How does the novel portray state-run homes in the novel, Opioid, Indiana?

In the novel, state-run homes symbolize the often dysfunctional nature of social services in the United States. When Riggle lived in an orphanage, the conditions there were quite atrocious. Later, when he discovers that Joe has died, he decides not to report the death, as he does not want to be transferred to a state-run home. These plot points have the effect of highlighting the need for better investment in social services in the United States.