EXHIBIT 10.22

                                 FIRST AMENDMENT

                                       TO

                              FACILITIES AGREEMENT

                                      AMONG

                     LITCHFIELD INVESTMENT COMPANY, L.L.C.,

                   INTEGRATED HEALTH SERVICES OF LESTER, INC.

                                       AND

                        INTEGRATED HEALTH SERVICES, INC.

                            AS OF SEPTEMBER 30, 1997








                                 FIRST AMENDMENT

                                       TO

                              FACILITIES AGREEMENT

         THIS FIRST AMENDMENT TO FACILITIES  AGREEMENT ("First  Amendment"),  is
made and entered into as of the 30th day of September,  1997,  among  Litchfield
Investment  Company,  L.L.C.,  a Connecticut  limited  liability  company,  with
principal  offices  at 128  Litchfield  Road,  New  Milford,  Connecticut  06776
(hereinafter referred to as "Litchfield"), Integrated Health Services of Lester,
Inc., a Delaware corporation, with principal offices at 10065 Red Run Boulevard,
Owings Mills,  Maryland 21117 (hereinafter  referred to as "IHS") and Integrated
Health Services,  Inc., a Delaware corporation,  with principal offices at 10065
Red Run  Boulevard,  Owings Mills,  Maryland 21117  (hereinafter  referred to as
"Integrated").

                              W I T N E S S E T H:

         WHEREAS, pursuant to an Agreement to Convey, dated as of June 30, 1997,
between  Litchfield Asset Management Corp.  (hereinafter  referred to as "LAMC")
and  Litchfield,   Litchfield  is  the  present  owner  of  the  real  property,
improvements and personal property  constituting  forty-one (41) skilled nursing
home  facilities  and two (2)  retirement  centers,  as  described  on Exhibit A
attached  hereto and made a part hereof for all purposes  (hereinafter  referred
to, collectively, as the "Facilities"); and

         WHEREAS,  pursuant to forty-three (43) Leases,  each dated as of August
31, 1994 (hereinafter referred to, collectively, as the "Prior Leases"), between
LAMC and IHS, LAMC leased the Facilities to IHS,  during the term from September
1, 1994 (hereinafter referred to as the "Effective Date of the Prior Leases") to
September 30, 1997; and

         WHEREAS, pursuant to forty-three (43) Purchase Option Agreements,  each
dated as of August 31,  1994  (hereinafter  referred  to,  collectively,  as the
"Prior Purchase Option  Agreements"),  between LAMC and IHS, LAMC granted to IHS
options to purchase each of the Facilities; and

         WHEREAS,  pursuant to the  Termination  of Leases and  Purchase  Option
Agreements,  dated  as of  September  30,  1997,  between  Litchfield  and  IHS,
Litchfield and IHS  terminated  the Prior Leases and the Prior  Purchase  Option
Agreements; and

         WHEREAS,  Litchfield  and IHS have (a) entered  into  forty-three  (43)
Leases,  each  dated  as  of  September  30,  1997  (hereinafter   referred  to,
collectively,  as the  "Leases"),  whereby  Litchfield  has  leased  each of the
Facilities  to IHS  and  (b)  entered  into  forty-three  (43)  Purchase  Option
Agreements,  each dated as of  September  30,  1997  (hereinafter  referred  to,
collectively,  as the "Purchase Option Agreements"),  whereby Litchfield granted
to IHS options to purchase each of the Facilities; and

         WHEREAS,  concurrently  with the  execution  and delivery of this First
Amendment, the Leases and the Purchase Option Agreements, among other things (a)
Litchfield, the Principal Members of Litchfield, Integrated and







IHS will  enter  into the  Amended  and  Restated  Non-Competition  and  Secrecy
Agreement,  dated as of  September  30,  1997  (hereinafter  referred  to as the
"Non-Competition and Secrecy Agreement"), (b) Litchfield and IHS will enter into
the Amended and Restated Participation Agreement, dated as of September 30, 1997
(hereinafter referred to as the "Participation  Agreement"),  and (c) Integrated
will execute the Guaranty,  dated as of September 30, 1997 (hereinafter referred
to as the  "Guaranty"),  as to payment of certain  obligations  of IHS under the
Leases and the Prior Leases; and

         WHEREAS,  to  refinance  the  secured   indebtedness   encumbering  the
Facilities,   German  American  Capital  Corporation,   a  Maryland  corporation
(hereinafter  referred  to as the  "Lender")  shall  make a loan to  Litchfield,
subject  to the  terms  and  conditions  of the  Credit  Agreement,  dated as of
September 30, 1997,  between Litchfield and Lender  (hereinafter  referred to as
the "Loan Agreement"); and

         NOW THEREFORE,  in  consideration  of the mutual promises and covenants
herein   contained  in  this  First   Amendment  and  other  good  and  valuable
consideration, the receipt and sufficiency of which hereby are acknowledged, and
intending to be legally bound hereby, the parties hereto agree as follows:

          1. Section 1.15 of the Facilities Agreement is amended and restated as
follows:

             1.15  Guaranty.  "Guaranty"  shall mean the  Guaranty,  dated as of
September 30, 1997, from Integrated for the benefit of Litchfield.

