Kary Hollingsworth mentions that Richard has disappeared and Pat Lynch-Hayes looks crestfallen.

"Oh my goodness," she said with genuine pain in her voice as she stood in the exam room at St. Vincent de Paul Health Center. "Oh, that is so not good. He was in rough shape. He came in and he did so good."

She doesn't need the last name to know exactly who Mr. Hollingsworth is talking about, including the medical history and her hope for his recovery. After 16 years serving the homeless and indigent at the clinic, located next door to the Salvation Army shelter on Greene Street, Ms. Lynch-Hayes has been there for them.

"She's seen them all," said the Rev. George Foster, president of Coordinated Health Services Inc., which oversees the clinic.

When Ms. Lynch-Hayes speaks, however, she always uses "We."

"I get input and we all figure out how things need to go," she said. "I've got very talented coworkers."

And a lot of volunteers, plus medical and nursing students and physicians who donate their time. Mr. Hollingsworth, who suffers from occasional seizures, was seen at the clinic by Dr. David Hess, chairman of the Department of Neurology at Medical College of Georgia.

Three dermatologists also see patients at the clinic, which seems to bring people out of the woodwork, Ms. Lynch-Hayes jokes.

She sees about 10 patients a day and laments that the clinic last year had to decide to concentrate on just treating the homeless.

"We felt really bad but we had to cut back just to homeless," she said. "We were too busy."

And it was too expensive -- the drug bill had escalated from $2,000 a couple of years ago to $5,000, and that is with getting the best price from Maxwell House Pharmacy, she said.

In part, it is because her patients are getting older.

"In general what's happening is the homeless population as a group is getting older," she said. "So they're having more chronic diseases. It's taken quite a lot to take care of them. It is very time-consuming."

Research from Loyola University found that in Chicago the number of homeless between the ages of 50 and 64 increased 20 percent between 2001 and 2006, according to Healing Hands , a publication of the National Health Care for the Homeless Council Clinician's Network.

That's certainly been the experience at Heartland Health Outreach, the homeless health care program in the Chicago area, said Medical Director Bechara Choucair, who is also chair of the national Clinicians' Network.

"When someone grows older, there is the potential that they develop more and more chronic disease," he said. "And chronic disease management is more complex than somebody who is younger and healthier."

It takes more medication, more appointments, more referrals to specialists, Dr. Choucair said.

"It really is more complex and having to do that with someone without a home makes it even more difficult," he said.

But being able to provide that care and make a difference is rewarding, Ms. Lynch-Hayes said.

"It's very satisfying to have somebody who has gotten very irregular care and give them a stable medical home and see their quality of life improve, even that little bit," she said.

The clinic aims to be part of a continuum of care, along with Good Samaritan Respite Center, also part of Coordinated Health Services. Because of growing need, the respite center is looking to double its beds from 16 to 32, and hopes to hire a drug addiction counselor in the future, the Rev. Foster said.

But a big part of that continuum of care is Ms. Lynch-Hayes, he said.

"To be honest with you, I don't know what we would do if she were to decide to move to Colorado or some place," the Rev. Foster said. "I am sincere about that. I don't know how we could replace someone of her caliber. She's that good."

Not that you will hear her say that, he added.

"She is extremely humble," he said.

Much of her skill seems to be in finding a way to get her patient what he or she needs, stretching the meager resources of the clinic or finagling an appointment with a specialist. For Mr. Hollingsworth, it is an anti-convulsive drug. His seizures have become more frequent and Dr. Hess wants to start him on the new drug. But it is not one the clinic has access to.

Still, Ms. Lynch-Hayes comes into the exam room and tells Mr. Hollingsworth that she will work something out.

"I'm sure we can get some, some place," she assures him.

Reach Tom Corwin at (706) 823-3213 or tom.corwin@augustachronicle.com.