AMENDMENT  NO. 4, DATED AS OF MARCH 25, 1999, TO THE REVOLVING
CREDIT AND TERM LOAN  AGREEMENT,  among  INTEGRATED  HEALTH  SERVICES,  INC.,  a
Delaware  corporation  (the  "Borrower"),  the  lenders  parties  to the  Credit
Agreement   referred  to  below  (the   "Lenders")   and   CITIBANK,   N.A.,  as
administrative agent (the "Agent") for the Lenders.

                  PRELIMINARY STATEMENTS:

                  (1) The Borrower,  the Lenders and the Agent have entered into
a Revolving  Credit and Term Loan Agreement dated as of September 15, 1997 (such
Credit Agreement,  as amended,  the "Credit  Agreement").  Capitalized terms not
otherwise  defined in this  Amendment have the same meanings as specified in the
Credit Agreement.

                  (2) The  Borrower  has  requested  various  amendments  to the
Credit Agreement, and the Lenders are, on the terms and conditions stated below,
willing to grant the request of the  Borrower  and the  Borrower and the Lenders
have agreed to amend the Credit Agreement as hereinafter set forth.

                  SECTION  1.  Amendments  to  Credit   Agreement.   The  Credit
Agreement is, effective as of the date hereof and subject to the satisfaction of
the conditions precedent set forth in Section 3, hereby amended as follows:

                  (a)      The following definitions in Section 1.01 are amended
         in full to read as follows:

                  "`Commitment  Fee Rate' means, for commitment fees accruing in
         any Pricing  Period,  the rate per annum set forth below  opposite  the
         Pricing Ratio determined for such Pricing Period:

                       Pricing Ratio                         Commitment Fee Rate
                       -------------                         -------------------
                  greater than or equal to 5.25                     0.500%
                  less than 5.25                                    0.375%

                  `Fixed Charge Coverage  Ratio' means the ratio,  (i) as of the
         last day of any Quarter  other than the Quarter  ending  September  30,
         2000, of (A) EBITDAR minus Capital Expenditures of the Borrower and its
         Subsidiaries  for the 12-month period then ending to (B) the sum of (1)
         (w) Interest Expense, (x) taxes paid in cash, (y) Lease Expense and (z)
         all cash dividends  paid on the  Borrower's  common stock and preferred
         stock,  each during the 12-month period then ending and (2) the Current
         Portion of Long-Term Debt as at the last day of such Quarter,  and (ii)
         as of the last day of the Quarter  ending  September  30, 2000,  of (A)
         EBITDAR minus Capital Expenditures of the Borrower and its Subsidiaries
         for the 12-month period then ending to (B) the amount of (1) the sum of
         (X) (I) Interest Expense,  (II) taxes paid in cash, (III) Lease Expense
         and (IV) all cash  dividends  paid on the  Borrower's  common stock and
         preferred stock,  each during the 12-month period then ending,  (Y) the
         Current  Portion of  Long-Term  Debt as at the last day of such Quarter
         and  (Z)  the   outstanding   principal





         amount of the Convertible Subordinated Debt as of the first day of such
         Quarter minus (2) the principal amount of any Subordinated  Debt not in
         excess of  $143,750,000  incurred  during such  Quarter the proceeds of
         which are used to repay the Convertible Subordinated Debt.

            `Minimum  Net Worth'  means the sum, as of the last day of any
         Quarter, of (i) $1,120,000,000, less up to $25,000,000 of extraordinary
         losses  (determined  in  accordance  with GAAP) of the Borrower and its
         Subsidiaries  on a  consolidated  basis  incurred  at  any  time  after
         December  31,  1997,   plus  (ii)  75%  of  the  aggregate  net  income
         (determined   in  accordance   with  GAAP)  of  the  Borrower  and  its
         Subsidiaries  on a  consolidated  basis  earned  in the  Quarter  ended
         December  31, 1997 and in each  Quarter  thereafter,  if net income was
         earned in such Quarter (and not reduced for a net loss in any Quarter),
         plus (iii)  100% of all  additions  to  Adjusted  Stockholders'  Equity
         resulting at any time after December 31, 1997 from the sale or issuance
         of  any  common  or  preferred  stock  of  the  Borrower,  except  upon
         conversion of any Convertible  Subordinated  Debt;  provided,  however,
         that the amount "$1,120,000,000"  referred to above shall be reduced by
         the  amount of cash  used by the  Borrower  to redeem on the  scheduled
         maturity  date  thereof  the notes  issued  under the 1993  Convertible
         Subordinated  Debt Indenture,  but in no event shall the amount of such
         reduction exceed $143,750,000.

