In this July 28, 2017, file photo, Jared, 20, a disabled adopted son of Vivian Shine-King, watches television at his home in Philadelphia. For foster parents of disabled children, money is getting tighter. The reimbursements are seen as crucial because the high costs of caring for such children makes it less likely they'll ever be adopted. Philadelphia, Missouri and Oklahoma are among places giving payments to foster parents of disabled children a closer look. (AP Photo/Jacqueline Larma)

PHILADELPHIA - Like most parents trying to make ends meet, Vivian Shine-King needs to get creative sometimes. When she has to take her four children to doctor's appointments, for instance, she'll make sure multiple kids are booked at the same clinic around the same time, helping her to save on gas and parking.

But Shine-King isn't your average parent. She is foster mother to four disabled children and relies on government money to make sure they get what they need, including — crucially — health care.

"Couple of times I've had to park the car away and take the children in a stroller," Shine-King said, because she didn't have enough money for a $15 parking garage. "If you gave me 50 cents more, it's a piece of change that matters."

Shine-King, 61, got a little respite starting in July when Philadelphia raised its foster care per-diem rates, a daily reimbursement of expenses per child to ease financial burdens, something seen as especially crucial for disabled children because the high cost of caring for them makes it less likely they'll ever be adopted.

Financial support for foster parents in general has lagged nationwide and is pervasive among child welfare agencies; Philadelphia is not alone in re-examining reimbursement rates. But even with the increases, parents and others say, it often isn't enough.

Some states have a set statewide foster care reimbursement, while a few determine it county by county, with the money coming from a combination of federal and state coffers. Meanwhile, federal funding for child welfare agencies dropped 16 per cent from 2004 to 2014, according to a 2017 policy report by the non-profit research organization Child Trends.

Federal dollars fund more than half the child welfare spending in Missouri, which raised foster care reimbursements in recent years, although Gov. Eric Greitens signed a budget in June that cut rates by 1.5 per cent. Greitens later said that it was a mistake and that there was enough money in savings elsewhere to stop those cuts from happening, but not officially in the budget.

Current rates do not do a good job covering costs, according to Lori Ross, who founded Foster Adopt Connect, a Missouri support organization for foster parents.

"It is about a third of what is actually spent out of pocket on taking care of a child," Ross said. The rate "should be adequate to cover the costs of care for those kids," she said.

Oklahoma's Department of Human Services had an $80 million reduction in funding for the past two years, putting pressure on foster care. The Department in July announced a reduction to payments for foster and adoptive families by 5 per cent, or $1 a day.

"Without a shadow of a doubt, a dollar-a-day cut goes a long way," said John DeGarmo, who has trained foster parents in Oklahoma.

In Philadelphia, Shine-King will see an increase in the reimbursement pay for disabled children 13 years and younger from $44 to $51 per day and an annual increase of $2 for five years.

"I am always begging and pleading, my kids need this, they need that," Shine-King said.

The old rates were "barely enough for three meals a day," said Cynthia Figueroa, Philadelphia human services commissioner.

Of the nearly 6,000 children in Philadelphia's foster care system, an estimated 900 have disabilities. The extra costs of their care make adoption less likely for children who will not be able to reunite with their biological families, said Heather Keafer, a city human services spokeswoman.

Finding permanent homes for children with physical, behavioural and mental disabilities is crucial to their development, advocates say. Constant moving can disrupt their health conditions.

Phyllis Stevens, executive director of Together as Adoptive Parents, a foster family support organization based in Philadelphia, said 70 per cent of foster parents adopt the child in their care and are more likely to do so with better financial aid.

Data on pay for foster care from Child Trends show Philadelphia had lagged further behind other states and counties after not raising its rates in 10 years. The city put forward $9 million with federal, state and county dollars to raise the rate, hoping foster parents would adopt.

Shine-King has been a single foster parent, mainly for disabled children, for 21 years.

She had intended to get a playmate for her son when she fostered her first child, with a mental disability. Later, she ended up adopting three children and fostering several at a time with mental, physical and behavioural disabilities over the years.

"What works you hard is when you need the outside help," Shine-King said when she reflected about her journey. But, she said, fostering children with significant medical needs is her gift.

Medical and other equipment is evident throughout the house. In one corner of the living room alone are stacked diapers, blue pads and feeding tubes. By the door sits a wheelchair; nearby, a portable toilet.

She calls the children's health insurance company to offset the costs when she restocks the items from her budget, and they don't always cover all expenses.

Right now, her children include adopted son Jared, 20, who has the joint disorder Beals syndrome; adopted daughter Kathleen, 12, who has a mental disability; foster daughter Heavenly, 5, who has cerebral palsy; and foster son Alexander, 2, whom she describes as having hidden disabilities.

Even though she must juggle her responsibilities, she acted with an air of normalcy and said she is not focused on money shortages.

"You're never going to look at the dollar sign and say they give you enough," she said. "I just make it work."

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Contributing to this report were Associated Press writers Sean Murphy in Oklahoma City and Summer Ballentine in Jefferson City, Missouri.

News from © The Associated Press, 2017