EMPLOYMENT AGREEMENT

                  This AGREEMENT is made  effective as of January 1, 1994,  (the
"Effective Date"), by and between  INTEGRATED HEALTH SERVICES,  INC., a Delaware
corporation  (hereinafter  referred to as the  "Company"),  and ROBERT N. ELKINS
(hereinafter referred to as the "Executive").
                                          
                              W I T N E S S E T H:

                  WHEREAS,  the Company  wishes to employ the  Executive  and to
ensure the  continued  services of the  Executive  for the Term (as  hereinafter
defined), and the Executive desires to be employed by the Company for such Term,
upon the terms and conditions hereinafter set forth.
                  NOW, THEREFORE,  in consideration of the foregoing premise and
the mutual  agreements herein  contained,  the parties,  intending to be legally
bound, hereby agree as follows:

                                    ARTICLE I
                             EMPLOYMENT RELATIONSHIP

                  1.1 Employment. During the Term, the Company and the Executive
agree that the  Executive  shall be employed as  President  and Chief  Executive
Officer of the Company and shall have the customary powers, responsibilities and
authorities of presidents and chief  executive  officers of  corporations of the
size, type and nature of the Company as they exist from time to time. During the
Term,  the Company shall also  recommend and propose the Executive as a Director
and as Chairman of the Board of Directors of the Company.  The  Executive  shall
only  report to and be  responsible  directly to the Board of  Directors  of the
Company (the "Board").


                  1.2  Exclusive  Employment.  During  the Term,  the  Executive
agrees  to  devote  all such  working  time as is  reasonably  required  for the
discharge of his duties hereunder and to perform such services faithfully and to
the  best  of his  ability.  Notwithstanding  the  foregoing,  nothing  in  this
Agreement  shall  preclude  the  Executive  from (a)  performing  his duties and
responsibilities  hereunder  at a location  other than the  Company's  executive
offices;  (b) engaging in charitable and community affairs,  so long as they are
consistent  with his  duties and  responsibilities  under  this  Agreement,  (c)
managing his personal investments,  and (d) serving on the Board of Directors of
Speciality  Care PLC  ("Speciality  Care") and Community  Care of America,  Inc.
("Community Care") and on the boards of directors of other companies.  From time
to time, the Executive may furnish  services to other  companies,  provided that
furnishing  such  services  does  not  materially   interfere  with  his  duties
hereunder.
                  1.3 Term.  Unless  sooner  terminated  pursuant to Article III
below,  the term of this  Agreement (the "Term") shall commence on the Effective
Date,  and be in effect for three (3)  years;  provided,  however,  that on each
January 1st after the date of this Agreement (an "Anniversary  Date"),  the then
current term of this Agreement  automatically shall be extended by an additional
period of  twelve  (12)  months,  so that,  as of each  Anniversary  Date,  this
Agreement shall have an unexpired Term of three (3) years.  Notwithstanding  the
foregoing,  either  party  hereto may elect not to so extend this  Agreement  by
giving  written notice of his or its election to the other party hereto at least
ninety (90) days prior to any  Anniversary  Date.  If the Company  elects not to
renew the Agreement,  the Executive shall be entitled to severance at the end of
the Term as set forth in Section 3.4.


                                      -2-

                                   ARTICLE II
                                  COMPENSATION

                  2.1 Salary.  The  Executive  shall receive a base salary at an
initial rate of $500,000 per year (the "Salary"), payable in substantially equal
installments in accordance  with the pay policy  established by the Company from
time to time, but not less frequently than monthly.  On each  Anniversary  Date,
the Salary shall be increased or decreased (but not below Five Hundred  Thousand
Dollars  ($500,000)),  by a percentage which is equal to the percentage increase
or  decrease,  as  applicable,  in the  "Consumer  Price  Index  for  All  Urban
Consumers"  published by the United States Department of Labor's Bureau of Labor
Statistics for the then most recently  ended  12-month  period as of the date of
such adjustment,  and increased by such additional  amounts as may be determined
at the  discretion  of the Board.  Once  adjusted,  such  adjusted  amount shall
constitute Salary for purposes of this Agreement.

                  2.2 Bonuses.  (a) If the Company's earnings per share equal or
exceed the earnings goals set by the Board (the "Target") then, no more than ten
(10) days following the date the Company  publicly  announces its earnings,  the
Company shall pay the Executive a bonus ("Bonus") determined as follows:

                  (1) with respect to each  calendar  quarter,  if the Company's
         earnings  equal  or  exceed  the  Target,  the  Company  shall  pay the
         Executive a lump sum cash amount equal to 12-1/2% of Salary;

                  (2) with  respect  to each  calendar  year,  if the  Company's
         earnings  equal  or  exceed  the  Target,  the  Company  shall  pay the
         Executive  a lump  sum  cash  amount  equal  to 50% of  Salary  plus an
         additional  12 1/2% of Salary for each  quarter  within  such year with
         respect  to  which  the  Executive  did not  receive  a  payment  under
         paragraph (1).

