The album spawned from her live, recorded performance, "The Depression Tour" in Cleveland, entitled "The Bette Midler Show".

A limited edition remastered version of the album was released by Friday Music in 2012.

Live at Last documents a full-length live performance at the Cleveland Music Hall, Cleveland, Ohio on the 1976 Depression Tour, and sees Midler, her backing group The Staggering Harlettes and her band Betsy and the Blowboys covering material from her three first albums as well as The Supremes' "Up the Ladder to the Roof", Neil Young's "Birds", Ringo Starr's "Oh My My", the mock lounge act The Vicky Eydie Show doing a "global revue" and the song cycle The Story of Nanette.

The album also captures Midler's rapport with - or loving heckling of - the Cleveland audience, a monologue about fried eggs and a part that since has become a staple of her live performances: the raunchy Sophie Tucker jokes.

"Bang, You're Dead", which was also not performed during the Cleveland show, replaced "I Sold My Heart to the Junkman" on the album because writers Nick Ashford and Valerie Simpson - who wrote the song for Midler - laid down an ultimatum that if she did not release the song on her next album, they would give it to another singer.