$500,000,000

                        INTEGRATED HEALTH SERVICES, INC.

                    9 1/4% Senior Subordinated Notes due 2008

                          REGISTRATION RIGHTS AGREEMENT
                          -----------------------------

                                                               September 8, 1997

SMITH BARNEY INC.
MORGAN STANLEY & CO. INCORPORATED
DONALDSON, LUFKIN & JENRETTE
  SECURITIES CORPORATION
CITICORP SECURITIES, INC.
c/o      SMITH BARNEY INC.
         388 Greenwich Street
         New York, New York 10013

Dear Sirs:


                  Integrated Health Services,  Inc., a Delaware corporation (the
"Company"),  proposes to issue and sell to Smith Barney Inc.,  Morgan  Stanley &
Co.  Incorporated,  Donaldson,  Lufkin &  Jenrette  Securities  Corporation  and
Citicorp Securities,  Inc. (the "Initial Purchasers"),  upon the terms set forth
in a purchase  agreement of even date herewith (the  "Purchase  Agreement"),  an
aggregate of  $500,000,000  principal  amount of its 9 1/4% Senior  Subordinated
Notes due 2008 (the "Notes").  The Notes will be issued pursuant to an indenture
(the "Indenture")  dated as of September 11, 1997, between the Company and First
Union National Bank, as trustee (the "Trustee"). As an inducement to the Initial
Purchasers  to enter  into  the  Purchase  Agreement  and in  satisfaction  of a
condition to the obligations of the Initial Purchasers  thereunder,  the Company
agrees with the Initial Purchasers,  for the benefit of the holders of the Notes
(including, without limitation, the Initial Purchasers), as follows:

                  1. Registered  Exchange Offer.  The Company shall prepare and,
as  promptly  as  reasonably  practicable  after the date on which  the  Company
delivers the Notes to the Initial Purchasers (the "Closing Date"), file with the
Securities and Exchange  Commission (the "Commission") a registration  statement
on an  appropriate  form  under the  Securities  Act of 1933,  as  amended  (the
"Securities  Act"),  with respect to a proposed offer (the "Registered  Exchange
Offer") to the  holders of the Notes to issue and  deliver to such  holders,  in
exchange  for the  Notes,  a like  principal  amount of debt  securities  of the
Company identical in all material respects to, and entitled to substantially the
same benefits of, the Notes (the "New Notes"),  shall use all reasonable efforts
to cause such  registration  statement to become  effective under the Securities
Act and,  following the declaration of the  effectiveness  of that  registration
statement,  shall use all reasonable efforts to commence the Registered Exchange
Offer and shall  cause the same to remain open for a period of not less than the
period required under  applicable  Federal and state  securities laws, and to be
conducted  in  accordance  with  such  procedures  as  may  be  required  by the
applicable  provisions of the  Securities  Exchange Act of 1934, as amended (the
"Exchange  Act"),  it being the objective of such  Registered  Exchange Offer to
enable each holder of Notes electing to


                                        


exchange  Notes for New Notes  (assuming that such holder is not an affiliate of
the Company within the meaning of the Securities Act,  acquires the New Notes in
the ordinary course of such holder's  business and has no arrangements  with any
person to  participate in the  distribution  of the New Notes) to trade such New
Notes from and after their receipt without any limitations or restrictions under
the Securities Act (subject to any applicable  requirement  that  broker-dealers
deliver  a  prospectus  meeting  the  requirements  of  the  Securities  Act  in
connection  with sales of New Notes received by them in the Registered  Exchange
Offer).  In connection  with such Registered  Exchange Offer,  the Company shall
take such other action, including, without limitation, appropriate filings under
state securities  laws, as may be necessary to realize the foregoing  objective.
The New  Notes  may be issued in the  Registered  Exchange  Offer  under (i) the
Indenture or (ii) an indenture substantially similar to the Indenture,  and will
not be subject to the transfer restrictions described in the Offering Memorandum
(subject to any applicable  requirement that broker-dealers deliver a prospectus
meeting the  requirements  of the Securities Act in connection with sales of New
Notes received by them in the Registered  Exchange Offer), and the New Notes and
the Notes will vote and consent together on all matters as one class and neither
the New Notes nor the Notes will have the right to vote or consent as a separate
class on any  matter.  The  Company  agrees  that for a period of 90 days  after
consummation  of  the  Registered  Exchange  Offer  it  will  make  available  a
prospectus  meeting the  requirements  of the  Securities  Act (which may be the
prospectus  used in  connection  with  the  Registered  Exchange  Offer)  to any
broker-dealer  for use in  connection  with any resale of New Notes  acquired by
such broker-dealer in the Registered Exchange Offer.

