EXHIBIT 10.5


                        AMENDMENT TO SETTLEMENT AGRFEMENT

         Amendment  (this  "Amendment"),  dated  as  of  June  29,  2000,  among
Integrated Health Services, Inc. and each of its direct or indirect subsidiaries
executing this Amendment,  and Senior Housing  Properties  Trust and each of its
direct or indirect  subsidiaries  executing this Amendment,  Advisors Healthcare
Group, Inc. and Five Star Quality Care, Inc.

                                   BACKGROUND

         WHEREAS,  the  parties  hereto are all of the  parties to a  Settlement
Agreement,  dated as of April 11.  2000 (the  "Settlement  Agreement"),  and the
parties  desire  to  clarify  and amend  certain  provisions  of the  Settlement
Agreement; and

         WHEREAS,  concurrently  herewith the parties hereto are entering into a
Stipulation  with the United  States  Department  of Health  and Human  Services
Regarding  Treatment  of  Medicare  Provider  Agreements  Pertaining  to Certain
"Transfer Facilities" and Order Thereon (the "Stipulation");

         NOW THEREFORE, in consideration of the premises, and for other good and
valuable  consideration,   the  receipt  and  sufficiency  of  which  is  hereby
acknowledged by the parties hereto,  the parties hereto,  intending to be bound,
hereby agree as follows:

         1. Capitalized  terms used herein and not otherwise  defined herein are
used with the meanings ascribed to such terms in the Settlement Agreement.

         2. The Settlement Agreement,  including without limitation,  Exhibits C
and D and all other  exhibits and  schedules  to the  Settlement  Agreement,  is
hereby amended to the extent necessary, to reflect that:

              (a) instead of entering into a Sublease with  Shopco-KS,  LLC (the
"Proposed New Kansas  Operator") of the Demised Premises  relating to the IHS of
Woodhaven Facility, in Ellinwood,  Kansas (the "Kansas Facility"), ECA Holdings,
Inc.  ("ECA") will directly lease said Demised  Premises from SPTIHS  Properties
Trust (the "Kansas Landlord") pursuant to a lease that will have all of the same
substance as the Sublease  except that ECA will be the direct tenant  thereunder
(instead of the Sublessee) and the Kansas  Landlord shall be the direct landlord
thereunder  (instead  of the  Proposed  New  Kansas  Operator  as the  Sublessor
thereunder);

              (b) instead of the Manager subcontracting obligations with respect
to the  Kansas  Facility  to  ECA in the  capacity  as the  Servicer  under  the
Management  Agreement,  ECA shall retain such obligations in its capacity as the
Relevant  Licensee until such time as the Proposed New Kansas  Operator  becomes
the Relevant  Licensee with respect to the Kansas  Facility,  in which case, ECA
shall  thereafter  satisfy only such  obligations in its capacity as Servicer as
shall not require a license  under the  applicable  laws of the State of Kansas;
provided, however, that the foregoing amendment shall not be deemed to change in
any respect any of the  obligations  of any of the parties under the  Management
Agreement,  but shall only serve to clarify  the  capacity in which ECA shall be
acting;

                                      -2-

              (c) the Demised  Premises to be sublet  pursuant to the  Subleases
and the Kansas Lease shall  include all of the personal  property  necessary for
the  operation of the Facility to which the Sublease or Kansas Lease  relates to
the extent that the  applicable  Sublessor  or, in the case of the Kansas Lease,
the Kansas Landlord, has any right, title or interest therein;

              (d) that neither CCA  Acquisition  1, Inc. nor  Community  Care of
America,  Inc. shall be a party to the Settlement  Agreement and neither of them
shall be deemed to be an IHS Acquisition Subsidiary;

              (e) Section 12.1 of the Management and Servicing  Agreement  shall
be  amended  in full to  provide  that  neither  the  Management  and  Servicing
Agreement nor any of the terms thereof may be terminated, amended, supplemented,
waived or modified  orally,  but only by an instrument in writing signed by each
party (x)against whom the enforcement of the termination, amendment, supplement,
waiver or modification  shall be sought or (y) who is affected (or whose rights,
obligations   or  remedies  are  affected)  by  such   termination,   amendment,
supplement, waiver or modification;

              (f) under Section 3.2.5(i) of the Settlement Agreement,  if SPTIHS
or HRES1  designates  a New LLC  Operator  as the  entity  to  which a  relevant
Mortgaged Facility is to be conveyed as provided therein, then the instrument of
conveyance  shall be a quitclaim  deed (rather than a quitclaim  deed in lieu of
foreclosure);

              (g) no recoupment,  offset or other payment of the Cure Amount (as
such  term is  defined  in the  Stipulation),  and no  release  or waiver of any
underpayment  claim pursuant to the  Stipulation,  shall  constitute a Reduction
Claim (as such term is defined in the Management and Servicing  Agreement),  and
no IHS Entity shall have any liability with respect thereto;

              (h) the amount of the monthly  payment  referred to in Section 3.3
of the Settlement Agreement shall be $600,000 in lieu of $500,000;

              (i) the SNH  Entities  acknowledge  that the  Facility  located in
Palmer,  Nebraska  has been closed and the SNH  Entities  waive any  breaches of
representations,  warranties and covenants and any closing conditions that arise
by reason of such closure;