         2. Section 1.25 of the Facilities  Agreement is amended and restated as
follows:

             1.25  Knowledge.  "Knowledge"  of a party  shall  mean  (a)  actual
knowledge of an officer or management level employee of such party, with respect
to a corporation,  including actual knowledge of any of the Principal Members of
Litchfield,  (b)  actual  knowledge  of a general  partner or  management  level
employee of such party,  with respect to a partnership,  or (c) actual knowledge
of the person with respect to a natural person.

         3. Section 1.27 of the Facilities Agreement is amended as follows:

             1.27  Leases or  Lease.  "Leases"  shall  mean,  collectively,  the
forty-three (43) leases, each dated as of September 30, 1997, between Litchfield
and IHS.  Reference to any one of the Leases  individually  and not specifically
shall be referred to herein as a "Lease".

         4. Section 1.28 of the Facilities  Agreement is amended and restated as
follows:

             1.28  Litchfield.  "Litchfield"  shall mean  Litchfield  Investment
Company, L.L.C., a Connecticut limited liability company, with principal offices
at 128 Litchfield Road, New Milford, Connecticut 06776.

         5. Section 1.34 of the Facilities  Agreement is amended and restated as
follows:

                  1.34  Non-Competition and Secrecy Agreement.  "Non-Competition
and Secrecy Agreement" shall mean the Amended and Restated  Non-Competition  and
Secrecy  Agreement,  dated as of  September  30,  1997,  among  Litchfield,  the
Principal Members of Litchfield, Integrated and IHS.


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         6. Section 1.35 of the Facilities  Agreement is amended and restated as
follows:

             1.35 Participation Agreement.  "Participation Agreement" shall mean
the Amended and Restated  Participation  Agreement,  dated as of  September  30,
1997, between IHS and Litchfield.

         7. Section 1.40 of the Facilities  Agreement is amended and restated as
follows:

             1.40  Principal  Members  of  Litchfield.   "Principal  Members  of
Litchfield"  shall  mean (a) Eugene H. Rosen  whose  address is 139 North  Shore
Road, New Preston,  Connecticut 06777, (b) Bruce Weinstein, whose address is 562
Tepi Drive,  Southbury,  Connecticut  06488,  and (c)  Michael S.  McGee,  whose
address is 5A Davison Lane West, West Islip, New York 11795.

         8. Section 1.41 of the Facilities  Agreement is amended and restated as
follows:

             1.41  Purchase  Option  Agreements  or Purchase  Option  Agreement.
"Purchase  Option  Agreements"  shall mean,  collectively,  the forty-three (43)
purchase  option  agreements,  each  dated as of  September  30,  1997,  between
Litchfield  and IHS.  Reference  to any one of the  Purchase  Option  Agreements
individually  and not  specifically  shall be  referred to herein as a "Purchase
Option Agreement".

         9. Section 1.45 of the Facilities  Agreement is amended and restated as
follows:

             1.45 Transaction Documents.  "Transaction Documents" shall mean (a)
the  Facilities  Agreement;  (b) the First  Amendment;  (c) the Leases;  (d) the
Purchase  Option  Agreements;  (e) the Memoranda of Lease;  (f) the Memoranda of
Option to Purchase Real Estate; (g) the  Non-Competition  and Secrecy Agreement;
(h) the Guaranty;  (i) the Warrant;  (j) the  Participation  Agreement;  (k) the
Litchfield  Shareholders  Notes;  (l) the Integrated  Loan  Agreements;  (m) the
Assignment  of Litchfield  Leases;  (n) the  Guaranties,  dated as of August 31,
1994, by each of the Principal Members of Litchfield;  (o) the Guaranty referred
to in Section IX hereof,  dated as of August 31, 1994,  by AVE; (p) the Guaranty
referred to in Section IX hereof,  dated as of August 31, 1994, by LAMC; (q) the
Security  Agreement/  Proceeds,  dated as of August  31,  1994,  by and  between
Litchfield and IHS; (r) the Termination of Lease and Purchase  Option,  dated as
of August 31, 1994, among LAMC, IHS, IHS at Hanover and Heritage/Highlands;  (s)
the  Termination of Lease and Purchase  Option,  dated as of August 31, 1994, by
and among LAMC,  IHS, IHS at Hawthorne,  and Charlotte;  (t) the  Termination of
Management  Agreement,  dated as of August 31, 1994, by and among LAMC, IHS, IHS
at Great Bend and Manorwood; (u) the Termination of Management Agreement,  dated
as of August 31, 1994, by and among LAMC,  IHS, IHS at Wichita and Manorwood (v)
the Prior Leases, each dated as of August 31, 1994, by and between LAMC and IHS;
(w) the Prior Purchase Option  Agreements,  each dated as of August 31, 1994, by
and  between  LAMC and IHS;  (x) the  Security  Agreement/Proceeds,  dated as of
September 30, 1997, by and between  Litchfield and IHS; and (y) the  Termination
of Leases and Purchase Option Agreements, dated as of September 30, 1997, by and
between Litchfield and IHS.