                  2. Shelf  Registration.  If, because the  Registered  Exchange
Offer would violate any applicable law or the applicable  interpretations of the
Commission's   staff  or  because  of  any   change  in   currently   prevailing
interpretations  of the  Commission's  staff,  the Company is not  permitted  to
effect the Registered  Exchange Offer as  contemplated by Section 1 hereof or in
the event the Registered  Exchange Offer is not for any other reason consummated
within 240 days after the Closing  Date,  the Company  shall take the  following
actions:


                  (a) The Company shall,  as promptly as reasonably  practicable
after (i) the Closing  Date, in the event the Company is not permitted to effect
the Registered  Exchange Offer as  contemplated  by Section 1 hereof because the
Registered  Exchange  Offer would  violate an  applicable  law or an  applicable
interpretation  of the Commission's  staff or because of a change in a currently
prevailing  interpretation of the Commission's  staff or (ii) 240 days after the
Closing  Date,  if the  Registered  Exchange  Offer is not for any other  reason
consummated by such date, file with the Commission and thereafter  shall use all
reasonable efforts to cause to be declared effective a registration statement on
an  appropriate  form under the Securities Act relating to the offer and sale of
the  Notes by the  holders  thereof  from  time to time in  accordance  with the
methods of distribution  set forth in such  registration  statement and Rule 415
under the Securities Act (hereafter, the "Shelf Registration").

                  (b) The Company shall use all  reasonable  efforts to keep the
registration statement relating to the Shelf Registration continuously effective
in order to permit the prospectus  included  therein to be usable by the holders
of the Notes for a period of two years from the date the registration  statement
is declared  effective or such shorter  period that will  terminate when all the
Notes  covered by the  registration  statement  have been sold  pursuant to such
registration  statement;  provided, that the Company shall be deemed not to have
used all reasonable efforts to keep the registration  statement effective during
the  requisite  period if it  voluntarily  takes any action that would result in
holders  of  Notes  covered  thereby  not  being  able to offer  and  sell  such
securities during that period, unless such action is required by applicable law,
including,   but  not  limited  to,  reasonable  periods  necessary  to  prepare
appropriate  disclosure.  The foregoing proviso shall not apply to actions taken
(or  contemplated  to be taken) by the  Company in good  faith and for  business
reasons (a "Suspension Event"), including, without limitation, the


                                       2


acquisition or  divestiture of assets or the offering or sale of securities,  so
long as the  Company  promptly  thereafter  complies  with the  requirements  of
Section 3(h) hereof,  if  applicable.  Any such period  during which the Company
fails to keep the  registration  statement  effective  and usable for offers and
sales of Notes is  referred to as a  "Suspension  Period." A  Suspension  Period
shall  commence on and include the date that the Company  gives  notice that the
registration statement is no longer effective or the prospectus included therein
is no longer usable for offers and sales of Notes and shall end on the date when
each seller of Notes covered by such registration  statement either receives the
copies of the  supplemented or amended  prospectus  contemplated by Section 3(h)
hereof or is advised in writing by the Company that use of the prospectus may be
resumed.

                  (c)  Notwithstanding any other provisions of this Agreement to
the contrary, the Company shall cause the registration statement and the related
prospectus and any amendment or supplement  thereto, as of the effective date of
such  registration  statement,  amendment  or  supplement,  (i) to comply in all
material respects with the applicable requirements of the Securities Act and the
rules and  regulations  of the  Commission  and (ii) not to  contain  any untrue
statement  of a material  fact or omit to state a material  fact  required to be
stated therein or necessary to make the statements  therein not misleading other
than  statements  or  omissions  made in reliance  upon and in  conformity  with
information  furnished  to the  Company  in writing  by the  Initial  Purchasers
expressly for use in such registration  statement and the related prospectus and
any amendment or supplement thereto.