                  `Revolving  Borrowing Base Rate Margin' means, for any Pricing
         Period,  the rate per annum set forth below  opposite the Pricing Ratio
         determined for that Pricing Period:

                               Pricing Ratio                              Margin
                               -------------                              ------
                  greater than or equal to 6.50                           1.500%
                  greater than or equal to 6.00 but less                  1.250%
                  than 6.50
                  greater than or equal to 5.25 but less                  1.000%
                  than 6.0
                  less than 5.25                                          0.750%

                  `Revolving  Borrowing  Eurodollar Rate Margin' means,  for any
         Pricing Period, the rate per annum set forth below opposite the Pricing
         Ratio determined for that Pricing Period:

                               Pricing Ratio                              Margin
                               -------------                              ------
                  greater than or equal to 6.50                           2.750%
                  greater than or equal to 6.00 but less                  2.500%
                  than 6.50
                  greater than or equal to 5.25 but less                  2.250%
                  than 6.00
                  less than 5.25                                           .000%

                  `Subordinated  Debt  Indentures'  means  the 1992  Convertible
Subordinated Debt Indenture;  the 1993 Convertible  Subordinated Debt Indenture;
the 1994 Subordinated Debt Indenture;  the 1995 Subordinated Debt Indenture; the
1996 Subordinated Debt Indenture; the





1997 Subordinated Debt Indenture;  the 1997 B Subordinated Debt Indenture;  and,
upon the  effectiveness  thereof,  the subordinated debt indenture to be entered
into in  connection  with the Debt incurred the proceeds of which are to be used
in part or in full to repay the Convertible Subordinated Debt.

                  `Term  Borrowing  Base Rate  Margin'  means,  for any  Pricing
Period, the rate per annum set forth below opposite the Pricing Ratio determined
for that Pricing Period:

                               Pricing Ratio                              Margin
                               -------------                              ------
                               less than 6.00                              1.50%
                   greater than or equal to 6.00 but less                  1.75%
                                 than 6.50
                       greater than or equal to 6.50                       2.00%

                  `Term Borrowing Eurodollar Rate Margin' means, for any Pricing
Period, the rate per annum set forth below opposite the Pricing Ratio determined
for that Pricing Period:

                               Pricing Ratio                              Margin
                               -------------                              ------
                               less than 6.00                              2.75%
                   greater than or equal to 6.00 but less                  3.00%
                                 than 6.50
                       greater than or equal to 6.50                       3.25%

                  `Term  Loan C  Borrowing  Base  Rate  Margin'  means,  for any
Pricing  Period,  the rate per annum set forth below  opposite the Pricing Ratio
determined for that Pricing Period:

                               Pricing Ratio                              Margin
                               -------------                              ------
                               less than 6.00                              1.75%
                   greater than or equal to 6.00 but less                  2.00%
                                 than 6.50
                       greater than or equal to 6.50                       2.25%

                  `Term Loan C Eurodollar  Rate Margin'  means,  for any Pricing
Period, the rate per annum set forth below opposite the Pricing Ratio determined
for that Pricing Period:

                               Pricing Ratio                              Margin
                               -------------                              ------
                               less than 6.00                              3.00%
                   greater than or equal to 6.00 but less                  3.25%
                                 than 6.50
                       greater than or equal to 6.50                      3.50%"

                  (b) The  definition of "Cash Flow from  Operations" in Section
         1.01 is  amended by adding  before the period at the end  thereof a new
         clause (E) to read as follows:





                           "and (E) cash  severance  payments  not in  excess of
         $25,000,000  reserved or accrued during the Quarter ending December 31,
         1998 shall be included as an addback to net income for purposes of this
         definition to the extent such payments are included in the December 31,
         1998 financial statements of the Borrower."