                  (b)   Notwithstanding   anything  in  Section  2.2(a)  to  the
contrary, if in any calendar year the Company pays an amount with respect to the
Company's quarterly earnings

                                      - 3 -


pursuant to Section  2.2(a)(1) but (because the Company's  earnings do not equal
or exceed the Target for the calendar  year  containing  any of the quarters for
which a payment  under  Section  2.2(a)(1) is made) the Company does not pay the
Executive an amount pursuant to Section 2.2(a)(2), then the Company shall either
treat the quarterly amounts paid to the Executive  pursuant to Section 2.2(a)(1)
in such year as a prepayment of its Salary, Severance, or Disability obligations
under Sections 2.1, 3.4 or 3.5, respectively, or, shall require the Executive to
repay such amounts to the Company  with  interest at the prime rate of Citibank,
N.A.

                  2.3 Employee  Benefits and  Perquisites.  During the Term, the
Company shall provide and/or pay for employee benefits and perquisites that are,
in the aggregate,  no less favorable than the employee  benefits and perquisites
that the Executive  enjoys as of the Effective  Date, as increased  from time to
time, including, without limitation:

                  (a) life insurance coverage in the amount of $2,000,000;

                  (b) medical and dental benefits;

                  (c) disability  insurance coverage in a monthly benefit amount
         equal to the sum of 100% of Executive's  Salary plus "Bonus Amount" (as
         defined in Section 3.4(a));

                  (d) one-half (1/2) of the cost of dues,  assessments and other
         charges  for a full  membership  in a country  club of the  Executive's
         choice;

                  (e) an  automobile  allowance  (including an allowance for all
         operating and maintenance  expenses) and automobile  insurance coverage
         at least equal to the allowance and coverage the Executive  receives as
         of the Effective Date, and as increased from time to time; and

                  (f) use of the Company-provided  airplane,  that Executive has
         use of as of the Effective Date.

                  Once increased,  the level of benefits and  perquisites  shall
not be decreased without the Executive's consent.

                  2.4   Equity-based   Compensation.   During   the  Term,   the
Compensation Committee, in its complete discretion,  may select the Executive to
participate in programs or


                                      - 4 -

enter  into  agreements  which  provide  for the grant of  certain  equity-based
compensation or rights to the Executive.

                                   ARTICLE III
                            TERMINATION AND SEVERANCE

                  3.1 Termination;  Nonrenewal. The Company shall have the right
to terminate the Executive's employment,  and the Executive shall have the right
to resign his employment with the Company,  at any time during the Term, for any
reason or for no  stated  reason,  upon no less than  ninety  (90)  days'  prior
written notice (or such shorter notice to the extent provided for herein).  Upon
the  Executive's  termination  without  "Cause" (as  defined in Section  3.2) or
resignation for "Good Reason" (as defined in Section 3.3) or upon the expiration
of the Term  following  the Company's  election not to renew this  Agreement (in
accordance  with Section 1.3),  the Executive  shall be entitled to severance as
set  forth  in  Section  3.4.  Upon the  Executive's  termination  for  Cause or
resignation  without  Good  Reason,  the  Executive  shall  not be  entitled  to
severance.  If the Executive's  employment is terminated  because of a Permanent
Disability (as defined in Section 3.5), the Executive shall receive the benefits
and  payments  described  in Section 3.5. 

                  3.2 Termination For Cause.  (a) The Company may terminate this
Agreement for Cause  following a  determination  by the Board that Cause exists.
For purposes of this  Agreement,  Cause shall mean any or all of the  following:
(i) the Executive's willful and continuing neglect of his duties hereunder;

                  (ii) a material breach by the Executive of his covenants under
         Sections 4.1 or 4.2;

                  (iii) the  conviction of the Executive of a felony  (including
         the  theft,  larceny  or  embezzlement  of the  Company's  tangible  or
         intangible property).

                  (b)   Notwithstanding   anything  in  Section  3.2(a)  to  the
contrary, a termination shall not be for Cause unless (i) the determination that
Cause exists is made by the Board at a special


                                      - 5 -



meeting  called  for the  purpose  of  determining  whether  Cause  exists,  the
Executive is provided  with at least thirty (30) days' prior  written  notice of
such  Board  meeting  (which  notice  shall  set forth the  conduct  alleged  to
constitute  Cause)  (the  "Cause  Notice"),  and  the  Executive  is  given  the
opportunity to be represented by counsel at such meeting; and (ii) the Executive
does not cure his conduct (to the reasonable  satisfaction  of the Board) within
sixty (60) days after the receipt of the Cause Notice.

                  3.3  Termination  for  Good  Reason.  (a)  The  Executive  may
terminate  this  Agreement for Good Reason,  provided he gives the Company prior
written notice that Good Reason exists (the "Good Reason Notice").  For purposes
of this Agreement, Good Reason shall mean one or more of the following:

                  (1)  a  material  breach  of  the  Agreement  by  the  Company
         (including,  without  limitation,  one or more of the following without
         the Executive's prior written consent:

                  (i) a material diminution of the Executive's responsibilities,
         title, authority or status,

                  (ii) the failure of the Company to pay the  Executive  amounts
         when due under this Agreement,

                  (iii) the Executive's removal or dismissal from, or failure to
         be reelected President or Chief Executive Officer; and

                  (iv) a reduction in salary or a material reduction in benefits
         (other than a reduction in salary permitted by Section 2.1).