                  3.  Registration  Procedures.  In  connection  with any  Shelf
Registration contemplated by Section 2 hereof and, to the extent applicable, the
Registered  Exchange  Offer  contemplated  by  Section 1 hereof,  the  following
provisions shall apply:


                  (a) The Company shall furnish to the Initial Purchasers, prior
to the filing thereof with the Commission,  a copy of the registration statement
and each  amendment  thereof  and each  supplement,  if any,  to the  prospectus
included  therein and shall obtain the consent (which shall not be  unreasonably
withheld or delayed) of the Initial Purchasers to any such filing.

                  (b) The Company  shall advise the Initial  Purchasers  and the
holders of the Notes and the New Notes (to the extent applicable) in writing:

                         (i) when the  registration  statement and any amendment
         thereto has been filed with the  Commission  and when the  registration
         statement or any post-effective amendment thereto has become effective;

                         (ii) of any request by the Commission for amendments or
         supplements to the  registration  statement or the prospectus  included
         therein or for  additional  information;

                         (iii) of the  issuance  by the  Commission  of any stop
         order suspending the effectiveness of the registration statement or the
         initiation of any proceedings for that purpose;

                         (iv) of the receipt by the Company of any  notification
         with respect to the  suspension of the  qualification  of the Notes and
         New Notes for sale in any jurisdiction or the initiation or threatening
         of any proceeding for such purpose; and

                         (v)  of  the  happening  of  any  event  (other  than a
         Suspension  Event,  in which  case the  Company  need only  notify  the
         Initial Purchasers and the holders of the Notes that a Suspension Event
         exists) that  requires the Company to make changes in the  registration
         statement


                                       3


         or  the  prospectus  in  order  to  make  the  statements  therein  not
         misleading  (which advice shall be accompanied  by an instruction  that
         such notice constitutes material nonpublic information,  and to suspend
         the use of the prospectus  until the requisite  changes have been made,
         and  which  instruction  shall  require  that  such  holders  shall not
         communicate such material nonpublic  information to any third party and
         shall  not  sell  or  purchase,  or  offer  to sell  or  purchase,  any
         securities of the Company after receipt of such advice and prior to the
         effectiveness  of any  action  required  to be  taken  by  the  Company
         pursuant to Section 3(h) hereof).

                  (c) The Company  shall use all  reasonable  efforts to prevent
the issuance or obtain the withdrawal of any order suspending the  effectiveness
of the registration statement at the earliest possible time.

                  (d) The Company shall furnish to each holder of Notes included
within the coverage of the Shelf Registration, without charge, at least one copy
of  the  registration  statement  and  any  post-effective   amendment  thereto,
including financial statements and schedules,  and, if the holder so requests in
writing,  all exhibits  (including  those  incorporated  by reference).

                  (e) The Company shall deliver to each holder of Notes included
within the coverage of the Shelf  Registration,  if any, without charge, as many
copies of the prospectus (including each preliminary prospectus) included in the
registration  statement with respect to the Shelf Registration and any amendment
or  supplement  thereto as such  persons  may  reasonably  request.  The Company
consents,  subject  to the  provisions  of  the  Agreement,  to  the  use of the
prospectus or any amendment or supplement thereto by each of the selling holders
of Notes in  connection  with the offering and sale of the Notes  covered by the
prospectus,   or  any  amendment  or  supplement   thereto,   included  in  such
registration  statement.

                  (f) Prior to any  public  offering  of Notes  pursuant  to the
Shelf Registration,  the Company shall register or qualify or cooperate with the
holders  of  securities   included  therein  and  their  respective  counsel  in
connection with the  registration or  qualification  of such Notes for offer and
sale under the securities or blue sky laws of such  jurisdictions  in the United
States as any holder of Notes reasonably  requests in writing and do any and all
other acts or things necessary or advisable to enable the offer and sale in such
jurisdictions of the securities covered by the Shelf Registration; provided that
the Company shall not be required to (i) qualify generally to do business in any
jurisdiction where it is not then so qualified,  (ii) take any action that would
subject it to the  service of  process  in suits,  other than as to matters  and
transactions relating to the Shelf Registration, in any jurisdiction where it is
not now  subject  or (iii)  take any action  which  would  subject it to general
service of process or to  taxation in any  jurisdiction  where it is not then so
subject.

