In her 33 years as a social worker, Susan Michihara has seen close-up how a medical crisis can tear at the fabric of family life.

“We would hope ideally that crisis brings families together, but many times that’s not the case,” she said. “For lack of a better word, it rips them apart.”

That’s why she’s an advocate of Kupuna Pono, a little-known program developed by the Mediation Center of the Pacific to help kupuna (elders) tackle tough issues early with family members and plan for their care needs.

Families typically put that off until they are forced to react in an emergency, and that can be the worst time, with emotions high and no time to reflect.

Perhaps a fall sends grandma to the hospital. Or a daughter breaks under the strain of caring for a parent with Alzheimer’s disease.

“Long-seated resentments or disagreements that could be held in check under normal times bubble up in times of crisis, in times of vulnerability,” Michihara said. “Ultimately the patient is the one that really feels the pain.”

Kupuna Pono brings family members together on neutral ground to focus on the needs of kupuna and how to meet them in the future. Impartial facilitators make sure each person — especially the elder — has a voice in the discussion.

The sessions are free for the needy, with support from the Harry & Jeanette Weinberg Foundation. A collaboration with Kaiser Permanente waives the $250 fee for its members.

The three-hour family conference covers a range of issues, including how to handle in-home care, medical needs, finances and end-of-life care. A plan is developed, with bullet points and responsibilities spelled out. For families already in strife, mediation is available.

“This forum allows for families to come together and hash out the hard stuff,” Michihara said. “The way they do it is really priceless. They start by having families identify their strengths.”

Mary Matayoshi, a lively 86-year-old widow who loves to travel, thought she had her future pretty well figured out. Her children are well established in their careers and she has a comfortable, independent lifestyle. But she found her family conference enlightening.

“I think I was the guinea pig,” she said with a giggle. “When they first called me, I said I’ve already planned for any eventuality, so maybe one hour would be enough. I thought three hours is awfully long. But we used every bit of the three hours.

“They had so many questions and concerns that we needed to talk about. It was a very thorough, much more intensive inquiry than I had expected and I was grateful for it.”

The meeting covered practical questions such as what would happen when she can no longer drive and how to pay for long-term care. And there were deeper questions as well: What would she prefer when the end is near? What are her hopes and dreams for her kids?

Matayoshi’s son, Ron, a faculty member at the University of Hawaii School of Social Work, said people need to take the time to broach such questions, which are largely overlooked in the bustle of daily living.

“I think the main thing here is that we heard her voice,” he said. “We captured in her words what she wanted.

“The facilitators were unbiased, very kind and quiet people,” he added. “They weren’t saying a lot. They simply asked leading questions: What would you do, why would you do that? That put us at ease.”

Tracey Wiltgen, executive director of the Mediation Center, created the program a couple of years ago to address common breakdowns in communication involving elders: Adult children making decisions without input from parents. Elders reluctant to ask for help for fear of being a burden. Disputes over assets like the family home. Divergent views on end-of-life care.

“They figure if they don’t talk about it, maybe it will go away,” Wiltgen said. But she knows that productive conversations can forestall problems and illuminate solutions.

She vividly remembers one session where a kupuna was asked what she wanted most. Her answer was: “For my kids to stop fighting.”

Kupuna Pono staffers talk to each family member before the conference to set the agenda. Then everyone gathers for a three-hour session at a convenient location — at the center, at home or even in a park. A facilitator asks questions and a note-taker keeps track. A plan is developed.

As Hawaii’s population ages, the need to take stock and prepare is growing. In families that are struggling financially, the potential for strain is greater. But few people know where to turn, and even fewer take action.

“Our elder population has grown tremendously,” Wiltgen said. “The Boomers are now old, and everybody has a caregiving story. Although the professionals see the value in Kupuna Pono, and even the family members, getting people to actually access it has been the challenge.”

Some local folks are shy about discussing sensitive issues with strangers. Mary Matayoshi said they shouldn’t worry about that with Kupuna Pono, which is confidential.

“Actually it’s easier in many ways to speak to strangers, because sometimes friends know too much about you or might be opinionated,” she said.

Her daughter-in-law, Aleza, an internist at Kaiser, has seen the value of Kupuna Pono in her daily work, which focuses on the care of elders in nursing homes.

“Often, as a physician, I find that when people are seriously ill, that person’s wants and needs get lost in the history that all families have,” she said. “We lose sight sometimes of what’s important to our mother or father, or our auntie or uncle.”

Kupuna Pono “is really centered on the loved one and it’s not the agenda of everybody else,” she said.

Ron Matayoshi, 63, thinks more people should take advantage of the program, reflecting on the challenges faced by some of his high school classmates as their family members aged.

“I wish they had an opportunity to have a family conference while their parents still had their wits,” he said. “Because right now, it’s just too late.”

To schedule a Kupuna Pono family conference, call 521-6767. For more information visit mediatehawaii.org/kupuna-pono.