         10. Article I is amended by adding the following definitions to the end
thereof:

             1.47 Prior Leases.  "Prior  Leases" shall mean,  collectively,  the
forty-three (43) leases, each dated as of August 31, 1994, between LAMC and IHS.


                                        3






             1.48 Prior  Purchase  Option  Agreements.  "Prior  Purchase  Option
Agreements"  shall mean,  collectively,  the  forty-three  (43) purchase  option
agreements, each dated as of August 31, 1994, between LAMC and IHS.

             1.49 LAMC.  "LAMC" shall mean Litchfield Asset Management  Corp., a
Connecticut  corporation,  with principal  offices at 128  Litchfield  Road, New
Milford, Connecticut 06776.

         11. Subsections (a) and (b) of Section 15.7 of the Facilities Agreement
are amended and restated as
follows:

             (a) Litchfield  shall indemnify and hold harmless IHS,  Integrated,
and their respective officers, directors,  shareholders,  employees, agents, and
assigns  (collectively,  the  "IHS  Indemnified  Parties"),  from  any  and  all
liabilities,  obligations, losses, demands, judgments, actions, suits, causes of
action,  claims,  proceedings,  investigations,   citations,  matters,  damages,
penalties,  sanctions,  costs, expenses, and disbursements  (including,  without
limitation reasonable attorneys' and consultants' fees and expenses), whether or
not  subject  to  litigation,  (hereinafter  collectively  referred  to  as  the
"Claims") of any kind or character  imposed upon,  arising out of, in connection
with, incurred or in any way attributed or relating to the following:

                                    (i)  the  use,  operation,   possession,  or
                  management of the  Facilities  prior to the Effective  Date of
                  the Prior Leases, whether or not IHS or Integrated is a party;
                  provided,  however,  that this indemnification does not relate
                  to any Claims  relating to the use,  operation,  possession or
                  management  of the IHS Leased  Facilities  by IHS at Hawthorne
                  accruing  or  arising on or after  April 1,  1993,  and IHS at
                  Hanover  accruing or arising on or after July 7, 1992,  or the
                  IHS Managed Facilities by IHS at Great Bend and IHS at Wichita
                  accruing or arising on or after July 16, 1993;

                                    (ii)   the   breach   or   failure   of  any
                  representation,  warranty or covenant that is contained in the
                  Facilities Agreement,  the First Amendment or contained in any
                  other agreement or Transaction  Documents to which Litchfield,
                  LAMC, any principal shareholder or member of Litchfield,  LAMC
                  and AVE, on the one hand, and IHS or Integrated,  on the other
                  hand, are parties;

                                    (iii)  other than the IHS Leased  Facilities
                  and the IHS Managed  Facilities  (except as  otherwise  agreed
                  upon by Litchfield), the termination of any and all management
                  agreements pertaining to the Facilities in effect prior to the
                  Effective Date of the Prior Leases, including, but not limited
                  to, all management agreements with Health Care Capital;

                                    (iv)   all   cancellation   fees,   if  any,
                  attributable  to IHS's  termination  of the HSG  Contracts for
                  which  Litchfield is liable in  accordance  with Section 11.13
                  herein.

                                    (v) any and all  matters  arising out of the
                  cause of action entitled,  "Life Care Centers of America, Inc.
                  v.  Charles  Town  Associates  Limited  Partnership,  et al.,"
                  United States District Court,  Eastern  District of Tennessee,
                  Southern Division, No. 1:92-CV-170;


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                                    (vi) any and all  Claims  accruing  prior to
                  the Effective Date of the Prior Leases relating to any current
                  or former  employee,  consultant or independent  contractor of
                  the Partnerships,  Litchfield, LAMC, or any of the Facilities,
                  including,   but  not  limited  to,  (A)  the  termination  or
                  discharge of any current or former  employee,  consultant,  or
                  independent  contractor of the  Partnerships  or Litchfield or
                  LAMC or any of the  Facilities  prior to the Effective Date of
                  the Prior Leases;  (B) Claims under federal,  state,  or local
                  laws,  rules or  regulations,  accruing prior to the Effective
                  Date of the  Prior  Leases,  related  to  wages,  hours,  fair
                  employment practices,  unfair labor practices,  or other terms
                  and  conditions  of  employment  and claims  arising under the
                  Worker  Adjustment  and  Retraining  Notification  Act  or any
                  analogous   state  statute;   (C)  matters  arising  from  any
                  severance policy, claim, agreement or contract; or (D) any and
                  all Claims that accrue after the  Effective  Date of the Prior
                  Leases  with  respect to the matters  provided  for in Section
                  11.16 herein and Section 3.4 of the Prior Leases;