                  (g) The Company shall  cooperate with the holders of the Notes
to facilitate the timely  preparation and delivery of certificates  representing
Notes to be sold in the Shelf  Registration free of any restrictive  legends and
in such  denominations and registered in such names as the holders may request a
reasonable  period  of time  prior  to  sales of  Notes  pursuant  to the  Shelf
Registration.

                  (h) Upon the occurrence of any event  contemplated  by Section
3(b)(v) above (including, without limitation, any Suspension Event), the Company
shall, as promptly as reasonably practicable, prepare a post-effective amendment
to the registration  statement or a supplement to the related prospectus or file
any other  required  document so that, as thereafter  delivered to purchasers of
the Notes,  the  prospectus  will not contain an untrue  statement of a material
fact or omit to state any material fact necessary to make the statements therein
not misleading.

                                       4


                  (i) Not  later  than  the  effective  date  of the  applicable
registration  statement,  the Company  will  provide a CUSIP  number for the New
Notes and provide the applicable trustee with printed certificates for the Notes
or New  Notes,  as the case may be,  in a form  eligible  for  deposit  with The
Depository  Trust Company.

                  (j) The Company will use all reasonable efforts to comply with
all rules and  regulations  of the  Commission to the extent and so long as they
are applicable to the Registered  Exchange Offer or the Shelf  Registration  and
will make generally  available to its security holders (or otherwise  provide in
accordance  with  Section  11(a) of the  Securities  Act) an earnings  statement
satisfying the provisions of Section 11(a) of the Securities  Act, no later than
45 days after the end of a  12-month  period  (or 90 days,  if such  period is a
fiscal  year)  beginning  with the first  month of the  Company's  first  fiscal
quarter  commencing  after the effective date of the Shelf  Registration,  which
statement  shall cover such  12-month  period.

                  (k) The Company  shall cause the  Indenture  (or an  indenture
substantially  identical to the  Indenture in the case of a Registered  Exchange
Offer) to be qualified  under the Trust  Indenture Act of 1939, as amended.

                  (l) The Company  may  require  each holder of Notes to be sold
pursuant to the Shelf  Registration  to furnish to the Company such  information
regarding the holder and the  distribution of such Notes as the Company may from
time to time reasonably require for inclusion in the registration statement. The
Company may also require each holder of Notes  participating  in the  Registered
Exchange Offer to represent to the Company that at the time of the  consummation
of the  Registered  Exchange  Offer (i) such holder is not an  affiliate  of the
Company,  (ii) any New Notes  received  by such  holder  will be acquired in the
ordinary  course of its business and (iii) such holder will have no  arrangement
or understanding with any person to participate in the distribution of the Notes
or the New Notes within the meaning of the Securities Act. Each holder agrees by
acquisition  of Notes that,  upon  receipt of any notice from the Company of the
existence of any fact of the kind  described  in Section  3(b)(v)  hereof,  such
holder will  forthwith  discontinue  disposition  of Notes  until such  holder's
receipt of the copies of the supplemented or amended Prospectus  contemplated by
Section 3(h)  hereof,  or until it is advised in writing by the Company that the
use of the prospectus may be resumed,  and has received copies of any additional
or supplemental  filings with respect to the  Prospectus.  If so directed by the
Company,  each holder will deliver to the Company (at the Company's expense) all
copies,  other than permanent file copies then in such holder's  possession,  of
the  prospectus  covering  such  Notes  current  at the time of  receipt of such
notice.

                  4. Registration  Expenses. The Company shall bear all expenses
incurred in connection with the performance of its obligations  under Sections 1
through  3 hereof  and,  in the  event of a Shelf  Registration,  shall  bear or
reimburse the holders of the Notes for the reasonable fees and  disbursements of
one firm of counsel  designated by the holders of a majority in principal amount
of the  Notes to act as  counsel  for the  holders  of the  Notes in  connection
therewith.