                  (c) Section 2.05 is amended by deleting subsection (b) therein
         and substituting the following therefor:

                           "(b)  The   Revolving   Facility   Amount   shall  be
         automatically  and  permanently  reduced  (i) on  January  1,  2001  to
         $800,000,000,  (ii) on  January  1,  2002  to  $600,000,000,  (iii)  on
         September  30,  2002  to  $500,000,000,  (iv)  on  January  1,  2003 to
         $400,000,000  and (v) on the  Termination  Date as  provided in Section
         2.06(a) below."

                  (d)      Section  2.06 is amended by adding at the end thereof
         a new subsection (h) to read as follows:

                           "(h) Mandatory  Prepayments.  The Borrower  shall, on
         the date of receipt of (i) the Net Cash  Proceeds of Sale in respect of
         any Asset Sale by the Borrower or any of its  Subsidiaries  or (ii) the
         cash proceeds (net of legal and accounting  fees and expenses  incurred
         in  connection  therewith)  in respect of any  issuance or sale of debt
         (except debt issued or sold where the proceeds of such debt are used to
         refinance  Subordinated  Debt and to pay the costs of such refinancing)
         or equity, the Borrower shall prepay the aggregate  principal amount of
         the  Advances  in an  amount  equal to (x) the  amount of such Net Cash
         Proceeds of Sale in the case of an Asset  Sale,  (y) the amount of such
         cash  proceeds in the event of an  issuance or sale of debt,  or (z) an
         amount  equal to 50% of such cash  proceeds in the event of an issuance
         or sale of equity, as applicable;  provided,  that each such prepayment
         shall be  applied  to the  outstanding  principal  amount of  Revolving
         Borrowings,  Term  Borrowings  and Term Loan C Borrowings  and shall be
         applied  thereto  on a  ratable  basis  calculated  on the basis of the
         Revolving Facility Amount,  Term Borrowings and Term Loan C Borrowings,
         respectively,  and in the case of  prepayments  of Term  Borrowings and
         Term Loan C Borrowings,  applied ratably to each respective installment
         thereof."

                  (e)      Section 5.01(a) is amended by replacing the table set
         forth therein with the table set forth below:

                   "Quarter(s) Ended                       Debt/EBITDAR Ratio
                    ----------------                       ------------------
                  December 31, 1998                             5.75
                  March 31, 1999                                6.25
                  June 30, 1999                                 6.50
                  September 30, 1999                            6.75
                  December 31, 1999                             6.75
                  March 31, 2000                                6.75
                  June 30, 2000                                 6.50
                  September 30, 2000                            6.25
                  December 31, 2000                             5.75
                  March 31, 2001                                5.75
                  June 30, 2001                                 5.50
                  September 30, 2001                            5.50
                  December 31, 2001                             5.25
                  March 31, 2002                                5.25
                  June 30, 2002                                 5.00
                  September 30, 2002                            5.00
                  December 31, 2002                             4.50
                  In 2003 and thereafter                        4.50"





                  (f)      Section 5.01(b) is amended by replacing the table set
         forth therein with the table set forth below:

                   "Quarter(s) Ended                 Fixed Charge Coverage Ratio
                   ----------------                  ---------------------------
                  December 31, 1998                             1.15
                  March 31, 1999                                1.10
                  June 30, 1999                                 1.10
                  September 30, 1999                            1.10
                  December 31, 1999                             1.10
                  March 31, 2000                                1.10
                  June 30, 2000                                 1.15
                  September 30, 2000                            1.15
                  December 31, 2000                             1.15
                  March 31, 2001                                1.15
                  June 30, 2001                                 1.15
                  September 30, 2001                            1.20
                  December 31, 2001                             1.20
                  March 31, 2002                                1.00
                  June 30, 2002                                 1.00
                  September 30, 2002                            1.00
                  December 31, 2002                             1.00
                  In 2003                                       1.00
                  In 2004                                       1.25
                  In 2005                                       1.50"

                  (g)  Section  5.03(c) is amended by deleting  subsection  (ix)
         therein, and such subsection shall be left blank.