                   (2) the  resignation  by the  Executive  within  one (1) year
         following a "Change of Control", as defined in Section 3.3(b), provided
         that the  Executive  gives the Company at least  ninety (90) days prior
         written  notice of his intent to resign and the effective  date of such
         resignation  is at least one hundred eighty (180) days after the Change
         of Control.

                  (3) the  Executive's  removal or dismissal from, or failure to
         be reelected Chairman of the Board of the Company.

Notwithstanding the foregoing, a termination on account of a reason described in
paragraph  (1),  shall be deemed not to be for Good Reason  unless the Executive
(i) gives the Company the  opportunity  to cure the  condition  that purports to
constitute Good Reason, and (ii) the Company


                                      - 6 -

fails to cure that  condition  within  sixty (60) days after the  receipt of the
Good Reason Notice (or, with respect to the failure to make any payment when due
to the Executive within ten (10) days after the receipt of such notice).

                  (b) For  purposes  of this  Agreement,  a "Change of  Control"
shall  be  deemed  to  occur  if  (i)  there  shall  be   consummated   (x)  any
consolidation,  reorganization  or merger of the Company in which the Company is
not the  continuing or surviving  corporation or pursuant to which shares of the
Company's  common  stock  would be  converted  into  cash,  securities  or other
property,  other  than a merger  of the  Company  in which  the  holders  of the
Company's  common  stock   immediately   prior  to  the  merger  have  the  same
proportionate ownership of common stock of the surviving corporation immediately
after the merger,  or (y) any sale,  lease,  exchange or other  transfer (in one
transaction or a series of related  transactions) of all, or substantially  all,
of the assets of the  Company,  or (ii) the  stockholders  of the Company  shall
approve any plan or proposal for  liquidation or dissolution of the Company,  or
(iii) any person (as such term is used in  Sections  13(d) and  14(d)(2)  of the
Exchange  Act,  including  any "group"  (as  defined in Section  13(d)(3) of the
Exchange  Act),  (other  than  the  Executive  or any  group  controlled  by the
Executive))  shall become the beneficial owner (within the meaning of Rule 13d-3
under the Exchange Act) of 20% or more of the Company's outstanding common stock
(other than  pursuant to a plan or  arrangement  entered into by such person and
the  Company)  and such  person  discloses  its intent to effect a change in the
control  or  ownership  of the  Company in any filing  with the  Securities  and
Exchange Commission,  or (iv) within any twenty-four (24) month period beginning
on or after the Effective  Date,  the persons who were  directors of the Company
immediately  before the  beginning  of such period (the  "Incumbent  Directors")
shall  cease (for any reason  other than death,  disability  or  retirement)  to
constitute  at least a majority  of the Board or the board of  directors  of any
successor to the Company,  provided that, any director who was not a director as
of the  Effective  Date  shall be deemed  to be an  Incumbent  Director  if such
director


                                      - 7 -

was elected to the Board by, or on the  recommendation  of or with the  approval
of,  at least  two-thirds  of the  directors  who then  qualified  as  Incumbent
Directors  either  actually or by prior  operation  of this  Section  3.3(b)(iv)
unless such election, recommendation or approval was the result of any actual or
threatened  election  contest  of the type  contemplated  by  Regulation  14a-11
promulgated under the Exchange Act or any successor provision.

                  3.4 Severance.  (a) If the Executive  resigns for Good Reason,
or is terminated  without Cause, or if the Company gives the Executive notice of
its intention not to extend the Term, in accordance with Article II, the Company
shall  cause the  Executive's  outstanding  options  which  are not  immediately
exercisable to vest and become  immediately  exercisable and the restrictions on
equity held by the  Executive  which are  scheduled to lapse solely  through the
passage of time to lapse (such events collectively  referred to as "Acceleration
of Equity Rights").  In addition,  the Company shall pay the Executive an amount
(the "Severance Amount") equal to three (3) times the sum of (1) his Salary; and
(2) the "Bonus Amount" which shall be the greater of i) 100% of the  Executive's
Salary (the "Bonus Amount") in the year of  termination;  or ii) the Executive's
Bonus in the immediately preceding calendar year. Such Severance Amount shall be
payable in cash as follows:

                  (x) no  later  than  10  days  after  the  effective  date  of
         Executive's  termination,  the Company shall pay the Executive one-half
         (1/2) of the Severance Amount in a lump sum;

                  (y)  commencing  on the first day of the month  following  the
         effective date of Executive's  termination  and on the first day of the
         month  thereafter  for a period of eighteen  (18)  months,  the Company
         shall pay the remaining  one-half (1/2) of the Severance  Amount to the
         Executive in equal monthly installments;

provided,  however, that if the Executive's employment terminates other than for
Cause, within one (1) year following a Change of Control,  the Company shall, in
lieu of the making the


                                      - 8 -


payments  described in (x) and (y), pay the Executive the Severance  Amount,  in
one lump sum cash  payment  within  ten (10) days  after the  effective  date of
Executive's termination.