                  5. Indemnification.
                     ---------------

                  (a) The Company agrees to indemnify and hold harmless (i) each
Initial  Purchaser,  (ii) each  holder  of Notes  and/or  New  Notes  (including
broker-dealers  receiving New Notes in the  Registered  Exchange  Offer) (each a
"Holder"),  (iii) each  person,  if any,  who  controls  (within  the meaning of
Section 15 of the Act or Section 20 of the Exchange  Act) any Initial  Purchaser
or any  Holder  (any of the  persons  referred  to in this  clause  (iii)  being
hereinafter  referred  to as a  "controlling  person")  and (iv) the


                                       5


respective officers, directors, partners, employees,  representatives and agents
of any Initial  Purchaser  or any Holder or any  controlling  person (any person
referred to in clause (i), (ii), (iii) or (iv) may hereinafter be referred to as
a "Non-Company Indemnitee"),  to the fullest extent lawful, from and against any
and all losses, claims, damages,  liabilities and judgments caused by any untrue
statement  or alleged  untrue  statement  of a material  fact  contained  in any
registration  statement or prospectus (or any amendments or supplements thereto)
prepared in accordance with this Agreement,  including any document incorporated
by reference  therein,  or caused by any  omission or alleged  omission to state
therein a material fact  required to be stated  therein or necessary to make the
statements  therein not  misleading,  except,  with  respect to any  Non-Company
Indemnitee,  insofar as such losses, claims,  damages,  liabilities or judgments
(1) are caused by any such  untrue  statement  or  omission  or  alleged  untrue
statement or omission based upon information furnished in writing to the Company
by such Non-Company  Indemnitee expressly for use therein or (2) with respect to
any  preliminary  prospectus,   result  from  the  fact  that  such  Non-Company
Indemnitee  sold  Notes or New Notes to a person  to whom  there was not sent or
given, at or prior to the written confirmation of such sale, a copy of the final
prospectus, as amended or supplemented, if required under the Securities Act and
if  the  Company  shall  have  previously   furnished  copies  thereof  to  such
Non-Company   Indemnitee  in  accordance  with  this  Agreement  and  the  final
prospectus,  as  amended  or  supplemented,  would have  corrected  such  untrue
statement or omission.

                  (b)  In  case  any  action   shall  be  brought   against  any
Non-Company Indemnitee based upon any registration  statement or prospectus,  or
any amendment or supplement thereto,  and with respect to which indemnity may be
sought against the Company,  such  Non-Company  Indemnitee shall promptly notify
the  Company in writing  and the  Company  shall  assume  the  defense  thereof,
including the employment of counsel reasonably  satisfactory to such Non-Company
Indemnitee  and payment of all fees and expenses.  Such  Non-Company  Indemnitee
shall  have  the  right to  employ  separate  counsel  in any  such  action  and
participate in the defense  thereof,  but the fees and expenses of counsel shall
be  paid by such  Non-Company  Indemnitee,  unless  (i) the  employment  of such
counsel shall have been specifically  authorized in writing by the Company, (ii)
the Company shall have failed to assume the defense and employ  counsel or (iii)
the named parties to any such action  (including any impleaded  parties) include
both such Non-Company Indemnitee and the Company and such Non-Company Indemnitee
shall have been advised by counsel that it would be  inappropriate  for the same
counsel to represent such Non-Company  Indemnitee and the Company (in which case
the  Company  shall not have the right to assume the  defense of such  action on
behalf of such Non-Company  Indemnitee,  it being understood,  however, that the
Company  shall not,  in  connection  with any one such  action or  separate  but
substantially similar or related actions in the same jurisdiction arising out of
the same  general  allegations  or  circumstances,  be  liable  for the fees and
expenses of more than one separate  firm of attorneys  (in addition to any local
counsel) for the  Non-Company  Indemnitees,  which firm shall be  designated  in
writing by the Non-Company  Indemnitees  and whose fees and expenses  reasonably
incurred  shall be  reimbursed as they are  incurred).  The Company shall not be
liable for any  settlement  of any such  action  effected  without  the  written
consent of the Company,  but if settled with the written consent of the Company,
the Company  agrees to indemnify  and hold harmless any  Non-Company  Indemnitee
from and  against  any  amounts  payable  pursuant  to such  written  consent in
connection  with such  settlement.  Notwithstanding  the  immediately  preceding
sentence,  if in any case  where the fees and  expenses  of  counsel  are at the
expense of the Company and a  Non-Company  Indemnitee  shall have  requested the
Company to reimburse such  Non-Company  Indemnitee for such fees and expenses of
counsel  as  incurred,  the  Company  agrees  that it  shall be  liable  for any
settlement  of any  action  effected  without  its  written  consent if (i) such
settlement  is entered into more than 30 business  days after the receipt by the
Company of the  aforesaid  request  and (ii) the  Company  shall have  failed to
reimburse  such  Non-Company  Indemnitee  in  accordance  with such  request for
reimbursement  prior to the date of such  settlement.  The  Company  shall  not,
without the prior written  consent of such  Non-Company  Indemnitee,  effect any
settlement of any pending or threatened proceeding