              (j) the IHS Entities shall withdraw the Debtors' motions described
on  Schedule  A hereto  promptly  after  the  Closing  documents  are  executed,
delivered and the Closing  occurred,  and the SNH Entities  shall withdraw SNH's
motions  described on Schedule B hereto promptly after the Closing documents are
executed, delivered and the Closing occurred;

              (k) the  Closing  Date for the  transactions  contemplated  by the
Settlement  Agreement shall be deemed to be June 30, 2000 and the Effective Time
will be deemed to be 12:01 a.m.  (Boston  time) on July 1, 2000  notwithstanding
that the Closing documents may be executed,  delivered, and the Closing occur on
a later date; provided, however, that this subsection (k) shall have no force or
effect if the Closing  documents  are not, in all material  respects,  executed,
delivered and the Closing occur on or prior to July 15, 2000;



                                      -3-

              (l) subject to the  occurrence  of the  Closing,  the IHS Entities
assign,  set over,  and convey to such  entities as SNH may designate any right,
title and  interest  any of them may have to any  underpayment  claim  under the
Nebraska  Medicaid  program (or if such claim  cannot be assigned in  accordance
with applicable law, the proceeds  thereof) arising out of any services provided
by any  Facility  in  Nebraska  on or prior  to the  Effective  Time  and  shall
cooperate  fully and take all reasonable  actions  requested by the SNH Entities
with regard to the collection of such funds,  provided that any reasonable  cost
or  expense  incurred  by the IHS  Entities  in  connection  therewith  shall be
reimbursed to them by the SNH Entities; and

              (m) at such  time as the  relevant  SNH  Entity  for any  Transfer
Facility has all  necessary  licenses and the relevant IHS Entity  transfers the
patient  trust  accounts  held for the  benefit  of  residents  of the  relevant
Facility to such SNH Entity,  the relevant IHS Entity shall  provide to such SNH
Entity all records and an accounting regarding such patient trust accounts.

         3. Except as expressly amended hereby,  all of the terms and conditions
of the Settlement Agreement shall remain in full force and effect.

         4. This Amendment may be executed in counterparts,  each of which shall
be deemed an original and all of which,  when taken together,  shall  constitute
one and the same agreement.  Signatures sent by telefacsimile transmission shall
be deemed to constitute delivery for purposes of creating a binding agreement.


                            [SIGNATURES ON NEXT PAGE]




                                      -4-

         IN WITNESS WHEREOF,  each of the undersigned has executed and delivered
this Amendment as of the date first above written.

INTEGRATED HEALTH SERVICES, INC.
COMMUNITY INC.
COMMUNITY CARE OF AMERICA, INC.
ECA HOLDINGS, INC.
COMMUNITY CARE OF NEBRASKA, INC.
W.S.T. CARE, INC.
QUALITY CARE OF LYONS, INC.
CCA ACQUISITION I, INC.
MARIETTA/SCC INC.
GLENWOOD/SCC, INC.
DUBLIN/SCC, INC.
COLLEGE PARK/SCC, INC.
IHS ACQUISITION NO. 108, INC.
IHS ACQUISITION NO. 112, INC.
IHS ACQUISITION NO. 113, INC.
IHS ACQUISITION NO. 135, INC.
IHS ACQUISITION NO. 148, INC.
IHS ACQUISITION NO. 152, INC.
IHS ACQUISITION NO. 153, INC.
IHS ACQUISITION NO. 154, INC.
IHS ACQUISITION NO. 155, INC.
IHS ACQUISITION NO. 175, INC.
INTEGRATED HEALTH SERVICES AT GRANDVIEW CARE CENTER, INC.
ECA PROPERTIES, INC.
CCA OF MIDWEST, INC.
QUALITY CARE OF COLUMBUS, INC.


By:   /s/ Daniel J. Booth
Its:  Senior Vice President




                                      -5-

SENIOR HOUSING PROPERTIES TRUST
SPTIHS PROPERTIES TRUST
HRES1 PROPERTIES TRUST
HRES2 PROPERTIES TRUST
SHOPCO-COLORADO, LLC
SHOPCO-CT, LLC
SHOPCO-GA, LLC
SHOPCO-IA, LLC
SHOPCO-KS, LLC
SHOPCO-MA, LLC
SHOPCO-MI, LLC
SHOPCO-MO, LLC
SHOPCO-NE, LLC
SHOPCO-WY, LLC
SNH-NEBRASKA, INC.
SNH-IOWA, INC.
SNH-MASSACHUSETTS, INC.
SNH-MICHIGAN, INC.


By:   /s/Ajay Saini
Its:  Treasurer


ADVISORS HEALTHCARE GROUP, INC.


By:   /s/Jennifer B. Clark
Its:  Assistant Secretary


FIVE STAR QUALITY CARE, INC.


By:   /s/Ajay Saini
Its:  Treasurer




                                      -6-

                                   SCHEDULE A

Motion  Pursuant  to  Section  365(d)(4)  of the  Bankruptcy  Code  for an Order
Extending the Time to Assume or Reject Unexpired Leases of  Nonresidential  Real
Property

Motion to Reject that Certain  Management  Agreement Between IHS Acquisition No.
175 and  Advisors  Healthcare  Group,  Inc.  Pursuant  to Section  365(a) of the
Bankruptcy Code and Rule 6006 of the Federal Rules of Bankruptcy Procedure





                                      -7-

                                   SCHEDULE B

Motion of Senior Housing Properties Trust and Related Entities to Compel Debtors
to pay Postpetition rent or Use and Occupancy and for Other Relief