                  In addition,  for a period of thirty-six (36) months following
the effective  date of the  Executive's  termination,  the Company shall provide
continued employee benefits and coverage for the Executive and his dependents of
the type and at a level of coverage  comparable to the coverage in effect at the
time of termination  ("Continued Benefits") and shall provide the Executive with
the following  additional  benefits:  (i) secretarial  services  provided by the
Executive's  secretary at the time of his  termination  or a secretary  with the
same skill and experience as such secretary, who is reasonably acceptable to the
Executive; (ii) office space with office equipment and furnishings, all of which
are comparable to that provided to the Executive at the time of his termination;
(iii) a continued automobile allowance (including an allowance for operating and
maintenance  expenses)  and continued  automobile  insurance  coverage,  in both
cases,  at a level,  which is not less than the allowance and coverage in effect
on the effective date of Executive's termination;  and (iv) continued use of the
Company-provided  airplane  used  by  the  Executive  immediately  prior  to the
effective   date  of   Executive's   termination   or  a  comparable   airplane.
Notwithstanding  the  foregoing,  if any  of the  Continued  Benefits  or  other
benefits to be provided  hereunder have been  decreased or otherwise  negatively
affected  within  twelve  (12)  months  prior  to  the  effective  date  of  the
Executive's  termination,  the reference for measuring such benefit shall be the
date prior to such reduction rather than the date of such termination.

                  (b) If the Executive is required,  pursuant to Section 4999 of
the  Internal  Revenue  Code of 1986,  as amended  (the  "Code") to pay (through
withholding  or  otherwise)  an excise tax on  "excess  parachute  payments"  as
defined  in  Section  280G of the Code,  the  Company  shall  pay the  Executive
three-quarters (3/4) of the amount or amounts that are necessary to place the


                                      - 9 -


Executive in the same after-tax financial position that he would have been in if
he had not incurred any tax liability under Section 4999 of the Code.

                  3.5 Termination for Disability.  (a) The Company may terminate
the Executive  following a  determination  by the Board that the Executive has a
Permanent  Disability;  provided,  however,  that no such  termination  shall be
effective (i) prior to the expiration of the six (6) month period  following the
date the  Executive  first  incurred  the  condition  which is the basis for the
Permanent  Disability or (ii) if the Executive begins to  substantially  perform
the  significant  aspects of his regular duties prior to the proposed  effective
date of such termination. For purposes of this Agreement, "Permanent Disability"
shall  mean the  Executive's  inability,  by  reason of any  physical  or mental
impairment,  to  substantially  perform the  significant  aspects of his regular
duties,  as  contemplated  by this  Agreement,  which  inability  is  reasonably
contemplated  to continue for at least one (1) year from its  incurrence  and at
least  ninety  (90)  days from the date of such  vote.  Any  question  as to the
existence, extent, or potentiality of the Executive's Permanent Disability shall
be determined  by a qualified  independent  physician  selected by the Executive
(or, if the  Executive is unable to make such  selection,  by an adult member of
the Executive's immediate family) and reasonably acceptable to the Board.

                  (b) If the  Executive is  terminated  because of his Permanent
Disability, the Company shall provide for the Acceleration of Equity Rights and,
the  Company  shall,  (i) for a period  of  thirty  (30)  months  following  the
effective date of such termination  (the "Disability  Period") pay the Executive
one  hundred  (100%)  percent of his Salary  plus  Bonus  Amount,  offset by the
amount,  if any, paid to the Executive under the salary  replacement  portion of
disability  benefits  paid  under a  disability  plan or policy  paid for by the
Company;  and (ii) provide him with  Continued  Benefits  during the  Disability
Period.

                  3.6  Death  or  Disability  After   Termination.   Should  the
Executive die or become  disabled before receipt of any or all payments to which
the Executive is entitled to under Section


                                     - 10 -


3.4 (or in the  case of the  Executive's  death  following  his  termination  on
account of Permanent  Disability,  before  receipt of all payments under Section
3.5),  then the balance of the payments to which the Executive is entitled shall
continue  to paid to the  Executive  (in the case of his  disability)  or to the
executors  or  administrators  of the  Executive's  estate  (in the event of the
Executive's death); provided,  however, that the Company may, at any time within
its discretion,  accelerate any payments and pay the Executive or his estate the
present  value of such  payments  in a lump sum cash  payment.  For  purposes of
determining the present value under this Section 3.6, the interest rate shall be
the prime rate of Citibank, N.A.

                                   ARTICLE IV

                           COVENANTS OF THE EXECUTIVE
                           --------------------------

     4.1  Confidential  Information.  In connection  with his  employment at the
Company, the Executive will have access to confidential  information  consisting
of some or all of the following categories of information:

                  (a)  Financial  Information,  including  but  not  limited  to
         information relating to the Company's earnings,  assets, debts, prices,
         pricing structure, volume of purchases or sales or other financial data
         whether related to the Company or generally, or to particular products,
         services, geographic areas, or time periods;

                  (b) Supply and Service Information,  including but not limited
         to  information  relating to goods and  services,  suppliers'  names or
         addresses,  terms of  supply  or  service  contracts  or of  particular
         transactions,  or related  information about potential suppliers to the
         extent that such information is not generally known to the public,  and
         the extent that the  combination  of  suppliers  or use of a particular
         supplier, though generally known or available, yields advantages to the
         Company details of which are not generally known;

                  (c)  Marketing  Information,  including  but  not  limited  to
         information  relating to details  about  ongoing or proposed  marketing
         programs or agreements by or on behalf of the Company, sales forecasts,
         advertising  formats  and  methods or results of  marketing  efforts or
         information about impending transactions;

                  (d)  Personnel  Information,  including  but  not  limited  to
         information  relating to  employees'  personnel  or medical  histories,
         compensation   or  other  terms  of   employment   actual  or  proposed
         promotions, hirings, resignation, disciplinary actions, terminations or
         reasons  therefor,  training  methods,  performance,  or other employee
         information; and

                                     - 11 -

                  (e)  Customer  Information,   including  but  not  limited  to
         information relating to past, existing or prospective customers' names,
         addresses or backgrounds,  records of agreements and prices,  proposals
         or agreements  between customers and the Company,  status of customers'
         accounts or credit, or related  information about actual or prospective
         customers as well as customer lists.