                                    (vii) any and all Claims  asserted  by or on
                  behalf  of  any  of  the  Limited   Partners  of  any  of  the
                  Partnerships  in connection with or relating to the activities
                  of LAMC or Litchfield  or any of the General  Partners of such
                  Partnerships and their respective affiliates in respect of the
                  transactions  contemplated  in this  Agreement  and the  other
                  Transaction Documents;

                                    (viii)  any and all  Claims  that  relate to
                  information   provided   by  or  on   behalf  of  any  of  the
                  Partnerships or LAMC or Litchfield  concerning the Facilities,
                  Litchfield, LAMC, any of the Partnerships,  any of the General
                  Partners and their  respective  affiliates,  to third  parties
                  which  was used or  relied  upon to  effect  the  transactions
                  contemplated in this Agreement,  the First  Amendment,  and by
                  the other Transaction Documents;

                                    (ix)  subject to the  provisions  of Section
                  11.13  hereof,   any  and  all  Claims  for  any  termination,
                  cancellation,   acceleration  or  modification,  penalties  or
                  payments or performance  obligations  relating to Contracts or
                  Leases provided for under Section 11.13 herein;

                                    (x) other than for the (A) liens,  claims or
                  encumbrances  established  under  the Loan  Documents,  or (B)
                  liens,   claims  or  encumbrances   necessary  to  effect  the
                  transactions   contemplated  in  this  Agreement,   the  First
                  Amendment,  and the other Transaction Documents, any mortgage,
                  pledge,  lien, or encumbrance made on any of the Facilities or
                  assets  relating  to any of the  Facilities,  and  any  claims
                  asserted  therefrom,  other than and except for the  Permitted
                  Liens; provided, however, that this subparagraph shall have no
                  application to any Claims which did not arise from,  accrue or
                  result from any action or inaction prior to the Effective Date
                  of the Prior Leases;

                                    (xi) any and all Claims with  respect to any
                  qualified  or  non-qualified  retirement  or benefit  plans or
                  arrangements  established  before  the  Effective  Date of the
                  Prior  Leases   involving  any  current  or  former  employee,
                  consultant  or  independent  contractor  of the  Partnerships,
                  Litchfield, LAMC or any of the Facilities;


                                        5






                                    (xii) except as otherwise  set forth in this
                  Agreement,  in particular  Section  11.13 herein,  any and all
                  Claims  accruing  prior  to the  Effective  Date of the  Prior
                  Leases  with   respect  to   admission   agreements,   patient
                  contracts, or agreements with others at the Facilities;

                                    (xiii)  any   deficiencies  or  inaccuracies
                  relating to patient funds and accounts associated therewith at
                  the Facilities,  which arose or accrued prior to the Effective
                  Date of the Prior Leases;

                                    (xiv) any  Claims  arising  out of LAMC's or
                  the Partnerships'  failure to have kept or maintained  patient
                  records  and  other  related  records  at  the  Facilities  in
                  accordance with applicable Law; or

                                    (xv) the violation of any  Environmental Law
                  or  the  existence,  presence  or  Release  of  any  Hazardous
                  Material (collectively,  "Environmental  Liability") where the
                  Environmental  Liability  is based on an event or condition at
                  or relating to any Facility that commenced or existed prior to
                  the  Effective  Date of the Prior Leases;  provided,  however,
                  that Litchfield's  indemnification  obligation hereunder shall
                  be   limited   solely  to  Claims  (of  any  kind  and  nature
                  whatsoever)  (i)  for  remediation  of  and  response  actions
                  related to such Environmental  Liability  (including,  without
                  limitation, any such Claim for cleanup, treatment,  corrective
                  action, compliance, financial assurance, restoration, removal,
                  abatement,    encapsulation,     containment,    revegetation,
                  monitoring,  sampling,  investigation,  study, assessment, and
                  the protection of, or mitigative  action related to, wildlife,
                  aquatic species,  wetlands,  vegetation,  flora and fauna) and
                  (ii) asserted by a third party relating to such  Environmental
                  Liability (including,  without limitation, any Claim involving
                  natural resource damages, property damage, payment of fines or
                  penalties or settlement  amounts, or any other action or cause
                  of action  by, or  obligation  to, a third  party  (including,
                  without  limitation,  any Claim for personal  injury or death,
                  contribution   or   cost   recovery)).   Notwithstanding   the
                  foregoing, Litchfield and IHS will share equally the liability
                  for Hazardous  Materials in existence on the Effective Date of
                  the Prior Leases, but not in violation of Environmental Law on
                  the Effective Date of the Prior Leases, whether as a result of
                  limits permissible under applicable Environmental Law, lack of
                  restriction or prohibition under applicable  Environmental Law
                  (i.e., non-friable asbestos) or changes in Environmental Law.