                                       6


in respect of which such  Non-Company  Indemnitee  is or could have been a party
and indemnity could have been sought hereunder by such  Non-Company  Indemnitee,
unless such settlement  includes an  unconditional  release of such  Non-Company
Indemnitee  from all  liability  on claims that are the  subject  matter of such
proceeding.

                  (c) Each Holder  agrees to indemnify and hold harmless (i) the
Company, (ii) each of the Initial Purchasers,  (iii) each other Holder, (iv) any
person controlling (within the meaning of Section 15 of the Act or Section 20 of
the Exchange Act) the Company,  any Initial  Purchaser and each other Holder and
(v) the respective officers, directors, partners, employees, representatives and
agents of each of the parties  referred to in clauses (i), (ii), (iii) and (iv),
to the same extent as the  foregoing  indemnity  from the Company to each of the
Non-Company  Indemnitees,  but only with respect to information relating to such
Holder that was  furnished  in writing by such Holder  expressly  for use in any
registration  statement  (or any amendment or  supplement  thereto)  prepared in
accordance  with this  Agreement.  In no event shall the liability of any Holder
hereunder be greater in amount than the dollar  amount of the proceeds  received
by such  Holder  upon the sales of the Notes or New  Notes  giving  rise to such
indemnification  obligation.

                  (d) If the  indemnification  provided for in this Section 5 is
unavailable to an indemnified party in respect of any losses,  claims,  damages,
liabilities or judgments  referred to herein,  then each indemnifying  party, in
lieu of indemnifying such indemnified party, shall contribute to the amount paid
or  payable  by such  indemnified  party as a  result  of such  losses,  claims,
damages,  liabilities  and  judgments in such  proportion as is  appropriate  to
reflect the relative fault of the  indemnifying  party, on the one hand, and the
indemnified  party,  on the other hand,  in  connection  with the  statements or
omissions  which  resulted  in such  losses,  claims,  damages,  liabilities  or
judgments, as well as any other relevant equitable considerations.  The relative
fault of the indemnifying  party, on the one hand, and the indemnified party, on
the other hand, shall be determined by reference to, among other things, whether
the untrue or alleged  untrue  statement  of a material  fact or the omission or
alleged omission to state a material fact relates to information supplied by the
indemnifying  party,  on the one hand, or the  indemnified  party,  on the other
hand, and the parties'  relative  intent,  knowledge,  access to information and
opportunity to correct or prevent such statement or omission.

                  The Company, each Initial Purchaser and each Holder agree that
it would not be just and equitable if contribution pursuant to this Section 5(d)
were  determined  by pro rata  allocation  or by any other method of  allocation
which does not take account of the equitable  considerations  referred to in the
immediately preceding paragraph.  The losses,  claims,  damages,  liabilities or
judgments  of an  indemnified  party  referred to in the  immediately  preceding
paragraph  shall be deemed to  include,  subject  to the  limitations  set forth
above, any legal or other expenses reasonably incurred by such indemnified party
in connection with  investigating or defending any such action or claim prior to
the indemnifying party's assumption of the defense thereof or subsequent thereto
to  the  extent  permitted  by the  second  sentence  of  Section  5(b)  hereof.
Notwithstanding  the  provisions of this Section 5, none of the Holders shall be
required to contribute,  in the aggregate, any amount in excess of the amount by
which the total amount received by such Holder with respect to the sale of Notes
or New Notes  exceeds the amount of any damages  which such Holder has otherwise
been  required to pay by reason of such untrue or alleged  untrue  statement  or
omission or alleged omission.  No person guilty of fraudulent  misrepresentation
(within the meaning of Section 11(f) of the Securities Act) shall be entitled to
contribution   from  any  person   who  was  not   guilty  of  such   fraudulent
misrepresentation.  The  obligations  of Holders to contribute  pursuant to this
Section 5(d) are several in proportion  to the  respective  principal  amount of
Notes and/or New Notes held by each of the Holders hereunder and not joint.