                  All of the  foregoing  are  hereinafter  referred to as "Trade
Secrets."  The  Company  and  the  Executive  consider  their  relation  one  of
confidence  with  respect  to Trade  Secrets.  Therefore,  during  and after the
employment by the Company,  regardless of the reasons that such employment ends,
the Executive agrees:
                  (aa) To hold all Trade Secrets in confidence  and not discuss,
         communicate or transmit to others,  or make any unauthorized copy of or
         use the Trade Secrets in any capacity,  position or business  except as
         it directly relates to the Executive's employment by the Company;

                  (bb) To use the Trade  Secrets only in  furtherance  of proper
         employment  related  reasons of the Company to further the interests of
         the Company;

                  (cc) To take all  reasonable  actions  that the Company  deems
         necessary or appropriate,  to prevent unauthorized use or disclosure of
         or to protect the Company's interest in the Trade Secrets; and

                  (dd) That any of the Trade  Secrets,  whether  prepared by the
         Executive or which may come into the Executive's  possession during the
         Executive's  employment  hereunder,  are and remain the property of the
         Company  and its  affiliates,  and all such  Trade  Secrets,  including
         copies  thereof,  together  with all other  property  belonging  to the
         Company  or its  affiliates,  or used in their  respective  businesses,
         shall be delivered to or left with the Company.

                  This Agreement does not apply to (i) information that by means
other than the Executive's deliberate or inadvertent disclosure becomes known to
the public; (ii) disclosure compelled by judicial or administrative  proceedings
provided the Executive  affords the Company the opportunity to obtain  assurance
that  compelled  disclosures  will  receive  confidential  treatment;  and (iii)
information  independently developed by the Executive,  the development of which
was not a breach of this Agreement.

                  4.2  Non-Competition.  During the Term and for a period of two
(2)  years  thereafter  (or  in the  event  of the  Executive's  termination  of
employment other than for Cause

                                     - 12 -


within  one (1) year  after a Change  of  Control,  for a period of one (1) year
thereafter),  the Executive agrees that he will not, without the express written
consent of the Company,  directly or indirectly,  for the Executive or on behalf
of any other person, firm, entity or other enterprise (i) directly or indirectly
solicit for employment or recommend to any subsequent  employer of the Executive
the  solicitation  for  employment  of any  person  who,  at the  time  of  such
solicitation is employed by Company or any affiliate  thereof,  (ii) directly or
indirectly  solicit,  divert,  or endeavor  to entice  away any  customer of the
Company or any affiliate  thereof,  or otherwise engage in any activity intended
to  terminate,  disrupt,  or interfere  with the  Company's  or any  affiliate's
relationship  with a customer,  supplier,  lessor or other  person,  or (iii) be
employed by, be a director, officer or manager of, act as a consultant for, be a
partner in,  have a  proprietary  interest  in, give advice to, loan money to or
otherwise  associate  with, any person,  enterprise,  partnership,  association,
corporation,  joint venture or other entity which is directly in the business of
owning,  operating or managing any subacute  healthcare  facility which competes
with any such  type of  facility  then  operated  by the  Company  or any of its
subsidiaries.  This  provision  shall not be construed to prohibit the Executive
from (i) acting as an employee, director, or consultant for, or owning more than
10% of, the outstanding  voting shares of the equity  securities of,  Speciality
Care or  Community  Care,  or (ii)  owning up to 10% of the  outstanding  voting
shares of the equity  securities of any company whose common stock is listed for
trading on any  national  securities  exchange or on the NASDAQ  System or (iii)
serving as a director of any company  which is not  directly in the  business of
owning,  operating  or managing  any subacute  healthcare  facility  (other than
Speciality  Care or Community  Care).  The  provisions of this Section 4.2 shall
only apply to businesses and operations  located in, or otherwise  conducted in,
the United States.

                  4.3  Remedies   For  Breach  of  Article  IV.  The   Executive
acknowledges  and  agrees  that  the  amount  of  damages  in the  event  of the
Executive's breach of this Article IV will be

                                     - 13 -


difficult, if not impossible,  to ascertain. The Executive therefore agrees that
the Company,  in addition to, and without  limiting any other remedy or right it
may have,  shall  have the right to an  injunction  enjoining  any breach of the
covenants made by the Executive in this Article IV.


                                    ARTICLE V

                            AMENDMENT AND ASSIGNMENT
                            ------------------------

                  5.1 Right of the  Executive to Assign.  The  Executive may not
assign,  transfer,  pledge or  hypothecate  or  otherwise  transfer  his rights,
obligations,  interests and benefits  under this Agreement and any attempt to do
so shall be null and void.