                  Litchfield  further  covenants  and  agrees to defend  the IHS
Indemnified  Parties on account of said Claims and to pay any  judgment  against
the IHS  Indemnified  Parties,  or any other amount as indicated in this Section
15.7(a),  along with all  reasonable  costs and  expenses  relative  to any such
Claims, including attorneys' fees and expenses;  provided, however, that the IHS
Indemnified  Parties shall,  nevertheless,  have the right, if they so elect, to
participate  (with counsel of their choosing,  which counsel must be approved by
Litchfield,  which approval may not be unreasonably  withheld) in the defense of
any such Claim in which they may be a party without relieving  Litchfield of the
obligation to defend the same.  To the extent  applicable,  the IHS  Indemnified
Parties  covenant  not to settle or  compromise  any Claim  under  this  section
without the written consent of Litchfield, which consent may not be unreasonably
withheld  or  delayed  under  the  circumstances.  Failure  to  comply  with the
preceding  covenant shall be deemed a complete waiver of any rights that the IHS
Indemnified Parties have or may have under this Section 15.7(a).


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                  (b) IHS shall  indemnify and hold harmless  Litchfield and its
officers, members, directors, shareholders,  employees, agents, and assigns (the
"Litchfield  Indemnified  Parties") from any and all  liabilities,  obligations,
losses,   demands,   judgments,   actions,  suits,  causes  of  action,  claims,
proceedings, investigations,  citations, matters, damages, penalties, sanctions,
costs,  expenses,  and disbursements  (including,  without limitation reasonable
attorneys'  and  consultants'  fees and  expenses),  whether  or not  subject to
litigation,  (hereinafter  collectively referred to as the "Claims") of any kind
or character  imposed upon,  arising out of, in connection with,  incurred or in
any way attributed or relating to the following:

                                  (i)   the    breach   or    failure   of   any
                  representation,  warranty  or  covenant  made  by IHS  that is
                  contained in the Facilities  Agreement or the First  Amendment
                  or contained in any other  agreement or Transaction  Documents
                  to  which  Litchfield,  LAMC  or IHS  are  parties;  provided,
                  however,  for purposes of this  subsection  (i) only, the term
                  Transaction  Documents  shall not  include  the  Leases or the
                  Prior Leases;

                                 (ii) any and all Claims  related to information
                  provided by or on behalf of IHS or Integrated  concerning  IHS
                  and Integrated, to third parties which was used or relied upon
                  to effect the transactions contemplated in this Agreement, the
                  First Amendment and by the other Transaction Documents;

                                (iii)  any and all  Claims  arising  out of,  in
                  connection  with,  or  resulting  from  the  use,   operation,
                  management or possession  of the Hawthorne  Nursing  Center by
                  IHS of Hawthorne  from April 1, 1993 until the Effective  Date
                  of the Prior Leases;

                                 (iv)  any and all  Claims  arising  out of,  in
                  connection   with  or  resulting  from  the  use,   operation,
                  management or  possession of the Hanover House Nursing  Center
                  by IHS at Hanover  from  December 7, 1992 until the  Effective
                  Date of the Prior Leases;

                                  (v) any  and all  Claims  arising  out of,  in
                  connection   with  or  resulting  from  the  use,   operation,
                  management or possession of the IHS Managed  Facilities by IHS
                  at Great Bend and IHS as Wichita  from July 16, 1993 until the
                  Effective Date of the Prior Leases; and

                                 (vi)  any and all  Claims  arising  out of,  in
                  connection with or resulting from the  cancellation of the HSG
                  Contracts for which IHS is liable  pursuant to the  provisions
                  of Section 11.13 hereof.

                  IHS  further  covenants  and agrees to defend  the  Litchfield
Indemnified  Parties on account of said Claims and to pay any  judgment  against
the  Litchfield  Indemnified  Parties,  or any other amount as indicated in this
Section 15.7(b),  along with all reasonable  costs and expenses  relative to any
such Claims, including attorneys' fees and expenses; provided, however, that the
Litchfield Indemnified Parties shall,  nevertheless,  have the right, if they so
elect,  to participate  (with counsel of their  choosing,  which counsel must be
approved by IHS, which approval may not be unreasonably withheld) in the defense
of any  such  Claim  in which  it may be a party  without  relieving  IHS of the
obligation  to  defend  the  same.  To the  extent  applicable,  the  Litchfield
Indemnified  Parties  covenant not to settle or compromise  any Claim under this
section   without  the  written  consent  of  IHS,  which  consent  may  not  be
unreasonably

                                        7






withheld  or  delayed  under  the  circumstances.  Failure  to  comply  with the
preceding  covenant  shall be deemed a complete  waiver of any  rights  that the
Litchfield Indemnified Parties have or may have under this Section 15.7(b).