                                       7



                  6. Additional Interest Under Certain Circumstances.
                     -----------------------------------------------

                  (a)  Additional  interest  (the "Penalty  Interest")  shall be
assessed as follows:


                         (i)  If a  registration  statement  with  respect  to a
         Registered Exchange Offer or a Shelf Registration is not filed with the
         Commission  within 90 days following the Closing Date,  then commencing
         on the 91st day after  the  Closing  Date,  Penalty  Interest  shall be
         accrued on the Notes over and above the  accrued  interest at a rate of
         .25% per annum for the first 90 days immediately following the 90th day
         after the Closing Date,  such Penalty  Interest  rate  increasing by an
         additional .25 % per annum at the beginning of each  subsequent  90-day
         period;

                         (ii) If a  registration  statement  with  respect  to a
         Registered   Exchange  Offer  or  a  Shelf  Registration  is  filed  as
         contemplated by subsection  6(a)(i) above and is not declared effective
         by the  Commission  within 180 days  following the Closing Date,  then,
         commencing  on the 181st day after the Closing Date,  Penalty  Interest
         shall be accrued on the Notes over and above the accrued  interest at a
         rate of .25% per annum for the first 90 days immediately  following the
         180th day after the Closing Date, such Penalty Interest rate increasing
         by an additional  .25 % per annum at the  beginning of each  subsequent
         90-day  period; and

                         (iii) If either (A) the Company has not  exchanged  New
         Notes for all Notes validly  tendered in  accordance  with the terms of
         the Registered  Exchange Offer on or prior to 40 days after the date on
         which  the  registration  statement  with  respect  to  the  Registered
         Exchange  Offer  was  declared  effective,  or  (B)  if  applicable,  a
         registration  statement with respect to a Shelf  Registration  has been
         declared  effective  and  such  registration  statement  ceases  to  be
         effective  prior to two years from its original  effective  date (other
         than by reason of the occurrence of a Suspension  Event),  then Penalty
         Interest  shall be  accrued  on the Notes  over and  above the  accrued
         interest at a rate of .25% per annum for the first 60 days  immediately
         following (x) the 40th day after such effective date in the case of (A)
         above,  or (y) the day such  registration  statement  with respect to a
         Shelf Registration  ceases to be effective (other than by reason of the
         occurrence  of a  Suspension  Event)  in the  case of (B)  above,  such
         Penalty Interest rate increasing by an additional .25% per annum at the
         beginning of each subsequent 60-day period;

provided,  however,  that the Penalty  Interest rate on the Notes may not exceed
1.0% per annum at any time; and provided,  further,  that (1) upon the filing of
the  registration  statement  with respect to a Registered  Exchange  Offer or a
Shelf Registration (in the case of (i) above), (2) upon the effectiveness of the
registration  statement  filed with respect to a Registered  Exchange Offer or a
Shelf  Registration (in the case of (ii) above), or (3) upon the exchange of New
Notes  for all  Notes  validly  tendered  in  accordance  with the  terms of the
Registered  Exchange  Offer,  or  upon  the  effectiveness  of the  registration
statement filed with respect to a Shelf  Registration which had ceased to remain
effective  prior to two years from its original  effective  date (in the case of
(iii)  above),  Penalty  Interest  on the Notes as a result of such  clause (i),
(ii), or (iii) shall immediately cease to accrue. The Penalty Interest specified
in this  Section 6(a) shall be payable by the Company to the holders of Notes at
the times,  in the manner and subject to the same terms and conditions set forth
in the  Indenture,  as nearly as may be, as though the rate set out in the Notes
had been increased,  which payments shall be calculated pursuant to Section 6(b)
below. The interest rate on the Notes,  inclusive of Penalty Interest,  shall in
no event exceed 10 1/4% per annum.

                  (b) Any  amounts of Penalty  Interest  due  pursuant to clause
(i),  (ii),  or (iii) of  Section  6(a)  above  will be  payable  in cash on the
interest payment dates of the Notes.