                  5.2  Right of  Company  to  Assign.  This  Agreement  shall be
assignable and  transferable  by the Company and any such assignment or transfer
shall inure to the benefit of and be binding upon the Executive, the Executive's
heirs and  personal  representatives,  and the  Company and its  successors  and
assigns.  The Executive agrees to execute all documents  necessary to ratify and
effectuate such assignment. An assignment of this Agreement by the Company shall
not release the Company from its monetary obligations under this Agreement.

                  5.3  Amendment/Waiver.  No  change  or  modification  of  this
Agreement  shall be valid  unless it is in writing  and  signed by both  parties
hereto.  No waiver of any provisions of this Agreement  shall be valid unless in
writing and signed by the person or party to be charged.

                                   ARTICLE VI
                                     GENERAL

                  6.1  Governing  Law.  This  Agreement  shall be subject to and
governed by the laws of the State of Delaware, irrespective of the fact that the
Executive may become a resident of a different state.


                                     - 14 -

                  6.2 Binding  Effect.  This Agreement shall be binding upon and
inure to the  benefit of the  Company  and the  Executive  and their  respective
heirs,  legal  representatives,   executors,   administrators,   successors  and
permitted assigns.

                  6.3 Entire  Agreement.  This Agreement  constitutes the entire
agreement  between the parties and supersedes the Prior  Agreement and all other
prior agreements,  either oral or written, between the parties hereto; provided,
however,  that this Agreement  does not supersede any  agreements  pertaining to
stock options which have been granted as of the  Effective  Date,  except to the
extent that any such option agreement contains  provisions which are contrary to
the  provisions  of  this   Agreement   (including   provisions   regarding  the
Acceleration of Equity Rights).

                  6.4  Mitigation.  The  Executive  shall  not  be  required  to
mitigate  damages or the amount of any payment provided for under this Agreement
by seeking other employment or otherwise nor may any payments provided for under
this Section be reduced by any amounts  earned by the Executive as a result of a
breach of the Executive's covenants in Article IV.

                  6.5 Survivorship. The respective rights and obligations of the
parties  hereunder shall survive the termination of this Agreement to the extent
necessary  to preserve  the rights and  obligations  of the  parties  under this
Agreement.

                  6.6  Notices.  All  notices,  demands,   requests,   consents,
approvals or other  communications  required or permitted  hereunder shall be in
writing and shall be delivered by hand, registered or certified mail with return
receipt requested or by a nationally  recognized  overnight delivery service, in
each case with all postage or other delivery charges prepaid, and to the address
of the party to whom it is directed as indicated below, or to such other address
as such party may specify by giving notice to the other in  accordance  with the
terms hereof. Any such notice shall be deemed to be received (i) when delivered,
if by hand,  (ii) on the next  business  day  following  timely  deposit  with a
nationally  recognized  overnight delivery service or (iii) on the date shown on
the return receipt as received or refused or on the date the postal

                                     - 15 -

authorities state that delivery cannot be accomplished, if sent by registered of
certified mail, return receipt requested.
 
If to the Company:                              Integrated Health Services, Inc.
                                                10065 Red Run Boulevard
                                                Owings Mills, Maryland  21117
                                                Attn: Robert Walkingshaw

If to the Executive:                            Robert N. Elkins
                                                10600 Park Heights Avenue
                                                Owings Mills, MD  21117

             Copy to:                           Alvin Brown, Esq.
                                                Simpson Thacher & Bartlett
                                                425 Lexington Avenue
                                                New York, NY  10017

                  6.7 Indemnification. The Company agrees to maintain Director's
and Officer's  liability  insurance at a level not less than the level in effect
on the Effective Date, or to the extent such level is increased during the Term,
at such increased level;  provided,  however, that the level of insurance may be
decreased  with the  Executive's  consent.  To the  extent  not  covered by such
liability insurance, the Company shall indemnify and hold the Executive harmless
to the fullest extent  permitted by Delaware law against any  judgments,  fines,
amounts  paid  in  settlement  and  reasonable  expenses  (including  reasonable
attorneys'  fees),  and advance  amounts  necessary to pay the  foregoing at the
earliest time and to the fullest extent permitted by law, in connection with any
claim, action or proceeding (whether civil or criminal) against the Executive as
a result of his  serving  as an  officer or  director  of the  Company or in any
capacity at the  request of the  Company in or with regard to any other  entity,
employee  benefit plan or enterprise.  This  indemnification  shall be in effect
during the Term and  thereafter  and shall be in  addition to and not in lieu of
any other indemnification rights the Executive may otherwise have.

                  6.8 Attorney's  Fees.  Upon  presentation  of an invoice,  the
Company  shall pay  directly  or  reimburse  the  Executive  for all  reasonable
attorney's fees and costs incurred by the Executive:

                                     - 16 -



                  (a)  in  connection  with  the  negotiation,  preparation  and
execution of this Agreement; and

                  (b) in  connection  with any dispute  brought by the Executive
over the  terms of this  Agreement  unless  there  is a  determination  that the
Executive had no reasonable basis for his claim.