         12. Section 15.8 of the Facilities Agreement is deleted.

         13. Section 15.9 of the Facilities Agreement is amended and restated as
follows:

                  15.9 Sales,  Assignments  or Transfers of  Litchfield  and the
Facilities; Right of First Refusal. The ownership interest of Litchfield held by
the  Principal  Members of  Litchfield  on the  Effective  Date or  Litchfield's
ownership  interest in the Facilities may not be sold,  assigned or transferred,
in whole or in part, by Litchfield,  any of the Principal  Members of Litchfield
or any other person or entity and furthermore, any such sale or assignment shall
be void ab initio, except as follows:

                  (a) From the Effective  Date and until the end of the eleventh
         month of the fourth Lease Year, no more than  forty-nine  percent (49%)
         of the total ownership interest in Litchfield may be sold,  assigned or
         transferred,  in whole or in part,  to any other person or entity other
         than the  Principal  Members of  Litchfield  so that from the Effective
         Date and until the end of the eleventh  month of the fourth Lease Year,
         the  Principal  Members  of  Litchfield  shall  at all  times  retain a
         fifty-one  percent (51%)  ownership  interest in Litchfield;  provided,
         however,  that any such sale,  assignment or transfer  pursuant to this
         subsection  (a) shall be subject to the written  approval of IHS, which
         approval  may  not  be   unreasonably   withheld  and  subject  to  the
         limitations set forth in subsection (f) hereof.

                  (b) From the first day of the twelth month of the fourth Lease
         Year and until the  expiration  of the Term (as defined in the Leases),
         all or any part of the ownership  interest in  Litchfield  may be sold,
         assigned  or  transferred,  to any  person  or  entity  other  than the
         Principal  Members of  Litchfield,  subject to IHS's  rights  under the
         Leases, the Purchase Option Agreements and the Participation Agreement;
         provided,  however, that any such sale, assignment or transfer pursuant
         to this subsection (b) shall be subject to the written approval of IHS,
         which  approval  may not be  unreasonably  withheld  and subject to the
         limitations set forth in subsection (f) hereof.

                  (c) From the Effective  Date and until the end of the eleventh
         month  of  the  third  Lease  Year,  no  form  of  ownership   interest
         (including,  but not  limited to, the Leases) in any one or more of the
         Facilities may be sold,  assigned or transferred,  in whole or in part,
         except pursuant to the Purchase Option Agreements.

                  (d) From the date  commencing with the first day of the twelth
         month of the third Lease Year and until the expiration of the Term, all
         or part of the ownership interest  (including,  but not limited to, the
         Leases) in any one or more of the Facilities  may be sold,  assigned or
         transferred to any person or entity,  subject to IHS's rights under the
         Leases, the Purchase Option Agreements and the Participation Agreement;
         provided,  however, that any such sale, assignment or transfer pursuant
         to this subsection (d) shall be subject to the written approval of IHS,
         which  approval  may not be  unreasonably  withheld  and subject to the
         limitations set forth in subsections (f) and (h) hereof.


                                        8






                  (e)  Except as set forth on the  leasehold  policies  of title
         provided to IHS by Fidelity  National  Title as of September  30, 1997,
         the loan  described in the First  Amendment and  subsequent  first lien
         secured  indebtedness  on the  Facilities,  from the Effective Date and
         until the  expiration of the Term, no ownership  interest in any one or
         more of the Facilities  and no ownership  interest in Litchfield may be
         mortgaged,  pledged,  subjected  to a security  interest,  or otherwise
         voluntarily  encumbered,  in  whole  or in part,  without  the  written
         approval  of IHS,  which  written  approval  shall not be  unreasonably
         withheld.

                  (f) Any sale, assignment or transfer of interest in Litchfield
         or an ownership interest (including, but not limited to, the Leases) in
         any one or more of the Facilities,  as permitted under subsections (a),
         (b) and (d) hereof, shall subject to the following condition precedents
         (except as waived by IHS in writing),  such that the buyer, assignee or
         transferee  must:  (i) have a net worth  calculated in accordance  with
         GAAP  of not  less  than  $5,000,000  immediately  prior  to the  sale,
         assignment  or  transfer  and (ii) not be a Direct  Competitor  of IHS,
         Integrated or any of its  Affiliates.  For purposes of this  subsection
         (f),  a "Direct  Competitor"  shall be deemed  to mean,  any  person or
         entity  in the  business,  through  itself  or one or  more  Affiliates
         thereof,  of providing health care services then being provided by IHS,
         Integrated or its or their Affiliates,  including,  but not limited to,
         nursing home care,  assisted  living  services,  residential  geriatric
         services,  hospital-based  nursing care,  subacute and postacute health
         care services (including,  but not limited to complex care,  ventilator
         care and wound management services),  nursing services,  rehabilitation
         services,   home  health  care   services,   pharmaceutical   services,
         diagnostic services and specialized treatment for Alzheimer's disease.

                  (g)  For  purposes  of  this  Section  15.9,   the  merger  or
         consolidation  of Litchfield  with or into another  person or entity or
         the transfer of any of the securities of Litchfield or the interests of
         the Principal Members of Litchfield shall be deemed to be a transfer of
         Litchfield's  ownership interest that shall be subject to the terms and
         conditions of this Section 15.9;  provided,  however,  that  Litchfield
         shall have the right to merge with or consolidate into any corporation,
         limited   partnership,   limited  liability  company  or  other  entity
         controlled by the Principal Members of Litchfield.