                  (h)  Section  5.03(c) is amended by  deleting  subsection  (x)
         therein and substituting the following therefor:

                           "(x)   Investments  by  existing,   newly-formed   or
         acquired  wholly-owned  Subsidiaries  of the  Borrower  in one or  more
         Health Care Companies or Health Care Facilities; provided that (A) with
         respect  to such  Investments  made (i)  after  the  Effective  Date of
         Amendment No. 4 to this Agreement and during 1999, each such Investment
         shall either be (X) in respect of a Health Care Facility  licensed as a
         skilled 





         nursing facility;  provided that if such Health Care Facility is listed
         on Schedule 5.03(c)(x)(A)(i)(X),  (1) such Investment shall be acquired
         by  exercise  of a  purchase  option in  respect  of such  Health  Care
         Facility,  (2) at the time of the exercise of any such purchase  option
         the Borrower or such Subsidiary shall have entered into a bona fide and
         enforceable  contract to sell the respective Health Care Facility for a
         cash purchase price not less than the gross purchase price thereof paid
         by such Subsidiary,  and (3) the proceeds of such sale shall be used by
         the  Borrower to make  mandatory  prepayments  in  accordance  with the
         provisions  of  Section  2.06(h);  and  provided,   further,  that  the
         aggregate  consideration  for all  such  Investments  does  not  exceed
         $75,000,000;  or (Y) an  Investment by RoTech or a Subsidiary of RoTech
         in the  normal  course of its  business;  provided  that the  aggregate
         consideration  for all such  Investments  does not exceed  $50,000,000;
         provided,  further that the aggregate consideration for all Investments
         made  pursuant  to the  preceding  clauses  (X) and (Y) does not exceed
         $100,000,000;  and provided, further that in the event that any portion
         of the amounts  specified in the  preceding  clauses (X) and (Y) is not
         used during 1999, an amount equal to  $100,000,000  minus the aggregate
         amount of the portions used shall be available during 2000,  subject to
         the respective  restrictions  provided in such clauses,  in addition to
         the amount  specified  in clause (ii)  below;  (ii)  during  2000,  the
         aggregate  consideration  for all  such  Investments  does  not  exceed
         $50,000,000; provided that the portion of such consideration consisting
         of cash, cash equivalents and Debt incurred or assumed shall not exceed
         $25,000,000 in the aggregate; and provided,  further that to the extent
         that any  portion of such  $50,000,000  is not used during  2000,  such
         portion  shall be  available  during  2001 in  addition  to the  amount
         specified in clause (iii) below;  and (iii) during 2001,  the aggregate
         consideration  for all such  Investments  does not exceed  $50,000,000;
         provided that no portion of such  consideration  shall consist of cash,
         cash  equivalents or Debt incurred or assumed;  (B) no such Investments
         shall be  permitted  after  2001;  (C) at the  time of or after  giving
         effect to any such Investment, no Event of Default or Potential Default
         exists or results; and (D) each entity that becomes a Subsidiary of the
         Borrower in connection with or as a result of any such Investment shall
         comply with the provisions of Section 5.02(e), and neither the Borrower
         nor any of its  Subsidiaries  nor any of their  properties  shall be or
         become  bound by or subject to any  contractual  obligation  that is or
         would be violated or put in default by reason of such  compliance or by
         reason  of the  enforcement  of the  claims  and Liens of the Agent and
         Lenders arising from such compliance;"