                                       8


                  The  amount  of  Penalty   Interest   will  be  determined  by
multiplying the applicable  Penalty Interest rate by the principal amount of the
Notes,  multiplied  by a fraction,  the numerator of which is the number of days
such Penalty Interest rate was applicable during such period  (determined on the
basis of a 360-day year comprised of twelve 30-day months),  and the denominator
of which is 360.

(v) If the Company effects the Registered  Exchange  Offer,  the Company will be
entitled to close the  Registered  Exchange  Offer provided that it has accepted
all Notes  theretofore  validly  tendered  in  accordance  with the terms of the
Registered  Exchange Offer. Notes not tendered in the Registered  Exchange Offer
shall bear  interest  at the same rates in effect at the time of issuance of the
Notes.

                  7. Miscellaneous.
                     -------------


                  (a) Amendments  and Waivers.  The provisions of this Agreement
may not be  amended,  modified  or  supplemented,  and  waivers or  consents  to
departures from the provisions  hereof may not be given,  unless the Company has
obtained  the written  consent of holders of a majority in  aggregate  principal
amount of the Notes.

                  (b) Notices. All notices and other communications provided for
or permitted  hereunder shall be made in writing by  hand-delivery,  first-class
mail, telex, telecopier or air courier which guarantees overnight delivery:

                                (1) If to a holder of Notes or New Notes, at the
                  most  current  address  given by such holder to the Company in
                  accordance  with the  provisions of this Section  7(b),  which
                  address initially is, with respect to each holder, the address
                  of such holder to which  confirmation  of the sale of Notes or
                  New Notes to such holder was first  sent,  with a copy in like
                  manner to the Initial  Purchasers c/o Smith Barney Inc. at 388
                  Greenwich Street, New York, New York 10013.

                                (2) If to an Initial Purchaser,  to  the address
                  specified in 7(b)(1);

                                 (3)If to the Company, at the following address:

                                  Integrated Health Services, Inc.
                                  10065 Red Run Boulevard
                                  Owings Mills, Maryland  21117
                                  Attention:  General Counsel

                  All such  notices and  communications  shall be deemed to have
been duly given: at the time delivered by hand, if personally  delivered;  three
business days after being  deposited in the mail,  postage  prepaid,  if mailed;
when  answered  back,  if telexed;  when  receipt  acknowledged  by  recipient's
telecopy operator, if telecopied; and on the day delivered, if sent by overnight
air courier guaranteeing next day delivery.

                  (c) Successors and Assigns.  This Agreement shall inure to the
benefit  of and be  binding  upon  the  successors  and  assigns  of each of the
parties,  including,  without  limitation,  and  without the need for an express
assignment, subsequent holders of the Notes and the New Notes.


                                       9


                  (d) Counterparts. This Agreement may be executed in any number
of  counterparts  and by the parties  hereto in separate  counterparts,  each of
which when so executed  shall be deemed to be an original and all of which taken
together  shall  constitute  one and the  same  agreement.

                  (e)  Headings.   The  headings  in  this   Agreement  are  for
convenience  of  reference  only and  shall not limit or  otherwise  affect  the
meaning  hereof.

                  (f) Governing  Law. This  Agreement  shall be governed by and
construed in accordance  with the laws of the State of New York,  without regard
to its  conflicts of laws rules.

                  (g)  Severability.  If any  one  or  more  of the  provisions
contained  herein,  or the  application  thereof  in any  circumstance,  is held
invalid, illegal or unenforceable,  the validity, legality and enforceability of
any such  provision  in every  other  respect  and of the  remaining  provisions
contained herein shall not be affected or impaired thereby.



                                       10



                  Please  confirm that the  foregoing  correctly  sets forth the
agreement between the Company and the Initial Purchasers.


                                          Very truly yours,

                                          INTEGRATED HEALTH SERVICES, INC.





                                          By: /s/ Eleanor C. Harding
                                             ------------------------------
                                              Name:  Eleanor C. Harding
                                              Title: Executive Vice President-
                                                     Finance





Confirmed as of the date first
above mentioned.


SMITH BARNEY INC.
MORGAN STANLEY & CO. INCORPORATED
DONALDSON, LUFKIN & JENRETTE
  SECURITIES CORPORATION
CITICORP SECURITIES, INC.

By: SMITH BARNEY INC.

By: /s/ Benjamine R. Lorello
    ------------------------------
    Name: Benjamin R. Lorello
    Title: Managing Director