                  (h) In the event that  Litchfield  desires to sell,  assign or
         transfer its  ownership  interest  (including,  but not limited to, the
         Leases) in any or all of the Facilities to a third party,  as permitted
         under subsection (d) hereof, Litchfield shall, as a condition precedent
         to its right to do so, by notice in writing, offer to sell Litchfield's
         ownership interest in the respective Facility or Facilities to IHS upon
         the same terms and conditions  specified in such third party offer. IHS
         shall have ten (10)  business  days after its  receipt of  Litchfield's
         notice  to  accept  such  offer by  delivering  written  notice  of its
         acceptance to Litchfield.  If IHS does not accept  Litchfield's  offer,
         Litchfield  shall be free to dispose of its  ownership  interest in the
         respective  Facility or  Facilities on terms  substantially  similar to
         those  contained  in   Litchfield's   offer.  If  Litchfield  does  not
         consummate a sale, assignment or transfer of its ownership interests in
         or ownership of the respective  Facility or Facilities  with respect to
         such  notice and offer,  then the sale,  assignment  or transfer of its
         ownership interest the respective Facility or Facilities shall again be
         subject in all  respects  to the  terms,  conditions  and  restrictions
         provided in this subsection (h).

                  (i)  Notwithstanding  the foregoing to the  contrary,  nothing
         herein  shall  restrict  any (a) sale,  transfer or  conveyance  of any
         interest in Litchfield among the Principal Members of Litchfield or (b)
         the


                                        9






         sale,  transfer or  conveyance  of the interest of any of the Principal
         Members  of  Litchfield  by  gift,  devise,   bequest  or  inheritance,
         provided,  however,  that any such  donee,  devisee or other  recipient
         shall be bound by the terms and conditions of this Section 15.9, except
         clause (i) of subsection (f) thereof.

         14.  Litchfield hereby represents and warrants as of the date hereof to
each of the other parties to this First Amendment that:

                  (a)   Corporate   Organization;   Good   Standing;   Corporate
Information.  Litchfield is a limited liability company, duly organized, validly
existing and in good standing  under the laws of the State of  Connecticut,  and
has the corporate power and authority to own and lease all of the Facilities, to
carry on its  businesses  as and in the  places  where such  businesses  are now
conducted and where such properties are now owned and leased,  and to enter into
the transactions and perform their obligations  under the Facilities  Agreement,
the First Amendment, the other Transaction Documents and any other documents and
instruments  required to be delivered to which it is or is to become a party and
Litchfield  is duly  qualified  as a foreign  corporation  to do business in all
jurisdictions  in which any of the Facilities are located or in which failure so
to qualify  would  impair  its  ability to  perform  its  obligations  under the
Facilities Agreement, the First Amendment, or any other Transaction Document.

                  (b) Authorization; Enforceability. The execution, delivery and
performance  by  Litchfield  of  the  First  Amendment,  the  other  Transaction
Documents  and of  all  of the  documents  and  instruments  contemplated  to be
executed and  delivered by Litchfield  are within the legal and corporate  power
and authority of Litchfield and have been duly authorized by all necessary legal
and  corporate  action  of  Litchfield.  The  Facilities  Agreement,  the  First
Amendment,  the  other  Transaction  Documents,  and  the  other  documents  and
instruments  required to be delivered by  Litchfield  will be, when executed and
delivered, the valid and binding obligations of Litchfield,  enforceable against
Litchfield in accordance with their respective terms.

                  (c) No Violation or  Conflict.  To the best of its  Knowledge,
after  reasonable  inquiry,  the  execution,  delivery  and  performance  of the
Facilities Agreement,  the First Amendment, the Transaction Documents and all of
the other documents and instruments contemplated to be executed and delivered by
Litchfield  do not and will not  conflict  with or  violate  any  material  Law,
judgment,  or any  order  or  decree  binding  on  Litchfield  or the  Operating
Agreement of Litchfield.

                  (d) No Litigation.  To the best of its Knowledge,  there is no
material  litigation,   arbitration  proceeding,   governmental   investigation,
citation,  suit, action,  proceeding or claim of any kind pending or threatened,
against Litchfield that would relate to the Facilities or any portion thereof or
the ability of  Litchfield  to perform  its  obligations  under the  Transaction
Documents.

         15. IHS hereby represents and warrants as of the date hereof to each of
the other parties to this First Amendment that:

                  (a) Organization. IHS is a corporation duly organized, validly
existing and in good standing  under the laws of the State of Delaware,  and has
full  corporate  power and  authority to enter into and perform its  obligations
under the  Facilities  Agreement,  the First  Amendment,  the other  Transaction
Documents and any other  documents and  instruments  required to be delivered to
which it is or is to become a party and IHS is duly qualified as


                                       10






a foreign  corporation to do business in all  jurisdictions  in which any of the
Facilities  are  located  or in which  failure to so  qualify  would  impair its
ability to perform its  obligations  under the Facilities  Agreement,  the First
Agreement, or any other Transaction Document.