                  (i) Section  5.03(d) is amended by deleting  the period at the
         end of subsection (viii) thereof and substituting  therefor "; and" and
         adding after such  subsection  (viii) a new subsection  (ix) to read as
         follows:
                           "(ix)  Subordinated  Debt incurred under an indenture
         the terms and  conditions of which are no less favorable to the Lenders
         than the terms and conditions of the 1997  Subordinated  Debt Indenture
         in an  aggregate  principal  amount not in excess of  $300,000,000  and
         having a maturity not earlier than 30 days after the scheduled maturity
         of the Term Loan C, and any  extension,  renewal or refinancing of such
         Debt so long as (A) either (I) the principal amount of such Debt is not
         increased or (II) any increase in the principal  amount of such Debt is
         permitted  pursuant to another  clause of this Section  5.03(d) and (B)
         the terms and  conditions of any indenture in connection





         therewith  are  no  less   favorable  to  the  Lenders  than  the  1997
         Subordinated  Debt  Indenture  and (C) the  Debt  incurred  under  such
         indenture matures not earlier than 30 days after the scheduled maturity
         date of the Term Loan C."

                  (j)  Section  5.03(h) is amended by  deleting  subsection  (B)
         therein, and such subsection shall be left blank.

                  (k) Schedule 1.01(a) of the Credit  Agreement  relating to the
         senior Debt  excluded  from the Current  Portion of  Long-Term  Debt is
         amended by adding the  contents of the  Supplemental  Schedule  1.01(a)
         attached hereto to such Schedule 1.01(a).

                  (l) Schedule 1.01(b) of the Credit  Agreement  relating to the
         Schedule 1.01(b) Assets is deleted in its entirety and Schedule 1.01(b)
         attached hereto is substituted therefor.

                  (m) Schedule 5.03(c)(x)(A)(i)(X) attached hereto is added as a
         new Schedule 5.03(c)(x)(A)(i)(X) to the Credit Agreement.

                  (n)  Schedule  5.03(f) of the  Credit  Agreement  relating  to
         Accommodation  Obligations  is amended by adding  the  contents  of the
         Supplemental Schedule 5.03(f) attached hereto to such Schedule 5.03(f).

                  SECTION 2. Special  Interest  Provision.  Notwithstanding  any
other  provision  contained in the Credit  Agreement to the  contrary,  from the
Effective  Date until the date on which the Borrower  shall deliver to the Agent
the  Pricing  Certificate  referred  to in Section  5.02(c)(viii)  of the Credit
Agreement in respect of the Quarter ending June 30, 1999:

                  (a) the Revolving Borrowing Base Rate Margin shall be 1.25%;

                  (b) the Term Borrowing Base Rate Margin shall be 1.75%;

                  (c) the Term Loan C Borrowing Base Rate Margin shall be 2.00%;

                  (d) the Revolving  Borrowing  Eurodollar  Rate Margin shall be
         2.50%;

                  (e) the Term Borrowing  Eurodollar Rate Margin shall be 3.00%;
         and

                  (f) the Term Loan C Borrowing  Eurodollar Rate Margin shall be
         3.25%.

                  SECTION 3. Conditions of  Effectiveness.  This Amendment shall
become  effective as of the date hereof (the  "Effective  Date") if on or before
the date hereof the Agent shall have received (i) counterparts of this Amendment
executed by the Borrower and the Requisite Lenders or, as to any of the Lenders,
advice  satisfactory  to the Agent that such Lender has executed this Amendment;
(ii)  evidence  that (a) all fees due  under the  letter  dated  March 10,  1999
between the Agent and the Borrower have been paid,  (b) the Borrower has paid to
the  Agent,  for the  account  of the  Lenders  executing  and  delivering  this
Amendment  on or prior to the






date hereof, a consent fee due under the letter dated March 11, 1999 between the
Agent and the Borrower, which amount will be distributed ratably to such Lenders
as  provided  in such  letter and (c) the  Borrower  has paid all fees due under
Section 8.04 of the Credit  Agreement and (iii) all of the following  documents,
each  such  document  in form and  substance  satisfactory  to the  Agent and in
sufficient copies for each Lender:

                  (a) Certified copies of (i) the resolutions of (A) the Finance
         Committee  of the Board of Directors  of the  Borrower  approving  this
         Amendment  and the  matters  contemplated  hereby  and (B) the Board of
         Directors of each other Loan Party  evidencing  approval of the Consent
         and the matters  contemplated thereby and (ii) all documents evidencing
         other necessary  corporate action and governmental  approvals,  if any,
         with  respect  to this  Amendment  and  the  Consent  and  the  matters
         contemplated hereby and thereby.