                  6.9 Arbitration.  Except as otherwise provided in Section 4.3,
any dispute or  controversy  arising under or in connection  with this Agreement
shall be settled  exclusively by arbitration,  conducted before a panel of three
arbitrators in Baltimore, Maryland, in accordance with the rules of the American
Arbitration  Association  then in effect,  and  judgement  may be entered on the
arbitrators' award in any court having  jurisdiction.  The Company shall pay all
costs of the American  Arbitration  Association and the  arbitrator.  Each party
shall  select one  arbitrator,  and the two so  designated  shall select a third
arbitrator.  If either party shall fail to designate an arbitrator  within seven
(7) days after arbitration is requested, or if the two arbitrators shall fail to
select a third  arbitrator  within  fourteen  (14)  days  after  arbitration  is
requested,  then an  arbitrator  shall be selected by the  American  Arbitration
Association upon application of either party. Notwithstanding the foregoing, the
Executive  shall be entitled to seek  specific  performance  from a court of the
Executive's  right to be paid until the date of termination  during the pendency
of any dispute or controversy arising under or in connection with this Agreement
and the Company shall have the right to obtain injunctive relief from a court.

                  6.10 Voidability. If the options granted by the Company to the
Executive  on October 25,  1993,  and  November  22,  1993,  are not approved by
shareholders  by June 30, 1994,  this  Agreement  shall be deemed void as of the
Effective Date and shall have no force or effect.

                  6.11  Severability.  No  provision  in this  Agreement if held
unenforceable  shall  in  any  way  invalidate  any  other  provisions  of  this
Agreement, all of which shall remain in full

                                     - 17 -


force and effect  except  that this  Section  6.11 shall not apply to the extent
Section 6.10 is held unenforceable.

                  IN WITNESS  WHEREOF,  the Company has caused this Agreement to
be signed by its duly authorized  officers and its corporate seal to be hereunto
affixed,  and the Executive has hereunto set the Executive's hand on the day and
year first above written.

COMPANY                                                  EXECUTIVE
- - -------                                                  ---------
Integrated Health Services,
Inc., a Delaware corporation

By:    /s/ Robert Walking Shaw                           /s/ Robert N. Elkins
       ------------------------                          -------------------
                                                         Robert N. Elkins
Name:  Robert Walking Shaw
       ------------------------

Title: Director
       ------------------------

By:    /s/ Lawrence P. Cirka
       ------------------------

Name:  Lawrence P. Cirka
       ------------------------

Title: Chief Operating Officer
       ------------------------

                                     - 18 -


                     AMENDMENT NO. 1 TO EMPLOYMENT AGREEMENT
                     ---------------------------------------

         This  AMENDMENT  No. 1 is made  effective  as of  January  1, 1995 (the
"Effective Date"), by and between  INTEGRATED HEALTH SERVICES,  INC., a Delaware
corporation  (hereinafter  referred to as the  "Company"),  and ROBERT N. ELKINS
(hereinafter referred to as the "Executive").


                              W I T N E S S E T H:


         WHEREAS,  effective  January 1, 1994,  the  Executive  entered  into an
employment agreement with the Company (the "Agreement");

         WHEREAS, the parties desire to amend the Agreement;

         WHEREAS,  Section 5.3 of the Agreement permits the parties to amend the
Agreement in a writing signed by both parties.

         NOW,  THEREFORE,  in  consideration  of the foregoing  premises and the
mutual agreements herein contained, the parties,  intending to be legally bound,
hereby agree to amend the Agreement as follows:

         1. The Term of the  Agreement  as defined in Section  1.3 shall be five
(5) years and all  references  to three (3) years within  Section 1.3 are hereby
amended to read five (5) years.

         2. The  Executive's  Salary as defined in Section 2.1 of the  Agreement
shall be Seven Hundred Fifty Thousand  Dollars  ($750,000) and all references to
Five Hundred Thousand Dollars  ($500,000)  within Section 2.1 are hereby amended
to read Seven Hundred Fifty Thousand Dollars ($750,000).

         3.  Within  Section 2.2 of the  Agreement  concerning  the  Executive's
Bonus,  all  references to "cash" are hereby  amended to read "cash or shares of
the Company's common stock pursuant to the Company's Cash Bonus Replacement Plan
or any combination thereof."

         4. The  following  Section  2.3(g) shall be added to Section 2.3 of the
Agreement:

         "(g)  Executive  shall be  eligible  to  participate  in the  Company's
         Supplemental Executive Retirement Plan (SERP)."

         5. The  definition of "Good  Reason" as set forth in Section  3.3(a) of
the Agreement is amended by adding a subparagraph (4) thereto as follows:

                  "(4) the  relocation  of the  Executive  to an office which is
         more than fifteen (15) miles from his then principal residence."

