I hope this is the appropriate Tilde for this. If no one has any input it will still have helped me to type this out.

TL;DR In over my head with marriage, foster care, family, and work.

My wife and I became foster parents about 1.5 years ago with the intention to not adopt, but to care for children 3 and under while bio parents worked to regain custody or other permanent placements were arranged. Our first placement was two girls (7 mo and 2.5 yrs) despite wanting to do just one kid at a time (especially to start). We had them for 6 weeks and mom got them back. We had another placement (8 mo boy) for about another 6 weeks. There was a considerable lull and we were getting frustrated about not getting any new placements when the girls from our first placement were placed into custody again. So we were able to take them in again (now about 1.2 and 3.5 yrs). FF to now and we've had them for about 6 months.

We never really intended to have more than one child and for quite this long and we're struggling. My wife has always had a little less ability to weather stressful situations like this and these last 2-3 weeks I'm carrying a lot of weight. In the meantime, bio mom has gotten pregnant and there's not another hearing regarding custody for another 9 months. We fully expect that she will not be able to take them back at that time (or really realistically ever). What should probably happen would be that the county could place the kids into permanent custody (basically getting them adopted). However, from what we've heard from other foster families, temporary custody could drag on for years.

So, our main dilemma is this. We are not equipped (as a couple) to care for these kids for years. With the likely prospect of no change in custody in the near future, it feels like the best thing for these kids would be to get them into the care of someone looking to do this long-term, perhaps to eventually adopt. That being said, we absolutely love them and it feels like some kind of betrayal to force them to make yet another transition. On the other hand, with our limitations, it seems like that is inevitable anyway. Do we try to make that happen sooner?

Some other data points:
Our fostering license expires in October (about a month after the hearing is scheduled) and we don't intend to continue fostering (at least for a while, and definitely not with our current agency).
We don't have many family members close by to give us a hand with the kids, making us feel isolated and making it hard to get breaks from the kids. Our agency has not been very helpful with lining up respite care, but we're trying to be more aggressive about that now.
I've got things pretty well lined up to retire in about 5 years. My company is also just now kicking off a major project of a similar time frame and I'm in a good position to really make a mark before moving on. It will probably require some serious time commitments and effort to do it the way I want to.

Thanks for listening.

This comes from an article in Current Affairs, which to be upfront is an openly leftist publication. I thought it was an interesting anecdote, especially with the news from a few weeks ago about the woman in Boston begging for people not to call an ambulance for her because she wouldn't be able to afford it (which is also mentioned in the article).

I was in a New York City diner two nights ago and something disturbing happened. It was about 2am, and a woman was sitting alone in the next booth. She was disheveled and possibly homeless, and looked unwell. She had been eating a plate of food, but then sprawled herself along the seat and fell asleep. Someone in the restaurant must have called 911, because an ambulance showed up. They parked directly in front of the entrance and left the flashing lights on, and through the large windows the lights filled the restaurant and were overwhelmingly dazzling. The two paramedics approached the woman and told her to sit up. She mumbled a refusal. They insisted. As she finally sat up, bleary, they told her she would need to leave with them and that she should pay her bill. She replied that she had no money. The paramedics became upset, one of them asking her why she would order food if she couldn’t pay for it, and telling her she’d need to pay before they left. While the paramedics stood issuing her instructions as she muttered and fumbled, a young man at the front of the restaurant quietly approached a server and paid her bill. He then told the paramedics he had paid for her. They looked vaguely annoyed, and told her she should be grateful that a stranger just paid for her. The woman did not seem to comprehend, and just made a noise. Then the paramedics took her out to the ambulance. In the hour or so I stayed in the restaurant, the ambulance didn’t leave, and kept its lights on.

Here’s why I was disturbed: the paramedics did not act like health professionals. They acted like cops. At first, I thought they were cops. Their uniform was similar, and the dazzling flashing lights were like police lights, and had the same bewildering effect. They were more concerned with whether the woman had paid her debts than whether she was okay. They had very clear contempt for her, treating her as a nuisance who was bothering restaurant patrons and needed to be removed. She wasn’t actually bothering anyone, of course; I was sitting in the next booth and had barely noticed her, and there were plenty of spare booths in the diner. But the paramedics were aggressive and unsympathetic in the way that many cops are. Incidents like the one I saw must happen constantly all across the country: homeless people and drug addicts (I don’t know whether the woman was intoxicated or on drugs, though it seemed somewhat likely) not being cared for with compassion, but being “policed” even by those who are supposed to be selflessly devoted to the improvement of health. The flashing lights were totally unnecessary, and made the whole diner feel like a police raid. And, of course, how typical of America that the issue of whether you can pay the bill is more important than whether you will live or die.

What do you think of this? If you've had an experience with emergency medical services, how did it compare?