                  (b) A certificate  of the Secretary or an Assistant  Secretary
         of the Borrower and each other Loan Party certifying the names and true
         signatures  of the  officers of the  Borrower and such other Loan Party
         authorized  to sign  this  Amendment  and  the  Consent  and the  other
         documents to be delivered hereunder and thereunder.

                  (c)   Counterparts   of  the  Consent   appended  hereto  (the
         "Consent"),  executed  by each of the  Loan  Parties  (other  than  the
         Borrower).

                  (d) A certificate  from an Authorized  Officer of the Borrower
         that (i) the representations  and warranties  contained in Section 4 of
         this  Amendment,  in Article IV of the Credit  Agreement and in Article
         III of the Pledge and Security Agreements are correct on and as of such
         date as  though  made on and as of such  date  and  (ii) no  event  has
         occurred  and is  continuing,  or would  result from such  extension of
         credit  or  from  the  application  of the  proceeds  therefrom,  which
         constitutes an Event of Default or a Potential Default.

                  (e) A  favorable  opinion of LeBoeuf,  Lamb,  Greene & MacRae,
         L.L.P., counsel for the Borrower,  substantially in the form of Exhibit
         A hereto and as to such other  matters as any Lender  through the Agent
         may reasonably request.

         SECTION 4. Representations and Warranties of the Borrower. The Borrower
represents and warrants as follows:

                  (a) Each  Loan  Party is a  corporation  or  partnership  duly
         organized,  validly  existing and in good  standing  (except  where the
         failure of one or more Loan  Parties,  other than the  Borrower and its
         Material  Subsidiaries,  to be in good standing could not reasonably be
         expected to result in a Material  Adverse Change) under the laws of the
         jurisdiction  in  which it is  organized  and is duly  qualified  to do
         business in each jurisdiction  where the character of its properties or
         the nature of its activities makes such qualification necessary.

                  (b) Each Loan Party has the corporate or partnership power (i)
         to carry on its business as now being  conducted  and as proposed to be
         conducted by it, (ii) to execute,





         deliver and perform this Amendment and the Credit Agreement, as amended
         hereby,  and  (iii) to take all  action  necessary  to  consummate  the
         transactions   contemplated   under  this   Amendment  and  the  Credit
         Agreement, as amended hereby.

                  (c) The execution, delivery and performance by each Loan Party
         of this Amendment,  the Credit  Agreement,  as amended hereby,  and the
         Consent,  as  applicable,  have been duly  authorized  by all necessary
         action of its board of directors (or, in the case of a partnership,  of
         its governing authority),  and do not contravene (i) its certificate or
         articles of incorporation (or, in the case of a partnership,  governing
         agreements)  or  (ii)  any  law  or any  indenture,  lease  or  written
         agreement  binding on or  affecting  it and do not result in or require
         the  creation  of any  Lien  (other  than  pursuant  to the  Collateral
         Documents) upon any of its property or assets.

                  (d) No  authorization  or approval or other  action by, and no
         notice to or filing with,  any  Governmental  Authority is required for
         the due execution,  delivery and  performance by any Loan Party of this
         Amendment,  the Credit Agreement, as amended hereby, or the Consent, as
         applicable.

                  (e) This Amendment and the Consent have been duly executed and
         delivered by the  respective  Loan Party.  This  Amendment,  the Credit
         Agreement,  as amended  hereby,  and the Consent  are legal,  valid and
         binding  obligations of the respective Loan Party,  enforceable against
         the respective  Loan Party in accordance with their  respective  terms,
         subject to laws  generally  affecting  the  enforcement  of  creditors'
         rights.

                  (f)  There is no  pending  or  overtly  threatened  action  or
         proceeding  affecting  any Loan Party  before  any court,  governmental
         agency or arbitrator which would, if adversely determined,  result in a
         Material  Adverse  Change or which  relates to or could  reasonably  be
         expected to affect the  legality,  validity or  enforceability  of this
         Amendment,  the Credit Agreement,  as amended hereby, or the Consent or
         the consummation of any of the transactions contemplated hereby.