                  (b) Authorization; Enforceability. The execution, delivery and
performance by IHS of the Facilities Agreement,  the First Amendment,  the other
Transaction  Documents and all of the documents and instruments  contemplated to
be executed and delivered by IHS are within the corporate  power of IHS and have
been duly  authorized by all necessary  corporate  action of IHS. The Facilities
Agreement,  the First Amendment,  the other Transaction Documents, and the other
documents and  instruments  required hereby to be delivered by IHS will be, when
executed and delivered,  the valid and binding  obligations of IHS,  enforceable
against IHS in accordance with their respective terms.

                  (c) No Violation or Conflict.  To the best of IHS's Knowledge,
after  reasonable  inquiry,  the  execution,  delivery  and  performance  of the
Facilities Agreement,  the First Amendment,  the other Transaction Documents and
all of the documents and  instruments  contemplated to be executed and delivered
by IHS does not and  will  not  conflict  with or  violate  the  Certificate  of
Incorporation or By-Laws of IHS or any material Law,  judgment,  order or decree
binding on IHS.

                  (d) No Litigation.  To the best of its Knowledge,  there is no
material  litigation,   arbitration  proceeding,   governmental   investigation,
citation,  suit, action,  proceeding or claim of any kind pending or threatened,
against IHS that would relate to the  Facilities  or any portion  thereof or the
ability of IHS to perform its obligations under the Transaction Documents.

         16. This First Amendment  shall be construed and interpreted  according
to the laws of the State of New York,  without  regard to  provisions  governing
conflicts of law.

         17. All communications,  notices and disclosures  required or permitted
by the Facilities Agreement shall be in writing and shall be deemed to have been
given at the earlier of the date when  actually  delivered  to an officer of the
other party or when deposited in the United States mail, certified or registered
mail,  postage prepaid,  return receipt  requested,  by personal  delivery or by
overnight courier service with signed receipt, and addressed as follows,  unless
and until either of such  parties  notifies  the other in  accordance  with this
Section of a change of address:

         To Litchfield:             Litchfield Investment Company, L.L.C.
                                            128 Litchfield Road
                                            P.O. Box 3039
                                            New Milford, Connecticut  06776
                                            Attention:  Eugene H. Rosen

                Copy to:                    Owens, Clary & Aiken, L.L.P.
                                            Suite 2400
                                            1717 Main Street
                                            Dallas, Texas 75201
                                            Attention:  Leighton Aiken, Esq.


                                       11






         To Integrated or IHS:     Integrated Health Services, Inc.

                                   or Integrated Health Services of Lester, Inc.
                                   10065 Red Run Boulevard
                                   Owings Mills, Maryland 21117
                                   Attention:  Daniel J. Booth

                         Copy to:  LeBoeuf, Lamb, Greene & MacRae, L.L.P.
                                   125 West 55th Street
                                   New York, New York  10019
                                   Attention:  John R. Fallon, Jr., Esq.

         18. This First Amendment may be executed in several counterparts,  each
of which  shall be deemed an  original,  but such  counterparts  shall  together
constitute but one and the same First Amendment.

         19.  Unless  otherwise  expressly  amended  or  deleted  by this  First
Amendment,  the provisions of the Facilities Agreement shall remain the same and
are in full  force and  effect as of the date  hereof;  provided,  however,  all
representations,  covenants and warranties contained in the Facilities Agreement
were made on and as of the Closing Date and are not  re-certified  or updated by
the  parties to this  First  Amendment  as of the date  hereof;  and,  provided,
further,  all  representations,  covenants,  warranties  and  indemnities of the
parties to the Facilities Agreement and this First Amendment shall not terminate
by this First  Amendment  and shall  survive the  execution and delivery of this
First Amendment in accordance with Section 16.12 of the Facilities Agreement.

                             SIGNATURE PAGE FOLLOWS


                                       12





         IN WITNESS  WHEREOF,  the parties  have caused this First  Amendment to
Facilities Agreement to be duly executed and delivered as a sealed instrument as
of September 30, 1997.

                                LITCHFIELD INVESTMENT COMPANY, L.L.C.





                                By:  /s/ Eugene H. Rosen
                                   ---------------------------------------------
                                Name:  Eugene H. Rosen
                                Title: President and Member

                                (Seal)

                                INTEGRATED HEALTH SERVICES OF LESTER, INC.

                                By: /s/ Daniel J. Booth
                                   ---------------------------------------------
                                Name: Daniel J. Booth
                                Title:   Senior Vice President

                                (Seal)

                                 INTEGRATED HEALTH SERVICES, INC.

                                 By: /s/ Daniel J. Booth
                                   ---------------------------------------------
                                 Name: Daniel J. Booth
                                 Title:   Senior Vice President

                                 (Seal)

                                                        13