An investigation by the Ombudsman for Children has found that a lack of coordination between two State agencies was responsible for denying adequate support to a woman who has been fostering a teenager with Down syndrome and severe autism.
The woman, who has been fostering the teenager since she was abandoned at birth, has accused the Health Service Executive and and the child and family agency Tusla of leaving her financially, emotionally and physically drained.
Ombudsman Dr Niall Muldoon has recommended that the HSE immediately devise a respite action plan for all children with a disability.
Dr Muldoon's report says "Molly" (not her real name) has been dependent for 14 years on her foster family for everything including feeding, toileting, dressing and accompaniment to very frequent medical and other appointments.
However, he said the State left the family substantially out of pocket for many of these outlays.
The Ombudsman said the refusal years ago by the HSE, Molly's then corporate parent, to fund her respite care suggests the HSE abdicated its duty to the foster mother.
He criticises Tusla, the current corporate parent, for failing to create a budget line to defray foster carers' spending on necessities for disabled children.
Dr Muldoon's recommendations, which have been accepted by the HSE and Tusla, include a review by each of their provision for about 471 foster children with moderate or severe disabilities with a view to making improvements.
He also recommended a review of Molly's services to ensure that she reaches her full potential.
Speaking on RTÉ's Six One news, Mr Muldoon said there has been a disconnect with Tusla and the HSE and the system has been letting children down.
He said it is a major step forward that both agencies have committed to working together.
Earlier, on RTE's Today with Sean O'Rourke, Mr Muldoon said the Department of Health and the Department for Children will have to work together to ensure that a case like Molly's does not happen again.
Mr Muldoon said the system has developed so "they can pass the buck from one side to the other".
Tusla Chief Operations Officer Jim Gibson said of the main issues in Molly's case was the availability of respite services.
On RTÉ's Morning Ireland, he said he was not trying to transfer the blame to the HSE, but that this was an issue for the executive.
Mr Gibbons said Tusla did provide supports to the family and allocated a social worker to Molly at all times.
"The real issue, when we look at Molly and what Molly's foster carer was saying, was that they needed access to supports and interventions and services.
"A good skill that a social worker has, and was demonstrated in the report, was strong advocacy for that child and for the foster carer, internally to Tusla and externally to other strategic partners," he said.
Mr Gibson added that social work training is transferable to all client groups and there were dedicated social workers for children with disabilities.
He welcomed the report into Molly's case, saying he accepted the recommendations, but said he was unaware of how many times her family contacted the agency.
The Chief Executive of the Irish Foster Care Association has said 4% of calls to its service last year were from foster carers experiencing difficulty in accessing services for children they support, or support for themselves in caring for the children.
Speaking on RTÉ's News at One, Catherine Bond said foster carers should not have to fight for services
She said all agencies need to work together and take a multidisciplinary approach.
Ms Bond said the striking thing about Molly's case is the efforts her foster mother had to go to in getting adequate care for her.
The Chief Executive Officer of Inclusion Ireland has said early intervention services for children with disabilities are critical and that all parents, including foster parents, struggle to access these services.
Speaking on RTÉ’s Drivetime, Paddy Connolly questioned why children with a disability are not part of Tusla's remit.
He said he wrote to Tusla in 2013 saying he had concerns about this.
Mr Connolly said it is clearly discriminatory and he called on Minster for Children Katherine Zappone to review the decision to exclude children with a disability from Tusla's remit.