                  (g) The execution, delivery and performance of this Amendment,
         the Consent and the Credit  Agreement,  as amended  hereby,  do not and
         will not (i) conflict with,  result in a breach of, or constitute (with
         or without  notice or the lapse of time or both) a default  under,  any
         instrument, lease, indenture, agreement or other contractual obligation
         issued  by any  Loan  Party  or  enforceable  against  it or any of its
         property or assets,  except under immaterial agreements for supplies or
         services  which are readily  replaceable  without any adverse effect on
         such Loan Party or its  business or (ii)  require  any  approval of its
         stockholders.

                  SECTION 5. Reference to and Effect on the Credit Agreement and
the Loan Documents.

                  (a) On and after the  effectiveness  of this  Amendment,  each
         reference  in the Credit  Agreement to "this  Agreement",  "hereunder",
         "hereof" or words of like import referring to the Credit Agreement, and
         each  reference  in the Notes and each of the other Loan  Documents  to
         "the Credit Agreement", "thereunder", "thereof" or words of like





         import referring to the Credit Agreement, shall mean and be a reference
         to the Credit Agreement, as amended by this Amendment.

                  (b) The  Credit  Agreement,  as  specifically  amended by this
         Amendment,  is and shall continue to be in full force and effect and is
         hereby in all respects  ratified and  confirmed.  Without  limiting the
         generality of the foregoing,  the  Collateral  Documents and all of the
         Collateral  described  therein  do and shall  continue  to  secure  the
         payment  of  all  Obligations  of  the  Loan  Parties  under  the  Loan
         Documents, in each case as amended by this Amendment.

                  (c)  The  execution,   delivery  and   effectiveness  of  this
         Amendment shall not, except as expressly provided herein,  operate as a
         waiver of any right,  power or remedy of any Lender or the Agent  under
         the Credit  Agreement,  nor constitute a waiver of any provision of the
         Credit Agreement.

                  SECTION 6. Costs,  Expenses and Taxes.  The Borrower agrees to
pay on demand all reasonable  and documented  costs and expenses of the Agent in
connection  with  the  preparation,   execution,  delivery  and  administration,
modification  and  amendment of this  Amendment  and the other  instruments  and
documents  to  be  delivered  hereunder  (including,   without  limitation,  the
reasonable  and  documented  fees and  expenses  of  counsel  for the  Agent) in
accordance with the terms of Section 8.04 of the Credit Agreement.  In addition,
the Borrower  shall pay any and all stamp and other taxes  payable or determined
to be payable in connection  with the  execution and delivery of this  Amendment
and the other instruments and documents to be delivered hereunder, and agrees to
save the Agent and each Lender harmless from and against any and all liabilities
with  respect to or  resulting  from any delay in paying or omission to pay such
taxes.

                  SECTION 7.  Execution in  Counterparts.  This Amendment may be
executed  in any  number of  counterparts  and by  different  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 but one and the same
agreement.  Delivery of an  executed  counterpart  of a  signature  page to this
Amendment by  telecopier  shall be effective as delivery of a manually  executed
counterpart of this Amendment.

                  SECTION 8. Governing Law. This Amendment shall be governed by,
and construed in accordance with, the laws of the State of New York.










                          SUPPLEMENTAL SCHEDULE 1.01(a)

Supplemental List of Senior Debt Excluded from Current Portion of Long-Term Debt
- --------------------------------------------------------------------------------










                          SUPPLEMENTAL SCHEDULE 1.01(b)

       Supplemental List of "Schedule 1.01(b) Assets" Designated for Sale
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                    SUPPLEMENTAL SCHEDULE 5.03(c)(x)(A)(i)(X)

          List of Skilled Nursing Facilities Subject to Purchase Option
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                                    [TO COME]









                          SUPPLEMENTAL SCHEDULE 5.03(f)

                 Supplemental List of Accommodation Obligations
                 ----------------------------------------------