AMENDMENT TO EMPLOYMENT AGREEMENT
                        ---------------------------------


                  This  AMENDMENT  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 LAWRENCE P. CIRKA
(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 to the Agreement as follows:

         1. The first sentence of Section 1.1 of the Agreement  shall be revised
to read as follows:  "The  Company and the  Executive  agree that the  Executive
shall be employed as President and Chief Operating Officer of the Company."

         2. 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.

         3. The  Executive's  Salary as defined in Section 2.1 of the  Agreement
shall be Five Hundred Fifty  Thousand  Dollars  ($550,000) and all references to
Four Hundred Thousand


Dollars  ($400,000)  within  Section 2.1 are hereby amended to read Five Hundred
Fifty Thousand Dollars ($550,000).

         4.  Within  Section 2.2 of the  Agreement  concerning  the  Executive's
Bonus,  all  references to "6-1/4%" are hereby  amended to read  "12-1/2%";  all
references  to "no less than 25%" are  hereby  amended  to read  "50%";  and 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."

         5. Within  Section 2.3 of the  Agreement,  Section 2.3(e) is revised to
read as follows:  "(e) one hundred  percent (100%) of a one-time  initiation fee
and 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;"  and 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)."

         6. The  following  paragraph is added to Section 2.4 of the  Agreement:

         "As additional compensation for the performance by the Executive of his
         services  hereunder,  the  Company  shall  grant  to the  Executive  an
         incentive  stock option to purchase  300,000  shares of common stock of
         the Company pursuant to the Company's Senior  Executives'  Stock Option
         Plan,  as amended,  or any other plan,  subject to the  approval of the
         shareholders  of  the  Company  at  the  May  1996  Annual  Meeting  of
         Shareholders  (the  "Option").  The  Option  shall  become  exercisable
         according  to the  following  schedule:  25% shall  become  exercisable
         immediately   following  shareholder  approval  and  75%  shall  become
         exercisable in equal annual  installments  over four (4) years from the
         date on which the Option was  approved by the Board of Directors of the
         Company.  The price per share for purposes of this Section 2.4 shall be
         the  price on the date on which the Board of  Directors  approves  this
         Option.  In the event  that  Executive  is  terminated  by the  Company
         without cause or the Executive  terminates this Agreement  according to
         Section  3.3,  the unvested  portion of the Option  granted  under this
         Section 2.4 shall vest immediately.  In the event that the shareholders
         do not approve the Option at the May 1996 meeting, the

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         Company  shall give  Executive a similar  economic  incentive  of equal
         value to be mutually agreed upon by Executive and the Company."

         7. The following  sentence is hereby added to the end of Section 1.2 of
the  Agreement:  "Subject  to the  consent of the Chief  Executive  Officer  and
subject to the  limitations  of Section 4.2, 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."

         8. The fist 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 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."

         9. Within  Section 3.4 (a) concerning  Severance,  the reference in the
second  paragraph to  "thirty-six  (36) months" is hereby amended to read "sixty
(60) months."

         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%)."

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         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. The last  sentence of Section 4.2 of the Agreement is struck in its
entirety and the following  new sentence is added in its place:  "Subject to the
provisions of Section 1.2, 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 PLC  ("Speciality  Care") or  Community  Care of America,  Inc.
("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)."

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

         14. 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.

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         15. 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.

         16. 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 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 Elkins                                     /s/ Lawrence P. Cirka
   ---------------------------                            ---------------------
                                                          Lawrence P. Cirka
Name: Robert Elkins
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Title: Chairman & CEO
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