement may be executed in
          counterparts, each of which shall be an original, but all of
          which together shall constitute but one and the same instrument.

               9.   No Further Waiver.  The waivers set forth herein shall
          be effective only for the specific purposes for which given.

               IN WITNESS WHEREOF, each of the parties hereto has caused
          this Agreement to be duly executed on its behalf as of the date
          first set forth above.



                                        NATIONAL MEDICAL ENTERPRISES, INC.,
                                        a Nevada corporation


                                        By: /s/ Timothy Pullen              
                
                                        Its: Vice President 






          

 
                                        NME PROPERTIES CORP.,
                                        a Tennessee corporation


                                        By: /s/ Timothy Pullen              
                
                                        Its: Vice President 


                                        NME PROPERTIES, INC.,
                                        a Delaware corporation


                                        By: /s/ Timothy Pullen              
                
                                        Its: Vice President 


                                        NME PROPERTY HOLDING CO., INC.,
                                        a Delaware corporation


                                        By: /s/ Timothy Pullen              
                
                                        Its: Vice President 


                                        NME PROPERTIES WEST, INC.,
                                        a Delaware corporation

                                        By: /s/ Timothy Pullen              
                
                                        Its: Vice President 


                                        HAMMOND HOLIDAY HOME, INC.,
                                        a Kansas corporation

                                        By: /s/ Timothy Pullen              
                
                                        Its: Vice President 


                                        SEDGWICK CONVALESCENT CENTER, INC.,
                                        a Kansas corporation

                                   
                                        By: /s/ Timothy Pullen              
                
                                        Its: Vice President 


                                        NORTHWEST CONTINUUM CARE 
                                           CENTER, INC.,
                                        a Washington corporation

                                        By: /s/ Timothy Pullen              
                
                                        Its: Vice President 
          

 
                                        FLAGG INDUSTRIES, INC.,
                                        a California corporation


                                        By: /s/ Timothy Pullen              
                
                                        Its: Vice President 


                                        GUARDIAN MEDICAL SERVICES, INC.,
                                        a North Carolina corporation

                                        By: /s/ Timothy Pullen              
                
                                        Its: Vice President 


                                        NHE ARIZONA, INC., 
                                        an Arizona corporation

                                        By: /s/ Timothy Pullen              
                
                                        Its: Vice President 


                                        LAKE HEALTH CARE FACILITIES, INC.,
                                        a Delaware corporation

                                        By: /s/ Timothy Pullen              
                
                                        Its: Vice President 


                                        THE HILLHAVEN CORPORATION,
                                        a Nevada corporation

                                        By: /s/ Robert K. Schneider         
                     
                                        Its: Vice President & Treasurer


                                        FIRST HEALTHCARE CORPORATION
                                        a Delaware corporation

                                        By: /s/ Robert K. Schneider         
                    
                                        Its: Vice President & Treasurer