         6. The first two (2)  sentences of Section  3.4(a) of the Agreement are
amended to read in their entirety as follows:

                  "If the  Executive  resigns for Good Reason,  or is terminated
         without  Cause,  or if the Company  gives the  Executive  notice of its
         intention not to extend the Term,  in  accordance  with Article II, the
         Company shall cause to become fully vested any of the Executive's stock
         which is then  subject to any risk of  forfeiture,  and shall  cause to
         become  fully  vested  and  immediately   exercisable  the  Executive's
         outstanding  options  which  are not  immediately  exercisable  and any
         employee benefits  (including,  without limitation,  any benefits under
         the Company's  Supplemental  Executive  Retirement Plan) which are then
         held by the  Executive,  and shall cause to lapse any  restrictions  on
         equity  held by the  Executive  which  are  scheduled  to lapse  solely
         through the passage of time (such  events  collectively  referred to as
         "Acceleration  of Equity Rights").  In addition,  the Company shall pay
         the  Executive  an amount (the  "Severance  Amount")  equal to five (5)
         times the sum of (1) his Salary; and (2) the "Bonus Amount" which shall
         be the  greatest of (i) 100% of the  Executive's  Salary in the year of
         termination,  (ii) the Executive's  Bonus in the immediately  preceding
         calendar  year,  or (iii) the  Executive's  Bonus in the calendar  year
         which was immediately prior to the year immediately  preceding the year
         of termination."

         7. The second  paragraph  of  Section  3.4(a) of the  Agreement  (which
paragraph  begins with the phrase "In addition  ...") is amended by changing all
references  to thirty-six  (36) months to sixty (60) months and changing  clause
(ii) thereof to read in its entirety as follows:

                  "(ii) the right to continue to occupy and utilize,  at no cost
         to the  Executive,  for a period of sixty  (60)  months  following  the
         effective date of the Executive's  termination,  the  Executive's  then
         current Company office space with office equipment and furnishings,  or
         any other office space with office  equipment and  furnishings,  all of
         which are  comparable  to that provided to the Executive at the time of
         his termination and which is reasonably acceptable to the Executive;"

         8. The said second  paragraph  of Section  3.4(a) of the  Agreement  is
further amended by adding thereto a clause (v) as follows:


                                       -2-


                  "(v) the  right,  but not the  obligation,  on the part of the
         Executive  to  purchase  from the  Company  the  Pilatus  C12  aircraft
         currently  owned  by the  Company,  or any  other  plane  owned  by the
         Company, at a price equal to the then book value of such aircraft,  and
         to lease or  purchase  from the  Company  at a fair  market  rental  or
         acquire  at  book  value  the  hangar   space   currently   under  such
         construction for such aircraft at the Naples, Florida, airport;"

         9. The said second  paragraph  of Section  3.4(a) of the  Agreement  is
further amended by adding thereto a clause (vi) as follows:

                  "(vi) the right,  but not the obligation,  to acquire from the
         Company,  for  no  additional  consideration,   an  assignment  of  the
         Company's  leasehold  interest  in the fourth  and fifth  floors of the
         Company's  offices  located at 8889 Pelican Bay  Boulevard,  Suite 500,
         Naples,  Florida 33963, in which event the Executive will assume all of
         the Company's obligations arising in respect of such leasehold interest
         from and after the date of such  assignment,  provided that the Company
         will  continue  to pay the rent and other  expenses  pertaining  to the
         Executive's  office,  equipment,  and  furnishings  in accordance  with
         clause (ii) above."

         10. Within Section 3.4(b)  concerning  excise tax on "excess  parachute
payments,"  the reference to  "three-quarters  (3/4)" is hereby  amended to read
"one-hundred percent (100%)."

         11.  Section  3.4(b) of the  Agreement  is  further  amended  by adding
thereto the following:


                  "To effect this  indemnification,  the  Company  shall pay the
                  Executive an  additional  amount that is sufficient to pay any
                  excise tax  imposed on the  Executive  by Section  4999 of the
                  Code,  plus the excise  tax,  income tax  (federal,  state and
                  local),  employment taxes and medicare  hospitalization  taxes
                  imposed  on  the   Executive  on  account  of  the   Company's
                  indemnification  payments. The determination of any additional
                  amount  that must be paid under this  section  must be made by
                  the Company in good faith."


         12. All capitalized terms within this Amendment shall have the meanings
set forth in the Agreement.

         13. The  amendments  contained  herein are the only  amendments  to the
Agreement and all other  provisions of the Agreement  shall remain in full force
and effect.


                                      -3-


         14. This  Amendment  shall be binding  upon and inure to the benefit of
the Company and the Executive and their respective heirs, legal representatives,
executors, administrators, successors and permitted assigns.

         15. This Amendment constitutes the entire agreement between the parties
and  supersedes  the  Agreement and all other prior  agreements,  either oral or
written, with respect to the provisions stated herein;  provided,  however, that
this  Agreement  does not supersede any  agreements  pertaining to stock options
which have been  previously  granted,  except to the extent that any such option
agreement  contains  provisions  which are  contrary to the  provisions  of this
Agreement (including provisions regarding the Acceleration of Equity Rights).


         IN WITNESS WHEREOF,  the Company has caused this Amendment to be signed
by its duly authorized officers and its corporate seal to be hereto affixed, and
the  Executive has hereunto set the  Executive's  hand on the day and year first
above written.

COMPANY                                               EXECUTIVE
- - -------                                               ---------
INTEGRATED HEALTH SERVICES,
INC., a Delaware corporation


By:                                                   /s/Robert N. Elkins
    -------------------------                         -------------------------

                                                      Robert N. Elkins
Name:
     ------------------------

Title:
      -----------------------



- - ------------------------------



                                      -4-