The caregivers

It takes a strict routine and a lot of help to raise a family of special-needs children. Few know this better than Eric and Dennis Volz-Benoit, who have five.

Typical days involve feeding tubes, breathing treatments, medications and assembly-line showers, not to mention taking kids to school, making dinner and washing clothes.

The couple are legal guardians and foster-to-adopt parents for five children, two of whom have complex medical care issues. Zachary was born with cerebral palsy, Tyler is autistic.

Photographs by Charles Krupa of the Associated Press

In this photo, Eric embraces his two sons, Zachary, right, and Tyler, as his partner Dennis, left, administers a blend of about twelve different medications shortly before bedtime at their home in Springfield, Mass., Sept. 15, 2015.

The caregivers

Tyler, who is autistic, rests his head on the shoulder of his adoptive brother Ryan, who gives him a hug at their family home in Springfield, Mass., Dec. 12, 2015.

The caregivers

Eric, a registered nurse who works with children afflicted with complex medical disabilities, attends to his adopted son Zachary, right, who is wheelchair-bound after being born with cerebral palsy, while Eric's partner Dennis, left rear, trims the Christmas tree at their family home in Springfield, Mass., Dec. 12, 2015.

"It's just kind of like a well-oiled machine," said Eric. "The key for us is routine. Everything is routine."

But routine only goes so far for the couple and their children, Zachary, 8, who has epilepsy and cerebral palsy; Tyler, 7, who has brain damage and autism; Jayden, 5, who has post-traumatic stress disorder and borderline behavior problems; and biological siblings Ryan and Mandie, 7 and 6, who both have PTSD.

The caregivers

Zachary watches as his adoptive sister Mandie trims the Christmas tree at their home, Dec. 12, 2015.

Zachary is a patient participating in the Collaborative Consultative Care Coordinator Program, known as 4C, where a team overseas all aspects of his care. He is the only child in the family who qualifies for the coordinated care offered by 4C.

The program is a partnership between Boston Medical Center and Baystate Medical Center, funded in September 2014 by a three-year, $6 million federal grant under the Affordable Care Act.

The caregivers

Private-duty registered nurse Deb Bronner carries Zachary back to the wheelchair in his bedroom at the home of his foster-to-adopt parents Eric and Dennis in Springfield, Dec. 12, 2015.

Zachary uses a wheelchair and requires a feeding tube and oxygen; early on after coming to live with the couple in 2008, he was frequently in and out of the hospital.

The caregivers

Tyler embraces pediatric gastroenterology specialist Dr. Susan Goode during a doctor's appointment with his dad, Eric, and brother Zachary in Springfield, Dec. 16, 2015.

The 4C program, funded by the Affordable Care Act, helps parents and pediatricians manage medically complex children. Families are paired with a team of helpers, including a nurse care coordinator and a social worker who can make home visits. A child's medical information is loaded into a central site, or "cloud," so any specialists needed to check or treat any given condition can get what they need quickly and easily.

The caregivers

Deb Bronner, a private-duty registered nurse, left, holds a gastric feeding tube with water for Zachary, who is wheelchair-bound, as Dennis, far right, and Eric hold up a gastric feeding tube with water for Tyler, during a family outing at the Quabbin Reservoir in Ware, Mass., Dec. 12, 2015.

The caregivers

Tyler holds the hand of his adoptive father Eric as they prepare to leave for a family outing from their home in Springfield, Dec. 12, 2015.

Eric credits Zachary with helping him "grow up a lot" and become a father to his brood of special children.

The caregivers

Eric, center, enjoys a warmer than usual December day with his family, Tyler, at left, and Zachary, laughing on his chest, on a grassy field at the Quabbin Reservoir observation tower in Ware, Dec. 12, 2015.

The caregivers

Dennis, right, embraces Tyler as Eric, left, holds Zachary during a family outing at the Quabbin Reservoir observation tower in Ware, Dec. 12, 2015.

The caregivers

Dennis, center, holds the hand of Tyler as Eric pushes the wheelchair of son Zachary as the family and private-care nurse walk at the Quabbin Reservoir observation tower in Ware, Dec. 12, 2015.